INTERVENTIONAL PROCEDURES PROGRAMME
|
|
- Valerie Houston
- 6 years ago
- Views:
Transcription
1 NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of balloon thermal endometrial ablation (Cavaterm) Introduction This overview has been prepared to assist members of IPAC advise on the safety and efficacy of an interventional procedure previously reviewed by SERNIP. It is based on a rapid survey of published literature, review of the procedure by one or more specialist advisor(s) and review of the content of the SERNIP file. It should not be regarded as a definitive assessment of the procedure. Procedure name Thermal endometrial ablation (Cavaterm) SERNIP procedure number 99 Specialty society Royal College of Obstetricians and Gynaecologists Indication(s) Heavy menstrual periods, also known as menorrhagia. Menorrhagia is a very common problem. We found no routine data on the numbers of gynaecological procedures carried out each year in the UK by indication. In 2000/2001, about 45,000 hysterectomies and 17,000 therapeutic endoscopic uterine procedures were carried out in England (Hospital Episode Statistics; ungrossed for missing data; Department of Health). About half of these are likely to be for heavy menstrual bleeding. 1 Summary of procedure Hysterectomy has been the traditional treatment for women with menorrhagia that has not responded to medical treatment. Minimally invasive procedures to destroy the lining of the uterus (endometrium) may reduce complications and recovery time compared with hysterectomy. They involve destroying the endometrium with lasers, radiofrequency waves, electrocautery, heated saline, a heated balloon, or microwaves. Balloon thermal endometrial ablation is one of these minimally invasive procedures. Cavaterm thermal balloon endometrial ablation involves inserting a balloon into the uterine cavity through the cervix. The surgeon inflates the balloon with a glycine solution to a pressure of 180 to 220 mmhg. The solution is heated to 75ºC for 15 minutes to destroy the endometrium. It can often be carried out under local anaesthetic on a day-case basis. Cavaterm thermal endometrial ablation page 1 of 9
2 The claimed advantage of Cavaterm over Gynecare Thermachoice, another thermal balloon endometrial ablation system, is that the balloon size is adjustable to fit different sized uterine cavities. Literature review Appraisal criteria We only included studies on balloon thermal ablation using the Cavaterm procedure in women with menorrhagia. Studies where the technique was not specified were excluded. List of studies found We found one Cochrane systematic review of endometrial destruction techniques. 1 The systematic review concluded that women undergoing thermal ablation techniques had a similar reduction in bleeding and were as satisfied as women having hysteroscopic resection of the endometrium. Advantages of thermal ablation techniques were that general anaesthetic was not required, and the procedures were quicker and easier to perform. The systematic review did not come to any conclusions about the relative benefits and harms of the different thermal endometrial destruction techniques. The systematic review included one randomised controlled trial using Cavaterm. 2 We found two further randomised controlled trials. 3,4 We found nine case series. The table provides details of the three largest of these. 5-7 The annex provides references to smaller studies. Cavaterm thermal endometrial ablation page 2 of 9
3 Summary of key efficacy and safety findings (1) Authors, location, date, patients Key efficacy findings Key safety findings Key reliability and validity issues Romer T 2 No difference between Cavaterm and Complications not reported in English Randomised controlled trial Rollerball in satisfaction abstract or Cochrane review Germany Date not stated (published 1998) n=20, age 35 to 52 Cavaterm; n= 10 Rollerball ablation; n= 10 Follow up: 9 to 15 months Exclusion criteria: desire for future fertility fibroids intrauterine abnormality Romer T 3 Randomised controlled trial Germany Date not stated (published 1997) n=30 Cavaterm; n= 15 Rollerball; n= 15 Minimum follow up: 6 months Exclusion criteria: intrauterine abnormality No difference between Cavaterm and rollerball in amenorrhoea rate Amenorrhoea: Cavaterm: 33% Rollerball: 33% Reduction of menstrual flow: Cavaterm: 100% Rollerball: 100% No intra- or postoperative complications Report in German: data taken from English abstract and Cochrane systematic review 1 Randomisation method not Comparison of baseline data not Power very limited Follow up short Losses to follow up not Blinding not Abstract presented at conference; full report not found in peer-reviewed journal Randomisation method not Comparison of baseline data not Power very limited Follow up short Losses to follow up not Outcomes not defined Blinding not May be duplication of women from those in Romer T 2 Cavaterm thermal endometrial ablation page 3 of 9
