chapter  15
Hysteroscopic rollerball endometrial ablation
Pages 10

Abnormal uterine bleeding (AUB) affects approximately 20-25% of premenopausal women. The prevalence increases with age and peaks just prior to menopause. 1 Traditionally, treatment of AUB included a variety of medical therapies, dilatation and curettage (D&C), and hysterectomy. Hysterectomy is a definitive treatment of AUB and is associated with high rates of patient satisfaction. However, public attention to inflated hysterectomy rates and evaluations of its risk and cost benefits has shifted the philosophy and practice of healthcare providers to exploring alternative therapies to hysterectomy, including endometrial ablation. 2

Hysteroscopic endometrial ablation using the Nd:YAG (neodymium-yttrium aluminum garnet) laser was described by Goldrath in 1981. Resection with a loop electrode was described by Hallez in 1985 and electrocoagulation, first with a loop electrode and subsequently with a rollerball electrode, were described by DeCherney and Polan in 1983 in the USA and by Lin et al. in 1988 in Japan, respectively. 2

In 1985, Hallez et al. described the continuous flow gynecologic resectoscope. The initial instrument consisted of a 2.7 mm diameter telescope, a working element with passive action that allowed articulation of the active electrode, an inner sheath allowing inflow of irrigation/distention liquid, and an outer sheath for outflow of the irrigant liquid (diameter 6.3 mm). 3 This system, in contradistinction to the urologic resectoscope, allowed continuous irrigation of the uterine cavity. The irrigant solution used was glycine (1.5%). In December 1989, the Food and Drug Administration (FDA) approved the use of the resectoscope in the USA for gynecologic indications.