Hysteroscopic Endometrial Ablation: From Indications to Instrumentation and Techniques—A Call to Action
Salvatore Giovanni Vitale,
Luigi Della Corte,
Michał Ciebiera,
Josè Carugno,
Gaetano Riemma,
Ricardo Bassil Lasmar,
Bernardo Portugal Lasmar,
Ilker Kahramanoglu,
Bulent Urman,
Mislav Mikuš,
Carlo De Angelis,
Péter Török,
Stefano Angioni
Affiliations
Salvatore Giovanni Vitale
Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
Luigi Della Corte
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
Michał Ciebiera
Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00189 Warsaw, Poland
Josè Carugno
Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
Gaetano Riemma
Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
Ricardo Bassil Lasmar
Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro 24020-140, Brazil
Bernardo Portugal Lasmar
Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro 24020-140, Brazil
Ilker Kahramanoglu
Department of Gynecologic Oncology, Emsey Hospital, 34912 Istanbul, Turkey
Bulent Urman
Department of Obstetrics and Gynecology, Koc University School of Medicine, 34010 Istanbul, Turkey
Mislav Mikuš
Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000 Zagreb, Croatia
Carlo De Angelis
Department of Maternal and Child Health and Urological Sciences, “Sapienza“ University of Rome, 00185 Rome, Italy
Péter Török
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
Stefano Angioni
Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
The development of minimally invasive techniques has led to the creation of innovative alternatives in cases where traditional methods are not applicable. In modern gynecology, hysteroscopy has become the gold standard for the evaluation and treatment of intrauterine pathology. Endometrial ablation (EA) is a procedure that uses different types of energy to destroy the endometrium and is currently used as an alternative technique in cases of heavy menstrual bleeding when medical treatment has failed and uterine preservation is desired. The aim of this review was to evaluate the feasibility, safety, and clinical outcomes of hysteroscopic EA as an alternative in patients with abnormal uterine bleeding. A detailed computerized search of the literature was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science, PubMed, and Cochrane Library), from 1994 to June 2022, to evaluate the outcomes in patients with abnormal uterine bleeding (AUB) undergoing EA using hysteroscopic and non-hysteroscopic techniques. Only scientific publications in English were included. Twelve articles on the current use of endometrial ablation were included. Data on patient symptoms, tools used for EA, primary outcomes, and adverse events were recorded. EA should be considered an effective and safe approach in the management of patients with abnormal uterine bleeding caused by benign pathology, in whom medical treatment has failed or is contraindicated. Due to the lack of evidence, it would be interesting to determine whether EA would also have a role in the treatment of women with premalignant lesions, avoiding invasive surgical procedures or medical treatment in those patients for whom hysterectomy or the use of hormonal treatment is contraindicated.