4 Summary of key efficacy and safety findings (2) Authors, location, date, patients Key efficacy findings Key safety findings Key reliability and validity issues Pellicano M 4 Operation time: Cavaterm (number of women): Randomisation method: computergenerated Cavaterm: 24 minutes fever (1) random number sequence TCRE: 37 minutes haemorrhage (5) p<0.01 blood transfusion (2) Randomised controlled trial Italy 1998 to 1999 n=82 Cavaterm; n=40; mean age 43 Transcervical resection of endometrium (TCRE); n= 42; mean age 43 Follow up: 2 years Exclusion criteria: age >50 weight >100 kg abnormal endometrium or Pap smear uterine size >12 weeks pregnancy fibroids prolapse endometriosis urinary symptoms Return to normal activities Cavaterm: 4 days TCRE: 6 days p>0.05 Bleeding recurrence at 2 years (not further defined): Cavaterm: 8% TCRE: 24% p<0.01 Pain recurrence at 2 years: Cavaterm: 6% TCRE: 27% p<0.01 Satisfaction at 2 years excellent : Cavaterm: 46% TCRE: 6% p<0.001 Reoperation at 2 years Cavaterm:6% TCRE: % p<0.01 TCRE (number of women): fever (2) urinary infection or retention (1) haemorrhage (4) fluid overload (5) cervical tear (1) conversion to hysterectomy (2) No large differences between groups in baseline characteristics Blinding not Losses to follow up: Cavaterm: 5 women TCRE: 9 women Outcomes appropriate Cavaterm thermal endometrial ablation page 4 of 9
5 Summary of key efficacy and safety findings (3) Authors, location, date, patients Key efficacy findings Key safety findings Key reliability and validity issues Friberg B 5 Returned home on day of treatment: No immediate perioperative Uncontrolled case series 91/117 complications Case series Sweden 1993 to 1996 n=117, mean age 43 Mean follow up: 25 months, range 10 to 49 months Inclusion criteria: no desire for future fertility no genital malignancy Treatment successful in 94% Amenorrhoea: 30/102 Satisfaction excellent : 97/106 Subsequent hysterectomy: 10 women Complications: endometritis: 3 women abdominal pain and fever: 1 woman Outcomes appropriate Follow up variable length Short follow up for some women general anaesthesia (n=95) spinal anaesthesia (n=18) local paracervical block (n=4) Gerber J 6 Satisfaction good to excellent : 93% No complications occurred Uncontrolled case series Case series Switzerland Date not stated (published 1999) n=67 Follow up available on 55 women Amenorrhoea: 30% Hysterectomy: 3 women Paper in German; data extracted from English abstract Short follow up Follow up: > 6 months Cavaterm thermal endometrial ablation page 5 of 9
6 Summary of key efficacy and safety findings (4) Authors, location, date, patients Key efficacy findings Key safety findings Key reliability and validity issues Hawe J 7 Amenorrhoea: 34 women No major complications occurred Uncontrolled case series Spotting: 12 women Normal periods: 2 women Short follow up in some women Case series UK Date not stated (published 1999) n=50; mean age 45, range 28 to 54 Mean follow up: 14 months, range 6 to 24 months Exclusion criteria: desire for future fertility endometrial hyperplasia uterine cavity length >12 cm polyps or fibroids General anaesthesia (n=36) Sedation and paracervical block (n=14) Subsequent hysterectomy or laser ablation: 2 women Complications: streptococcal infection: 2 women unexplained right iliac fossa pain for 24 hours: 1 woman endometritis: 1 woman Methods of measuring outcomes not Cavaterm thermal endometrial ablation page 6 of 9
7 Validity and generalisability of the studies We found three randomised controlled trials. 2-4 Two may have included the same study participants. 2,3 Reports of these two trials were only available as abstracts, so it was difficult to assess quality. Both trials were very small and follow up was short. The third trial was of reasonable quality, though also small, and blinding of outcome assessment was not. 4 The first two trials 2,3 compared Cavaterm with Rollerball hysteroscopic ablation. The third trial compared Cavaterm with hysteroscopic resection. 4 We found three case series including 50 or more women. 5-7 Follow up was short for many of the included women. Bazian comments None Specialist advisor s opinion / advisors opinions Specialist advice was sought from the Royal College of Obstetricians and Gynaecologists Cavaterm is now established practice. It does not require hysteroscopic skills. Issues for consideration by IPAC None other than those above. Cavaterm thermal endometrial ablation page 7 of 9
