Discussion On The Clinical Effect And Safety Of Novasure Impedance Controlled Endometrial Ablation In The Treatment Of Abnormal Uterine Bleeding

Objective:Abnormal uterine bleeding is a common problem among women,with a high incidence,complex etiology,and easy recurrence,which seriously affects women’s lives and puts a burden on individuals and the medical system.When medication fails or is contraindicated,people often seek surgical intervention,including hysterectomy or endometrial ablation.Hysterectomy is the most common gynecological procedure in the world,and its effectiveness in improving AUB symptoms is well recognized.Although it is the most common gynecological procedure,its disadvantages are also obvious:hysterectomy is necessary,the damage is great,postoperative complications are numerous,and recovery is slow.Although with the deepening of minimally invasive concept,the advance of surgical equipment and the increase of surgical experience,complications have been reduced.But many women prefer to keep their wombs,for a variety of reasons,including cultural and personal values,avoiding prolonged recovery and minimizing the risk of complications.Endometrial ablation,an alternative to total hysterectomy for women whose medication failed or who were reluctant to stay on medication,came to dominate in the 1990 s,leading to a rapid decline in the number of hysterectomies.First-generation endometrial ablation refers to the destruction of the endometrium under direct vision by hysteroscopic surgery.These include transcervical endometrial resection(TCRE),rollball ablation,and laser ablation.These methods use liquid mediato enlarge the uterine cavity and provide direct visualization of the endometrium,requiring sophisticated hysteroscopic surgical techniques.Because of the need for liquid cavity during the operation,the first-generation technology is prone to fluid overload,uterine perforation and electrical damage.In addition,it requires high surgical skills for the operators and is not conducive to the use in the local anaesthesia clinic.The second generation of devices provides simultaneous ablation of the entire endometrium,called total endometrial ablation.The advantages of this technology over the first-generation technology include simple operation,semi-automation,short surgical time,and high safety and efficacy.It also relies less on the operator and allows for use in outpatient local anesthesia conditions,is technically easier to operate,has fewer postoperative complications and faster recovery,and has become increasingly mainstream over the past decade.They mainly include five methods of endometrial ablation: hot balloon ablation,circulating hydrothermal ablation,cryoablation,microwave ablation,bipolar radiofrequency ablation.Nova Sure has gained increasing popularity since it was approved by the U.S.FDA in 2001.Compared with other GEA technologies,Nova Sure has the shortest treatment time,does not require uterine preconditioning,and can be performed at any time during the menstrual cycle.This study was intended to investigate the efficacy and safety of novasure in the treatment of abnormal uterine bleeding Method:From January 2018 to June 2019,a total of 64 patients were admitted to our hospital for treatment of failed drug therapy and abnormal uterine bleeding.The age,ablation time,operation time,hemoglobin,intraoperative adverse events and postoperative complications of the patients were counted,and the menstrual improvement of the patients was followed up by telephone at 1,3 and 6 months aftersurgery.Results:1)General clinical data of the patients: 64 patients with AUB were aged 27-53 years old,with an average age of 44.5 years old,and the uterine cavity depth was4.5-8.5 cm,with an average of 6.0 cm.The width of the uterine cavity is 3-5.5cm,with an average of 4.1cm;The operation time was 15-35 minutes,with an average of 21.8minutes.The ablation time was 63-116 seconds,with an average of 89.5 seconds,and the blood loss was < 10 ml.2)Postoperative complications: the postoperative hospital stay was 1-5 days,with an average of 2.2 days.Fourteen patients had abdominal pain of different degrees after surgery,and 11 of them could endure it without any treatment.3)Menstrual improvement: the amenorrhea rate in 1,3 and 6 months was68.7%(44/64),65.6%(42/64)and 59.3%(38/64),respectively.The effective rate was100%,96.8% and 93.7% respectively.The satisfaction rate was 100%,95.3% and92.1% respectively.4)Improvement of anemia: preoperative hemoglobin of the patient was 53-123g/L,with an average of 99.0g/L;Hemoglobin was 85-127g/L 6 months after surgery,with an average of 114.1g/L.Conclusion:Nova Sure has high efficiency in treating abnormal uterine bleeding,less postoperative complications and high patient satisfaction,which can be used as an alternative to hysterectomy and provide a good choice for gynecologists.