Rh. Taylor, ENDOMETRIAL ABLATION WITH THE COMBINED ND-YAG LASER-ROLLERBALL, The Journal of the American Association of Gynecologic Laparoscopists, 3(4), 1996, pp. 589-592
Endometrial ablation, an effective treatment for intractable uterine b
leeding, can be performed with hysteroscopic rollerball coagulation, n
eodymium:yttrium-aluminum-garnet (Nd:YAG) laser, and endomyometrial re
section techniques. Between November 1990 and January 1995, 49 women u
nderwent ablation with the Nd:YAG laser and a nontouch technique on th
e ostia, uterine fundus, and upper one-third to one-half of the poster
ior uterine wall, in combination with rollerball coagulation over the
entire endometrial surface after 60-W Nd:YAG application. The power so
urce of the rollerball was set at 80 W of pure coagulation current. Ea
ch patient was pretreated with a gonadotropin-releasing hormone agonis
t or an antiestrogenic compound. The complications were one uterine pe
rforation with a dilator with no sequelae, and one severe infection re
quiring hysterectomy. There were no failures. Of the 48 women availabl
e to follow-up, amenorrhea was achieved in 43 (90%). Two continued to
spot very slightly on occasion, but did not require minipads. Three wo
men had light flow requiring one to two tampons for 1 to 4 days every
month. The technique continues to provide a very high rate of complete
amenorrhea.