Practical Tips for Office Hysteroscopy and Second-Generation "Global" Endometrial Ablation

Hysteroscopy and endometrial ablation using the second-generation devices are safe, generally well tolerated, and effective when performed ill the medical office its opposed to the ambulatory surgery center or hospital operating, room. Not only does this benefit the patient and physician in terms of convenience and cost savings, and the overall economic benefit to the health care system is great. The availability of modern hysteroscopic and video equipment, the advent of second-generation "global" endometrial ablation devices, and use of minimal sedation combined with effective local anesthesia have made office procedures possible. Several states have enacted specific regulations and requirements for office based surgery. It is incumbent oil the physician to be aware of which local regulations are applicable and the level of procedure lie or she is willing to perform before embarking on an office-based surgery program. The AAGL ListServ discussion forum provides members with all invaluable source of clinical opinion about patient care issues in minimally invasive gynecology. These opinions come from experts around the world representing both academic centers and clinical practice who respond to questions or issues posed by colleagues. This review discusses each of the second-general ion endometrial ablation device.,; in detail and some of the more pertinent issues related to office hysteroscopy and global endometrial ablation that were posted oil the ListServ. Rollerball and transcervical resection of the endometrium are not discussed because the overwhelming majority of these procedures are performed ill the operating room and there is little potential for their becoming office procedures. Practical clinical lips based on the evidence in the literature are discussed. Journal of Minimally Invasive Gynecology (2009) 16, 384-399 (C) 2009 AAGL. All rights reserved.