Endometrial ablation: Choosing between nonresectoscopic and resectoscopic techniques

NREA techniques include: Bipolar radiofrequency (NovaSure), cryotherapy (Cerene), circulating hot water (Hydro ThermAblator), a combined thermal and bipolar radiofrequency (Minerva), and vapor ablation (Mara). Other NREA technologies including cryotherapy (Her Option), hot liquid-filled balloon (ThermaChoice), and microwave (Microwave endometrial ablation) are not clinically available in the United States. REA techniques include resectoscopic instruments such as rollerball, wire loop, and laser.

The choice between NREA and REA must also be individualized to the patient and the surgeon's familiarity with the procedure.

REA: resectoscopic endometrial ablation; NREA: nonresectoscopic endometrial ablation.

* The minimum myometrial thickness required to prevent complications (eg, visceral injury to the bladder/bowel) is unclear. As NREA typically ablates 4 to 6 mm into tissue, our practice is to avoid performing NREA in patients with myometrial thinning.

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Endometrial ablation: Choosing between nonresectoscopic and resectoscopic techniques