Comparison of microwave endometrial ablation and transcervical resection of the endometrium for treatment of heavy menstrual loss: a randomised trial

Cooper, Kevin; Bain, Christine; Parkin, David E.

doi:10.1016/s0140-6736(99)04101-x

Cited by 154 publications

(168 citation statements)

References 25 publications

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“…We found that second-generation techniques, such as thermal balloon ablation (ThermaChoice and Cavaterm), [51][52][53] the NovaSure device 56 or microwave (Microsulis), 54,68 were not significantly different to first-generation techniques in terms of patient dissatisfaction. Moreover, they are simpler and quicker, require less skill on the part of the operator and can be attempted under local anaesthetic.…”

Section: Discussionmentioning

confidence: 79%

“…Examples of second-generation ablative techniques are fluid-filled thermal balloon EA (TBEA), radiofrequency (thermoregulated) balloon endometrial ablation, hydrothermal EA, 3D bipolar radiofrequency EA, microwave endometrial ablation (MEA), diode laser hyperthermy, cryoablation and photodynamic therapy. The most common techniques in the UK are TBEA Very common (> 1 in 10) Common (> 1 in 100, < 1 in 10) Uncommon (> 1 in 1000, < 1 in 100) [51][52][53] and MEA, 54,55 while the NovaSure  (Hologic Inc., Bedford, MA, USA) device 56 is becoming more widely used.…”

Section: Endometrial Ablationmentioning

confidence: 99%

“…One study compared hysterectomy 93 with Mirena. Fourteen studies compared first-generation EA techniques with those of second generation 53,54,56,79,[94][95][96][97][98][99][100][101][102][103] and eight studies compared Mirena with EA, three of which were first generation 80,104,105 and five second generation.…”

Section: Trials and Patientsmentioning

confidence: 99%

“…Data from four studies that provided IPD on both outcomes 42,54,99,107 showed that satisfied patients had significantly increased scores in seven of eight domains of the SF-36 QoL questionnaire when compared with dissatisfied patients in the analysis of change from baseline scores, including the general health perception (7.4 points, 95% CI 3.1 to 11.8 points; p = 0.0008) and mental health (10.5 points, 95% CI 5.4 to 15.6 points; p < 0.0001) domains ( Table 4). Differences from absolute differences (not adjusted for baseline score) were highly significant (p < 0.0001) in all eight domains in favour of satisfied patients.…”

Section: Dissatisfaction As An Outcome Measurementioning

confidence: 99%

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Hysterectomy, endometrial ablation and Mirena® for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis

Bhattacharya

Middleton²,

Tsourapas³

et al. 2011

Health Technol Assess

100

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of project...

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Section: Discussionmentioning

confidence: 79%

Section: Endometrial Ablationmentioning

confidence: 99%

Section: Trials and Patientsmentioning

confidence: 99%

Section: Dissatisfaction As An Outcome Measurementioning

confidence: 99%

See 2 more Smart Citations

Hysterectomy, endometrial ablation and Mirena® for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis

Bhattacharya

Middleton²,

Tsourapas³

et al. 2011

Health Technol Assess

100

View full text Add to dashboard Cite

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“…This trial did not show any significant difference in the outcome between the two groups regarding complications, postoperative analgesia and duration of surgery among other parameters. 3 NICE guidelines on interventional procedures recommend careful use of all thermal endometrial ablation techniques in the presence of small, thin-walled uteri and/or a history of pelvic infections where bowel adhesions are likely to be present. In the absence of guidelines specifically relating to use of second-generation ablation techniques, these precautions could be extended to include microwave endometrial ablation procedure (guidelines currently under preparation by NICE).…”

Section: Discussionmentioning

confidence: 99%

Pelvic abscess following microwave endometrial ablation

Das

Kirwan

Drakeley

et al. 2004

BJOG

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A 44 year old woman presented with severe left-sided lower abdominal pain three days after a microwave endometrial ablation for menorrhagia. The pain was described as sharp, worsened with movement and associated with vomiting. She had not opened bowels since the operation. It was severe enough to require opiate analgesia. She had undergone a microwave endometrial ablation procedure three years previously for treatment of menorrhagia. However, over the last eight months, the symptoms had returned and she requested a second microwave endometrial ablation. She had a twin pregnancy following IVF treatment 11 years ago. The twins had been delivered by caesarean section. She was also known to have pelvic endometriosis.The microwave endometrial ablation procedure was preceded by saline hysteroscopy that revealed a normal size, anteverted uterus with a regular endometrial cavity. The saline was then aspirated from the endometrial cavity. An uneventful microwave endometrial ablation was then performed. The treatment lasted 2 1 = 2 minutes and the entire cavity was ablated.On admission, the patient was febrile and tachycardic. Abdominal examination revealed tenderness over the left iliac fossa but was not associated with guarding or rebound. Bowel sounds were present and normal.A full blood count revealed an elevated white cell count of 15.1 Â 10 9 /L with a predominance of neutrophils, C-reactive protein was raised at 374 mg/L (normal <5 mg/L). Abdominal and chest X-ray did not show any evidence of bowel perforation. A working diagnosis of endometritis was made, and a broad-spectrum antibiotic commenced. Her symptoms initially settled with this treatment. Transabdominal ultrasound scan showed a 6-cm mass of mixed heterogeneity in the left iliac fossa. CA125 was found to be mildly elevated at 44 IU/L (normal <25 IU/L).In view of these findings, laparotomy was performed via a midline incision. On the left side, a pelvic abscess of approximate size 7 Â 10 cm was identified. The abscess extended up the left pelvic side wall beneath the sigmoid mesentery and inferiorly to the uterus. Although the sigmoid colon itself was inflamed, the serosa was intact with no evidence of thermal injury. The uterine serosa showed signs of inflammation without any evidence of thermal injury or perforation. The left tube and ovary could not be visualised. The right ovary had an endometrioma of approximately 4 cm, and was adherent to the pelvic wall on that side. The Pouch of Douglas was obliterated by adhesions.Following surgical drainage, treatment with intravenous metronidazole, 500 mg 8 hourly, and ciprofloxacin, 500 mg 8 hourly, was followed by oral antibiotics for two weeks. Microbiological culture from the abscess revealed growth of lactose fermenting coliforms and mixed anaerobes and confirmed sensitivity to the prescribed antibiotics. The patient made a good recovery and was discharged home on the seventh post-operative day.The woman was readmitted 10 days later with a recurrence of symptoms. Full blood count continued to show raised wh...

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