New Technique for Endometrial Ablation

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Dr. Hans van der Slikke: “We’re here at FIGO 2000 in Washington and next to me is Professor Loffer, a world famous Laparoscopist. This afternoon he will present a new method of endometrial ablation. Could you tell us, Professor Loffer, how your method works?”

Professor Franklin Loffer: “Endometrial ablation is a medical treatment for heavy menstrual flow that’s been practiced now for twenty some years. The newer second-generation equipment makes it easier to accomplish. What I will be speaking on this afternoon is the hydrothermal ablation system which has the singular advantage of viewing the cavity during the ablation. It’s a technique that circulates externally heated saline to ninety degrees for ten minutes to the uterine cavity.”

Dr. Hans van der Slikke: “What’s special about this because there are some balloon methods with which you can do the endometrial ablation but yours is freely floating saline?”

Professor Franklin Loffer: “One of the advantages of the free saline is that it can go around small obstructions such as fibroids that might project into the cavity. Some uteruses have a septum in it, and it can be done in those patients where the balloons will not accommodate to those cavities. Of course, the advantage of it is being done under direct visualization, and the safety element of knowing exactly where you are is built into the system.”

Dr. Hans van der Slikke: “How do you prevent the saline from passing the fallopian tubes?”

Professor Franklin Loffer: “This is always a concern but it’s unfounded. The pressures that we use are low enough that the fluid simply doesn’t go out through the tubes, and there’s a monitoring device in the system that if more than 10 ml of fluid is lost in any fashion, the machine will shut down. So if a tube leaked, at 10 ml the machine would quit functioning but in the clinical studies, I’m not aware of any case where that’s happened.”

Dr. Hans van der Slikke: “Could you tell us something about the fall in the temperature from external heating till ninety degrees you said?”

Professor Franklin Loffer: “Yes, ninety.”

Dr. Hans van der Slikke: “Ninety degrees Celsius, yes, and will the temperature be about the same then in the uterus?”

Professor Franklin Loffer: “The fluid is circulated continuously through the procedure. Initially there is probably some difficulty in maintaining that at the very start but as the vascular supply of the uterus is damaged, which is the intent of the procedure, it acts less as a heat sink and the fluid will maintain itself almost at ninety degrees throughout the whole circulating cycle.” 

Dr. Hans van der Slikke: “I see.”

Professor Franklin Loffer: “But clearly that’s why we circulate it, it always has to have a supply of fresh and heated saline.”

Dr. Hans van der Slikke: “Yes, and I’m sure you’ll present some figures about the results this afternoon.”

Professor Franklin Loffer: “The study was compared with the traditional rollerball method and statistically they are similar results; slightly less than a 40% amenorrhea rate and an effective rate of well over 80%.”

Dr. Hans van der Slikke: “And the complication rate?”

Professor Franklin Loffer: “Essentially no complications, there were a small number of thermal effects found on the cervix which had disappeared by a month, and no residual effects in any case in the PMA Study which is what will go before the FDA in the United States.”

Dr. Hans van der Slikke: “So it’s a promising method.”

Professor Franklin Loffer: “It’s very promising, it’s very easy to accomplish, and it certainly opens up vistas for endometrial ablation.”

Dr. Hans van der Slikke: “That’s interesting. I wish you good luck with your new method and your presentation this afternoon. Thank you very much.”

Professor Franklin Loffer: “Thank you very much.”