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In-office cryoablation safe, effective in menorrhagia

Key clinical point: Cryoablation for menorrhagia can be done safely in the office.

Major finding: Among 100 consecutive patients, there were no intraoperative or immediate postoperative complications. The failure rate was 2%.

Data source: A chart review of consecutive cases in a single practice over 3 years.

Disclosures: Dr. Syed reported having no financial disclosures.


 

AT MINIMALLY INVASIVE SURGERY WEEK

References

NEW YORK – Cryoablation of the endometrium is a safe and effective office-based procedure for the treatment of menorrhagia, resulting in few operative complications, according to a chart review of 100 consecutive cases over a 3-year period.

“Abnormal uterine bleeding is the most common reason for referral to a gynecologist, and it is associated with an adverse impact on quality of life, health care use, and cost. Hysterectomy cures abnormal uterine bleeding, but surgery has risks,” study author Dr. Radha Syed said at the annual Minimally Invasive Surgery Week.

Between 2012 and 2015, Dr. Syed treated women aged 37-51 years with cryoablation of the endometrium under ultrasound guidance in her office. Anesthesia was provided by intravenous conscious sedation and paracervical blocks. Manufacturer’s guidelines were followed for the procedure, with voice prompts from the generator device, said Dr. Syed of the North Shore LIJ Health System, Staten Island, N.Y.

Indications for cryoablation included refractory menorrhagia or menorrhagia affecting quality of life with benign etiology; patients who did not want hysterectomy were not operative candidates.

Patient-based outcome measures were used to assess results of cryoablation. In the recovery room, pain scores were between 2 and 3, as assessed by a visual analog scale ranging from 0 to 10, with 10 signifying the most severe pain. Patients were able to return to work on the first or second postoperative day.

There were no intraoperative or immediate postoperative complications among the 100 consecutive cases reviewed. The maximum follow-up time was 36 months.

The most pressing postoperative symptom was excess watery discharge lasting 2-3 weeks, which was sometimes bloody, Dr. Syed said at the meeting, which was presented by the Society of Laparoendoscopic Surgeons and affiliated societies.

Delayed complications included two hematometra due to cervical cicatrix 4-6 weeks from surgery, which was managed by dilation under ultrasound guidance. One to two years after surgery, two patients underwent hysterectomy for recurrence of menorrhagia; both were associated with fibroids.

Patient satisfaction was 90%, as assessed over the phone using patient-based outcome measures. Most patients achieved hypomenorrhea or eumenorrhea. The rate of amenorrhea was less than 30%.

“Other minimally invasive procedures are available, but it is difficult to compare these procedures due to the subjective nature of complaints and variable symptoms,” Dr. Syed said. “I find cryoablation useful. There is less pain than with hysterectomy, and patient satisfaction is high. Even though the equipment is expensive, cryoablation avoids hysterectomy and all its attendant risks.”

Dr. Syed reported having no financial disclosures.

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