8 References 1. Lethaby A, Hickey M Endometrial destruction techniques for heavy menstrual bleeding (Cochrane Review). In: The Cochrane Library, Issue 4, Oxford: Update Software 2. Romer T. Rollerball endometrial ablation - a prospective randomized comparative study [German]. Zentralblatt fur Gynakologie 1998; 120: Romer T, Muller J. Comparative prospective study of the treatment of recurrent menorrhagias: Cavaterm coagulation versus rollerball ablation. Gynaecological Endoscopy 1997; 6 (supplement 2): Pellicano M, Guida M, Acunzo G, Cirillo D, Bifulco G, Nappi C. Hysteroscopic transcervical endometrial resection versus thermal destruction for menorrhagia: A prospective randomized trial on satisfaction rate. American Journal of Obstetrics & Gynecology 2002; 187(3): Friberg B, Ahlgren M. Thermal balloon endometrial destruction: The outcome of treatment of 117 women followed up for a maximum period of 4 years. Gynaecological Endoscopy 2000; 9(6): Gerber S, Wirz C, Genolet PM, de Grandi P. Thermal endometrial destruction: clinical results of a new technique of endometrial ablation [German]. Journal fur Menopause 1999; 6: Hawe JA, Phillips AG, Chien PF, Erian J, Garry R. Cavaterm thermal balloon ablation for the treatment of menorrhagia. British Journal of Obstetrics & Gynaecology 1999; 106(11): Cavaterm thermal endometrial ablation page 8 of 9
9 Annex: References to smaller case series Reference Aletebi FA, Vilos GA, Eskandar MA. Thermal balloon endometrial ablation to treat menorrhagia in high-risk surgical candidates. Journal of the American Association of Gynecologic Laparoscopists 1999; 6(4): Friberg B, Persson BRR, Willen R, Ahlgren M. Endometrial destruction by thermal coagulation: Evaluation of a new form of treatment for menorrhagia. Gynaecological Endoscopy 1998; 7(2):73-78 Refaie AMN, Salim MS, Cheah SS, Anderson T. Is uterine thermal balloon ablation an effective treatment for menorrhagia? Middle East Fertility Society Journal 2001; 6(3): Vilos GA, Vilos EC, Pendley L. Endometrial ablation with a thermal balloon for the treatment of menorrhagia. Journal of the American Association of Gynecologic Laparoscopists 1996; 3(3): Singh KC, Sengupta R, Agarwal N, Misra K. Thermal endometrial ablation: A simple technique. Acta Obstetricia et Gynecologica Scandinavica 2000; 79(1):54-59 Friberg B, Persson BR, Willen R, Ahlgren M. Endometrial destruction by hyperthermia - a possible treatment of menorrhagia. An experimental study. Acta Obstetricia et Gynecologica Scandinavica 1996; 75(4): Number of study participants Overview prepared by: Bazian Ltd November 2002 Cavaterm thermal endometrial ablation page 9 of 9
INTERVENTIONAL PROCEDURES PROGRAMME
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of microwave endometrial ablation Introduction This overview has been prepared to assist
More informationINTERVENTIONAL PROCEDURES PROGRAMME
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of laparoscopic laser myomectomy Introduction This overview has been prepared to assist
More informationPRE-ASS ESSMENT. Endometrial Ablation for Menorrhagia
PRE-ASS ESSMENT No. 30 Feb 2004 Before decides to undertake a health technology assessment, a pre-assessment of the literature is performed. Pre-assessments are based on a limited literature search; they
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE GUIDANCE EXECUTIVE (GE)
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE GUIDANCE EXECUTIVE (GE) Review of TA78 fluid filled thermal balloon and microwave endometrial ablation for menstrual bleeding This guidance was issued
More informationJed Hawe a,b, *, Jason Abbott c, David Hunter d, Graham Phillips d, Ray Garry d,e
BJOG: an International Journal of Obstetrics and Gynaecology April 2003, Vol. 110, pp. 350 357 A randomised controlled trial comparing the endometrial ablation system with the Nd:YAG laser for the treatment
More informationOriginal Policy Date
MP 4.01.01 Endometrial Ablation Medical Policy Section OB/Gyn/Reproduction Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return to Medical Policy
More informationEndometrial Ablation. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Endometrial Ablation Page: 1 of 10 Last Review Status/Date: December 2012 Endometrial Ablation
More informationCorporate Medical Policy
Corporate Medical Policy Intrauterine Ablation or Resection of the Endometrium File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intrauterine_ablation_or_resection_of_the_endometrium
More informationExcessive menstrual blood loss
Ian Chilcott Excessive menstrual blood loss >80mls - That interferes with physical, emotional, social and material quality of life 1 in 20 women aged 30 to 49 years consult their GP each year with menorrhagia
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE PROGRAMME. Interventional procedure overview of laser assisted serial tonsillectomy
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTE RVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of laser assisted serial tonsillectomy Introduction This overview has been prepared to
More informationLong-term Results in the Treatment of Menorrhagia and Hypermenorrhea With a Thermal Balloon Endometrial Ablation Technique
Longterm Results in the Treatment of Menorrhagia and Hypermenorrhea With a Thermal Balloon Endometrial Ablation Technique L. Mettler, Prof Dr Med SCIENTIFIC PAPER ABSTRACT Background and Objectives: Evaluation
More informationMEDICAL POLICY SUBJECT: ENDOMETRIAL ABLATION
MEDICAL POLICY PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.
