Rates of Intraoperative Complications and Treatment Failure with Double Endometrial Ablation

Background: Radio frequency endometrial ablation (EA) is a procedure used to treat abnormal uterine bleeding (AUB). It is a less invasive method compared to hysterectomy, however the procedure fails to resolve AUB in 20-30% of patients. Double ablation (running the ablation cycle again if the endometrium is not fully ablated with a single cycle) is an off label use of the Novasure endometrial ablation device but is performed by some surgeons. To date, there has been no published research on the effectiveness of this method, or the rates of intraoperative complications. Objectives: Measure the rates of treatment failure and intraoperative complications in patients who received single and double ablations using the Novasure device. Study Design: A retrospective cohort study at a large academic hospital system. Patients who received EA between January 2017 and December 2021 were evaluated, and follow-up extended through May 2022. Charts were evaluated for intraoperative complications (hemorrhage, hematoma, infection, uterine perforation, gastrointestinal injury, or genitourinary injury) and late onset treatment failure (hysterectomy or lack of resolution of AUB). Results: 89 patients were reviewed (61 single ablations, 28 double ablations). No intraoperative complications were observed in either group. The relative risk of treatment failure was not significantly different between the two groups. Conclusions: The data from this study show that there is unlikely to be a large difference between single and double ablation in any outcome. A larger, more controlled study is needed to evaluate the procedures further as this study is not powered adequately. Preliminary results point to double ablation as being safe, but more data is needed.