LASER ENDOMETRIAL ABLATION WITH THE NEODYNIUM-YTTRIUM-ALUMINUM GARNET(ND-YAG) LASER - A REVIEW OF 90 CONSECUTIVE PATIENTS

Objective. To assess the effectiveness of laser endometrial ablation i n women with dysfunctional bleeding. Design. A retrospective analysis of 90 patients. Setting. Department of Gynaecology, King George Hospit al, Parley Lane, Goodmayes, Essex IG3 8YB, U.K. Subjects. Ninety patie nts with dysfunctional uterine bleeding who were hysteroscopically sui table for laser endometrial ablation. Interventions. Endometrial laser ablations using the neodynium-yttrium-garnet laser at 70 watts power output. Main outcome measures. Patient satisfaction/dissatisfaction at 6 months follow-up and response to repeat ablation. Results. A total of 117 procedures were carried out on the 90 patients. There was one s uspected perforation which was not confirmed at subsequent hysterectom y and one primary hemorrhage which required tamponade with Foley cathe ter. There were three cases of fluid overload with no clinical evidenc e of fluid over-load syndrome. All five major complications occurred i n the first six months or 'learning phase' of the study. During this p eriod, there were proportionately more treatment failures after one at tempt (52.8% versus 42.6%) than the second six months of the study. Ov erall, 53.3% of the patients were satisfied with the initial ablation and 73.3% were satisfied after repeat ablations. Conclusion. Endometri al laser ablation is a major advance in the management of dysfunctiona l uterine bleeding, especially in patients who would otherwise have ha d a hysterectomy.