More informationA cost utility analysis of microwave and thermal balloon endometrial ablation techniques for the treatment of heavy menstrual bleeding
BJOG: an International Journal of Obstetrics and Gynaecology May 2004, Vol. 111, pp. 1103 1114 DOI: 10.1111/j.1471-0528.2004.00265.x A cost utility analysis of microwave and thermal balloon endometrial
More informationHeavy Menstrual Bleeding. Mr Nick Nicholas MD FRCOG Grad Dip Law. Consultant Gynaecologist
Heavy Menstrual Bleeding Mr Nick Nicholas MD FRCOG Grad Dip Law. Consultant Gynaecologist Why is HMB so important? 1:20 women aged 30-49 consult their GP with HMB Once referred to gynaecologist, surgical
More informationSubject Index. Cavaterm, endometrial ablation complications 146, 150 contraindications 152 cost analysis compared with hysterectomy
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOO Subject Index Abnormal uterine bleeding, see also Adenomyosis, Endometrial cancer, Menorrhagia dilatation and curettage 21, 22, 25 hysteroscopy of premenopausal women anesthesia
More informationIMPORTANT REMINDER DESCRIPTION
Medical Policy Manual Surgery, Policy No. 01 Endometrial Ablation Next Review: February 2019 Last Review: September 2018 Effective: October 1, 2018 IMPORTANT REMINDER Medical Policies are developed to
More informationCOMPARING THE EFFICACY AND ACCEPTABILITY OF NOVASURE TM VERSUS CAVATERM TM PLUS IN DUB PATIENTS
: 1035-1045 ISSN: 2277 4998 COMPARING THE EFFICACY AND ACCEPTABILITY OF NOVASURE TM VERSUS CAVATERM TM PLUS IN DUB PATIENTS ZAHRA ASGARI 1, M.D., LEILI HAFIZI 2, M.D., FARIDEH HOSSEINZADEH 3, M.D., AZAM
More informationEndometrial Ablation for Heavy Menstrual Bleeding. Jonathan Lord Consultant gynaecologist
Endometrial Ablation for Heavy Menstrual Bleeding Jonathan Lord Consultant gynaecologist Affiliation: Declaration of Interests NICE HMB guideline committee member Expenses & honaria: Hologic (manufacturer
More informationLong-term economic evaluation of resectoscopic endometrial ablation versus hysterectomy for the treatment of menorrhagia Hidlebaugh D A, Orr R K
Long-term economic evaluation of resectoscopic endometrial ablation versus hysterectomy for the treatment of menorrhagia Hidlebaugh D A, Orr R K Record Status This is a critical abstract of an economic
More informationEvidence Based Guideline Intrauterine Ablation or Resection of the Endometrium
Evidence Based Guideline Intrauterine Ablation or Resection of the Endometrium File Name: intrauterine_ablation_or_resection_of_the_endometrium Guideline Number: EBG.OBGYN3030 Origination: 4/1993 Last
More informationCOLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS, SINGAPORE 2006
COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS, SINGAPORE 2006 CONSENSUS STATEMENT ON THE MANAGEMENT AND EVALUATION OF MENORRHAGIA (INCLUDING MANAGEMENT OF FIBROIDS) Introduction Menorrhagia is defined as
More informationThermal Balloon Ablation Versus Endometrial Resection for the Treatment of Abnormal Uterine Bleeding
Med. J. Cairo Univ., Vol. 77, No. 1, June: 295-300, 2009 www.medicaljournalofcairouniversity.com Thermal Balloon Ablation Versus Endometrial Resection for the Treatment of Abnormal Uterine Bleeding ROY
More informationPreventing hysterectomies for dysfunctional uterine bleeding with the HTA : a survival analysis
Gynecol Surg (2007) 4:39 43 DOI 10.1007/s10397-006-0244-7 ORIGINAL ARTICLE Preventing hysterectomies for dysfunctional uterine bleeding with the HTA : a survival analysis Etienne Ciantar & Kevin Jones
More informationAn Update on the Management of Heavy Menstrual Bleeding
An Update on the Management of Heavy Menstrual Bleeding Sonia WM LAI MBBS, MRCOG SL MOK MBBS SK LAM MBBS, FRCOG Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon,
More informationClinical and health service implications of second generation endometrial ablation devices Nazar N. Amso
Clinical and health service implications of second generation endometrial ablation devices Nazar N. Amso Purpose of review This review evaluates the current evidence on the efficacy, safety and cost-effectiveness
More informationBENEFIT APPLICATION BLUECARD/NATIONAL ACCOUNT ISSUES
Medical Policy MP 4.01.04 BCBSA Ref. Policy: 4.01.04 Last Review: 08/30/2017 Effective Date: 08/30/2017 Section: OB/GYN Reproduction End Date: 08/19/2018 Related Policies 4.01.11 Occlusion of Uterine Arteries
More informationA randomised trial comparing the levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding
DOI: 10.1111/j.1471-0528.2005.00863.x www.blackwellpublishing.com/bjog General gynaecology A randomised trial comparing the levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual
More informationThermal Balloon Endometrial Ablation in the Treatment of Heavy Menstrual Bleeding
ORIGINAL ARTICLE doi: 10.5455/medarh.2014.68.411-413 Received: November 15th 2014 Accepted: December 08th 2014 AVICENA 2014 Thermal Balloon Endometrial Ablation in the Treatment of Heavy Menstrual Bleeding
More informationEndometrial Ablation. Description
Subject: Endometrial Ablation Page: 1 of 12 Last Review Status/Date: September 2016 Endometrial Ablation Description Endometrial ablation is a potential alternative to hysterectomy for abnormal uterine
More informationMedical Policy. MP Endometrial Ablation
Medical Policy MP 4.01.04 BCBSA Ref. Policy: 4.01.04 Last Review: 10/18/2018 Effective Date: 10/18/2018 Section: OB/GYN Reproduction End Date: 01/25/2019 Related Policies 4.01.11 Occlusion of Uterine Arteries
More informationNovasure as a Mechanical Endometrial Preparation Agent in Large Uteri
SCIENTIFIC PAPER Novasure as a Mechanical Endometrial Preparation Agent in Large Uteri Sushma Potti, MD, Shitanshu Uppal, MD, Ashwin J. Chatwani, MD, Enrique Hernandez, MD, Vani Dandolu, MD, MPH, MBA ABSTRACT
More informationENDOMETRIAL ABLATION: TRENDS AND CHALLENGES IN 2017
ENDOMETRIAL ABLATION: TRENDS AND CHALLENGES IN 2017 Philippe Laberge MD FRCSC ACGE Professor Obstetrics and Gynecology Laval University Quebec, Canada Disclosures I have used products or done clinical
More information(ARCHIVED: 12/20/01-05/18/05) CATEGORY: Technology Assessment. Proprietary Information of Excellus Health Plan, Inc.
