Evaluating Endometrial Ablation Devices

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Dr. Paul Indman:  “I’m at the National Congress of Gynecologic Endoscopy in Cancun, Mexico, and I’m very pleased to have with me Dr. Jose Garza whose friends call him Pepe.  For those who don’t know Dr. Garza, he’s an internationally renowned gynecologist and researcher in Monterrey, Mexico.  He’s been involved in the development and testing of more endometrial ablation devices than anyone I know and is a superb researcher and clinician.  Dr. Garza, could you just list the types of endometrial ablation and the companies that you have evaluated so far?”

Dr. Jose Garza:  “Yes, we’ve been working since 1994 with different techniques for endometrial ablation.  In the beginning, we started to work with the Vesta balloon, which is a metal electrode balloon.  After that, we were working with the Thermachoice hot wire balloon and Cavaterm hot wire-circulating balloon, with just hot water inside the uterus.  In 1998, we were working with a laser by the name of Elite to do endometrial ablation in an automatic manner, and more recently this last year with the NovaSure device which is a bipolar device to do endometrial ablation.”

Dr. Paul Indman:  “That’s five different endometrial ablation devices.  Dr. Garza, could you comment on the advantages and disadvantages of using a global endometrial ablation device that you just put in the uterus as compared to the standard technique of endometrial ablation with a resectoscope, whether it’s a rollerball or other methods?”

Dr. Jose Garza:  “In my opinion, what this company is trying to do is to automate everything and take out the surgeon factor of the endometrial ablation.  That is good for the people who don’t know how to use the resectoscope.  In some cases, you cannot see that there is something inside the cavity, and now with the new techniques of sonograms and such, that will be no problem but I think if the people have good results with the rollerball and sander techniques, I don’t see a reason to change but these automatic things to do endometrial ablation will be for everybody, all gynecologists even if they are not endoscopists.”

Dr. Paul Indman:  “Pepe, could you comment on the evaluation of abnormal bleeding?  One concern is that it is so easy to do, that not only can anyone do it, anyone will.  What is the preoperative evaluation of someone who comes in with abnormal bleeding before you use one of these global endometrial ablation devices?”

Dr. Jose Garza:  “It’s very important to evaluate the patient in the proper way.  We always use a clinical interview and after that a clinical examination.  In all the patients we perform an endometrial sample, which is to rule out malignancy or atypical hyperplasia, and that’s very important.  After that, we take a sonogram and if possible, we perform a hysteroscopy in the office.  I think it’s best to evaluate the patient previously to the surgery and for some patients we have hormones like FCH (FSH), estriol/estradiol, and progesterone.”