Hysteroscopic
endometrial ablation (HEA) was introduced in the 1980s to treat
menorrhagia. Its use required additional training, surgical expertise and specialized equipment to minimize emergent complications such as
uterine perforations, thermal
injuries and excessive fluid absorption. To overcome these difficulties and concerns, thermal balloon
endometrial ablation (
TBEA) was introduced in the 1990s. Four hot liquid balloons have been introduced into clinical practice. All systems consist of a
catheter (4-10mm diameter), a
silicone balloon and a control unit. Liquids used to inflate the balloons include internally heated
dextrose in water (ThermaChoice, 87 degrees C), and externally heated
glycine (Cavaterm, 78 degrees C), saline (Menotreat, 85 degrees ) and
glycerine (Thermablate, 173 degrees C). All balloons require pressurization from 160 to 240 mmHg for treatment cycles of 2 to 10 minutes. Prior to
TBEA, preoperative endometrial thinning, including
suction curettage, is optional. Several RCTs and cohort studies indicate that the advantages of
TBEA include portability, ease of use and short learning curve. In addition, small diameter
catheters requiring minimal cervical dilatation (5-7 mm) and short
duration of treatment cycles (2-8 min) allow treatment under minimal
analgesia/
anesthesia requirements in a clinic setting. Following
TBEA serious adverse events, including thermal
injuries to viscera have been experienced. To minimize such
injuries some surgeons advocate the use of routine post-dilatation hysteroscopy and/or ultrasonography to confirm correct intrauterine placement of the balloon prior to initiating the treatment cycle. After 10 years of clinical practice,
TBEA is thought to be the preferred first-line surgical treatment of
menorrhagia in appropriately selected candidates. Economic modeling also suggested that
TBEA may be more cost-effective than HEA.