MEDICAL POLICY SUBJECT: ENDOMETRIAL ABLATION EFFECTIVE DATE: 11/19/99 PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial
More informationPOLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
Original Issue Date (Created): July 1, 2002 Most Recent Review Date (Revised): January 28, 2014 Effective Date: April 1, 2014 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT
More informationMENORRHAGIA TREATED BY THERMAL BALLOON ENDOMETRIAL ABLATION
, ORIGINAL RESEARCH,,,, MENORRHAGIA TREATED BY THERMAL BALLOON ENDOMETRIAL ABLATION Douglass B. Yackel, MD, FRCSC, Consultant Gynaecologist, Delta Hospital, Delta, British Columbia ABSTRACT RESUME One
More informationFirst-generation endometrial ablation revisited: retrospective outcome study a series of 218 patients with premenopausal dysfunctional bleeding
Gynecol Surg (2015) 12:291 297 DOI 10.1007/s10397-015-0902-8 ORIGINAL ARTICLE First-generation endometrial ablation revisited: retrospective outcome study a series of 218 patients with premenopausal dysfunctional
More informationTreatment of Heavy Menstrual Bleeding: Ludkin (Nurse Hysteroscopist, Bradford Royal Infirmary) & M Rogers (Advanced
Treatment of Heavy Menstrual Bleeding: Nov 14 th 2013- Authors: Prof Sian Jones (Gynaecologist, Bradford Royal Infirmary, H Ludkin (Nurse Hysteroscopist, Bradford Royal Infirmary) & M Rogers (Advanced
More informationMenstrual Disorders & Ambulatory Gynaecology
Menstrual Disorders & Ambulatory Gynaecology Mr. Nagui Lewis Aziz M B, CH B, FRCOG Consultant Gynaecologist The Royal Oldham Hospital 01/09/2018 Heavy menstrual bleeding (HMB ) is a common problem responsible
More informationConsent Advice No. XX (Joint with BSGE) Peer Review Draft Spring Morcellation for Laparoscopic Myomectomy or Hysterectomy
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 Consent Advice No. XX (Joint with BSGE) Peer Review Draft
More informationInvestigating HMB- an evidence based approach
BSGE Meeting: Contemporary management of heavy menstrual bleeding (HMB) in primary and secondary care: (7 th December 2018, RCOG) Investigating HMB- an evidence based approach T. Justin Clark MB ChB, MD(Hons),
More informationUterine artery embolisation for treating adenomyosis
Uterine artery embolisation for treating Issued: December 2013 guidance.nice.org.uk/ipg NICE has accredited the process used by the NICE Interventional Procedures Programme to produce interventional procedures
More informationHeavy menstrual bleeding: assessment and management
Heavy menstrual bleeding: assessment and management NICE guideline Draft for consultation, August 0 This guideline covers assessing and treating heavy menstrual bleeding. It aims to help healthcare professionals
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Health and social care directorate. Quality standards and indicators.
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health and social care directorate Quality standards and indicators Briefing paper Quality standard topic: Heavy menstrual bleeding Output: Prioritised
More informationMICROWAVE AND THERMAL BALLOON ENDOMETRIAL ABLATION FOR HEAVY MENSTRUAL BLEEDING. STRIPPED OF CIC DATA*
MICROWAVE AND THERMAL BALLOON ENDOMETRIAL ABLATION FOR HEAVY MENSTRUAL BLEEDING. STRIPPED OF CIC DATA* Report commissioned by: NHS R&D HTA Programme Produced by: Peninsula Technology Assessment Group Peninsula
More informationName of Policy: Endometrial Ablation
Name of Policy: Endometrial Ablation Policy #: 453 Latest Review Date: July 2014 Category: Surgical Policy Grade: B Background/Definitions: As a general rule, benefits are payable under Blue Cross and
More informationClinical Policy: Endometrial Ablation Reference Number: CP.MP.106
Clinical Policy: Reference Number: CP.MP.106 Effective Date: 02/16 Last Review Date: 09/17 Revision Log Coding Implications See Important Reminder at the end of this policy for important regulatory and
More informationENDOMETRIAL RESECTION FOR THE TREATMENT OF MENORRHAGIA ENDOMETRIAL RESECTION FOR THE TREATMENT OF MENORRHAGIA. Study Patients
ENDOMETRIAL RESECTION FOR THE TREATMENT OF MENORRHAGIA ENDOMETRIAL RESECTION FOR THE TREATMENT OF MENORRHAGIA HUGH O CONNOR, M.R.C.O.G., AND ADAM MAGOS, M.D. ABSTRACT Background Endometrial resection is
More informationEndometrial ablation was developed as a uterinesparing
Minimally Invasive Device Complications and Use Outside of the Manufacturers Instructions Jill Brown, MD, MPH, and Ken Blank, MD OBJECTIVE: To review the U.S. Food and Drug Administration (FDA) Manufacturer
More informationGLOBAL ENDOMETRIAL ABLATION TECHNOLOGY
GLOBAL ENDOMETRIAL ABLATION TECHNOLOGY Training: Part 1 Anatomy and Physiology Female Anatomy Normal Uterus Female Anatomy Normal Uterus Female Anatomy Uterine Positions Abnormal Uterus Retroflexed Normal
More informationMinimal Access Surgery in Gynaecology
Gynaecology & Fertility Information for GPs August 2014 Minimal Access Surgery in Gynaecology Today, laparoscopy is an alternative technique for carrying out many operations that have traditionally required
More informationDr John Short. Obstetrician and Gynaecologist Christchurch Women s Hospital Oxford Women's Health Christchurch
Dr John Short Obstetrician and Gynaecologist Christchurch Women s Hospital Oxford Women's Health Christchurch 16:30-17:30 WS #125: Everything GPs Should Know About Gynaecologists 17:35-18:30 WS #135: Everything
More informationHYSTERECTOMY FOR BENIGN CONDITIONS
HYSTERECTOMY FOR BENIGN CONDITIONS UnitedHealthcare Oxford Clinical Policy Policy Number: SURGERY 104.7 T2 Effective Date: April 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 CONDITIONS OF COVERAGE...
More informationHealthcare Education Research
Healthcare Education Research Heavy menstrual bleeding: investigation, diagnosis & management An update for health professionals Assessment of heavy menstrual bleeding in primary care Dr Amanda Newman
More informationAbnormal uterine bleeding:
Primary Care Women s Health Forum 16th June 2010 Abnormal uterine bleeding: The University Of Birmingham T Justin Clark MD (Hons), MRCOG Consultant Obstetrician and Gynaecologist Birmingham Women s Hospital
More informationUterine endometrial thermal balloon therapy for the treatment of menorrhagia: long-term multicentre follow-up study
Human Reproduction Vol.18, No.5 pp. 1082±1087, 2003 DOI: 10.1093/humrep/deg206 Uterine endometrial thermal balloon therapy for the treatment of menorrhagia: long-term multicentre follow-up study Nazar
More informationTHERMAL BALLOON ENDOMETRIAL ABLATION: A SAFE AND EFFECTIVE MODALITY FOR TREATMENT OF DYSFUNCTIONAL MENORRHAGIA
THERMAL BALLOON ENDOMETRIAL ABLATION: A SAFE AND EFFECTIVE MODALITY FOR TREATMENT OF DYSFUNCTIONAL MENORRHAGIA Osama Shawki, AshrafYounis, Mohamad I. El Bokl, and Gamal Eid. Department (~lobstetrics and
More informationSIMPLE SAFE EFFECTIVE. Your Solution to Outpatient Ablation
SIMPLE SAFE EFFECTIVE Your Solution to Outpatient Ablation WWW.THERMABLATE-EAS.COM SIMPLE Unique, fully automated design continually controls parameters of time, temperature and pressure to ensure consistent
More informationREPRODUCTIVE ENDOCRINOLOGY
REPRODUCTIVE ENDOCRINOLOGY FERTILITY AND STERILITY VOL. 82, NO. 1, JULY 2004 Copyright 2004 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Treatment
More informationHYSTERECTOMY FOR BENIGN CONDITIONS
UnitedHealthcare Commercial Medical Policy HYSTERECTOMY FOR BENIGN CONDITIONS Policy Number: 2018T0572G Effective Date: September 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 BENEFIT CONSIDERATIONS...
More informationLaparoscopic Hysterectomy
Women s Service Laparoscopic Hysterectomy Information for patients Information for Patients This leaflet is for women who have been advised to have a laparoscopic hysterectomy. It outlines the common reasons
More informationBipolar Radiofrequency Endometrial Ablation Compared With Hydrothermablation for Dysfunctional Uterine Bleeding A Randomized Controlled Trial
Bipolar Endometrial Ablation Compared With Hydrotherm for Dysfunctional Uterine Bleeding A Randomized Controlled Trial Josien P.M. Penninx, MD, Ben Willem Mol, MD, Ruben Engels, MD, Minouche M.E. van Rumste,
More informationLaparoscopy-Hysteroscopy
Laparoscopy-Hysteroscopy Patient Information Laparoscopy The laparoscope, a surgical instrument similar to a telescope, is inserted through a small incision (cut) in the belly button during laparoscopy.
More informationEndometrial tissues have amazing
SURGICAL TECHNIQUES PHILLIP BRZOZOWSKI, MD, and JAMES H. LIU, MD 4 global ablation devices: Efficacy, indications, and technique Newer endometrial ablation technologies are easy to learn, and high efficacy
More informationVirtaMed GynoS hysteroscopy Module descriptions
VirtaMed GynoS hysteroscopy Module descriptions VirtaMed AG Rütistr. 12, 8952 Zurich Switzerland info@virtamed.com www.virtamed.com Phone: +41 44 500 9690 Table of contents Table of contents... 1 Essential
More informationMedical Management of Fibroids Esmya. Dr Paula Briggs Consultant in Sexual and Reproductive Health
Medical Management of Fibroids Esmya Dr Paula Briggs Consultant in Sexual and Reproductive Health Treatment options for Uterine Fibroids ESMYA Selective Uterine Artery Embolisation Fibroid ablation (hysteroscopic
More informationJSLS. Combining Myoma Coagulation with Endometrial Ablation/Resection Reduces Subsequent Surgery Rates. Herbert A. Goldfarb, MD ABSTRACT INTRODUCTION
JSLS Combining Myoma Coagulation with Endometrial Ablation/Resection Reduces Subsequent Surgery Rates Herbert A. Goldfarb, MD ABSTRACT Background: This study compares results of endometrial ablation alone
More informationGayatrri Anipindi *, Vani I. Original Research Article. Abstract
Original Research Article Role of levonorgestrel releasing intrauterine device in management of heavy menstrual bleeding: A safe and effective option for all PALM COEIN variants Gayatrri Anipindi *, Vani
More informationINTERVENTIONAL PROCEDURES PROGRAMME
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of laser/radiofrequency valvotomy in pulmonary atresia Introduction This overview has been
More informationProfessor Christian Phillips BSc Hons BM DM FRCOG Consultant Gynaecologist and Urogynaecologist
Professor Christian Phillips BSc Hons BM DM FRCOG Consultant Gynaecologist and Urogynaecologist Laparoscopic Hysterectomy What is a laparoscopic hysterectomy? Laparoscopic hysterectomy is an operation
More informationFacing Gynecologic Surgery?
Facing Gynecologic Surgery? Domenico Vitobello, MD Domenico Vitobello is the medical director of the Gynecologic Unit at the Humanitas Clinical and Research Center since 2009. He has developed a comprehensive
More informationRESEARCH. INTRODUCTION Heavy menstrual bleeding is a common problem 1 that affects about 1.5 million women in England and
, endometrial ablation, and levonorgestrel releasing intrauterine system () for treatment of heavy menstrual bleeding: cost effectiveness analysis T E Roberts, professor of health economics, 1 A Tsourapas,
More informationThe effectiveness of outpatient Thermachoice endometrial balloon ablation: a long-term 11-year outcome study
Gynecol Surg (2013) 10:261 265 DOI 10.1007/s10397-013-0809-1 ORIGINAL ARTICLE The effectiveness of outpatient Thermachoice endometrial balloon ablation: a long-term 11-year outcome study Vinod Kumar &
More informationPerimenopausal Age Group (45-55yrs): For Early Detection And Treatment.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 9 Ver. 4 (September. 2018), PP 73-77 www.iosrjournals.org Perimenopausal Age Group (45-55yrs):
More informationFibroid mapping. Haitham Hamoda MD FRCOG Consultant Gynaecologist, Subspecialist in Reproductive Medicine & Surgery King s College Hospital
Fibroid mapping Haitham Hamoda MD FRCOG Consultant Gynaecologist, Subspecialist in Reproductive Medicine & Surgery King s College Hospital Fibroids Common condition >70% of women by onset of menopause.
More informationNICE guideline Published: 14 March 2018 nice.org.uk/guidance/ng88
Heavy menstrual bleeding: assessment and management NICE guideline Published: 14 March 2018 nice.org.uk/guidance/ng88 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationLaparoscopy and Hysteroscopy
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Laparoscopy and Hysteroscopy A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of
More informationAdvanced 3D Ultrasound Incorporating Fly Thru Virtual Imaging Promotes the Concept of Ultrasound Hysteroscopy
Advanced 3D Ultrasound Incorporating Fly Thru Virtual Imaging Promotes the Concept of Ultrasound Hysteroscopy Bill Smith Clinical Diagnostics Services, London, UK Introduction Conventional hysteroscopy
More informationOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO. Hysteroscopy. State of the Art
Hysteroscopy. State of the Art Contributions to Gynecology and Obstetrics Vol. 20 Series Editor Ossi R. Köchli, Basel ABC Basel W Freiburg W Paris W London W New York W New Delhi W Bangkok W Singapore
More informationSummary CHAPTER 1. Introduction
Summary This thesis aims to evaluate the diagnostic work-up in postmenopausal women presenting with abnormal vaginal bleeding. The Society of Dutch Obstetrics and Gynaecology composed a guideline, which
More informationASHERMAN S SYNDROME FOLLOWING THERMAL ABLATION OF THE ENDOMETRIUM Sheila K. Pillai 1, Bhuvana S 2, Jaya Vijayaraghavan 3
ASHERMAN S SYNDROME FOLLOWING THERMAL ABLATION OF THE ENDOMETRIUM Sheila K. Pillai 1, Bhuvana S 2, Jaya Vijayaraghavan 3 HOW TO CITE THIS ARTICLE: Sheila K. Pillai, Bhuvana S, Jaya Vijayaraghavan. Asherman
More informationOutpatient thermal balloon ablation of the endometrium
FERTILITY AND STERILITY VOL. 82, NO. 5, NOVEMBER 2004 Copyright 2004 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Outpatient thermal balloon
More informationRole of diagnostic hysteroscopy in evaluation of abnormal uterine bleeding and its histopathological correlation
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Chaudhari KR et al. Int J Reprod Contracept Obstet Gynecol. 2014 Sep;3(3):666-670 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationHysteroscopy Clinic. Patient Information. Women and Children - Gynaecology
8 Hysteroscopy Clinic Patient Information Women and Children - Gynaecology When a woman is first told that she has a gynaecological condition that requires further investigation at a specialised hospital
More informationYour visit to the Outpatient Hysteroscopy Clinic
Your visit to the Outpatient Hysteroscopy Clinic Department of Gynaecology Patient Information What What is the is an Outpatient outpatient Cystoscopy hysteroscopy? Clinic? An outpatient hysteroscopy means
More informationChronic pelvic pain and menorrhagia: Assessing treatment effectiveness Daniels, J.P.
UvA-DARE (Digital Academic Repository) Chronic pelvic pain and menorrhagia: Assessing treatment effectiveness Daniels, J.P. Link to publication Citation for published version (APA): Daniels, J. P. (2013).
More informationWhich Hysterectomy for Heavy Menstrual Bleeding? Ray Garry
Which Hysterectomy for Heavy Menstrual Bleeding? Ray Garry I do not believe it! Victor Meldrew Insert Interim heading Clinical depending Commissioning Insert Insert heading depending on line on Policy:
More informationMenorrhagia Update. Simon Edmonds Middlemore Hospital Ascot Central Women s Clinic Auckland
Menorrhagia Update Simon Edmonds Middlemore Hospital Ascot Central Women s Clinic Auckland What is it? Subjective Excessive blood loss at time of menstruation flooding heavy clots Objective > 80mls volume
More informationAbnormal Uterine Bleeding. Richard Dover Specialist gynaecologist
Abnormal Uterine Bleeding Richard Dover Specialist gynaecologist A pragmatic guide. Wide topic range What s not coming up Precocious puberty Menorrhagia well maybe just a little Topics Adolescents IMB
More informationCenter for Menstrual Disorders, Fibroids and Hysteroscopic Services
Center for Menstrual Disorders, Fibroids and Hysteroscopic Services If you experience heavy periods, there is no need to suffer in silence. And if you ve been told that hysterectomy is your only choice,
More informationReview Current minimal access techniques in the treatment of heavy menstrual bleeding
The Obstetrician & Gynaecologist 10.1576/toag.9.4.223.27352 www.rcog.org.uk/togonline 2007;9:223 232 Review Review Current minimal access techniques in the treatment of heavy menstrual bleeding Authors
More informationFrequency of menses. Duration of menses 3 days to 7 days. Flow/amount of menses Average blood loss with menstruation is 60-80cc.
Frequency of menses 24 days (0.5%) to 35 days (0.9%) Age 25, 40% are between 25 and 28 days Age 25-35, 60% are between 25 and 28 days Teens and women over 40 s cycles may be longer apart Duration of menses
More informationRANZCOG Advanced Training Modules
RANZCOG Advanced Training Modules Generalist Obstetrics ATM and Generalist Gynaecology ATM The Generalist ATMs in each of Obstetrics and Gynaecology provide a framework for trainees to consolidate and
More informationA double blinded randomized controlled trial to compare Ormeloxifene and Norethisterone in the treatment of Dysfunctional Uterine Bleeding
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861. Volume 13, Issue 1 Ver. VII. (Jan. 2014), PP 52-56 A double blinded randomized controlled trial to compare
More informationModern Management of Fibroids
Modern Management of Fibroids Mr Narendra Pisal The Portland Hospital Fibroids Very common 20-40% of all women Up to 80% of black women by 50y Most fibroids are asymptomatic 50% will have significant symptoms
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of auditory brain stem implants Introduction This overview has been prepared to assist
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 2/12/2011 Radiology Quiz of the Week # 7 Page 1 CLINICAL PRESENTATION AND RADIOLOGY QUIZ
More informationFor personal use only. Endometrial ablation devices: How to make them truly safe
For mass reproduction, content licensing and permissions contact Dowden Health Media. Michael S. Baggish, MD Dr. Baggish is Chairman of the Department of Obstetrics and Gynecology at Good Samaritan Hospital
More information