- What is Outpatient or Ambulatory Gynaecology?
- Thermablate Under Local Anaesthsia
- What is required?
- Local Anaesthesia Option
Outpatient or ambulatory gynaecology clinics are usually found within a hospital’s outpatient department. These clinics utilize the “see and treat” or “one stop” approach to outpatient gynaecological care.
Minor surgical procedures, including endometrial ablation, can be easily and conveniently performed in this type of setting due to the numerous advances in minimally invasive surgical techniques.
The benefits of performing endometrial ablations under local anaesthesia:
- – Less costly for the hospital and healthcare system
- – Quicker treatment time for both patient and physician
- – Shorter recovery time and avoidance of risks associated with general anaesthesia
- – Increased efficiency for physicians who can perform a greater number of procedures in less time.
The Thermablate system’s compact design, ease-of-use and short treatment time make it an ideal ablation system for use under local anaesthesia
“Thermablate EAS is an extremely well-tolerated device ideal for use in the outpatient or office setting.” (1)
Both patients and physicians report low pain scores during and after treatment with Thermablate under local anaesthesia. It is common for patients to be discharged approximately 1-2 hours after a procedure, making the need for recovery time and resources minimal.
Clinical data has shown the following results when patients were treated with Thermablate under local anaesthesia:
- – 100% of patients return to normal activity within two days(1)
- – 93% of patients would have the procedure again1,(2)
- – 88% would recommend the procedure to a friend1
- – Majority of patients treated are discharged within 30 minutes(3)
- – Thermablate patients reported lower pain levels both intra and post operatively compared to those treated with radio frequency ablation(4)
Patient Assessment and Selection
Not all patients will be good candidates for outpatient endometrial ablation. It is important to discuss all treatment options and determine important factors such as:
- – A good way to assess level of pain tolerance is by conducting an in-office endometrial biopsy and/or diagnostic hysteroscopy
- – Ease or difficulty of cervical dilation
- – Uterine position and size
For a complete list of the Patient Selection Criteria and other contraindications, please refer to the Thermablate EAS Treatment Protocol
Below is a sample list of key equipment and supplies that must be available to successfully carry out a treatment with Thermablate under local anaesthesia:
- – Thermablate Treatment Control Unit and disposable cartridge
- – Diagnostic hysteroscope and / or ultrasound machine
- – Standard sterile gynaecology tray including speculum, tenaculum, sterile drapes, etc.
- – Equipment to perform a paracervical block
- – Cervical dilators up to 7mm
- – Sounding device (disposable or reusable)
- – Hysteroscopic injection needle for pain management (optional)
Please note: If using a Wing Needle for the injection of intrauterine anaesthesia, an operative hysteroscope with a slim outer sheath and 5 French working channel is required.
The most common technique used to manage patient pain levels during an outpatient treatment with Thermablate is the paracervical block. The specific medication administered and protocol followed should be reviewed and decided prior to commencing the procedure.
A number of different local anaesthesia protocol variations are available below:
Other Important Considerations
To offer patients the optimal outpatient experience along with proper medication for pain management, it is important that patients feel as relaxed and as comfortable as possible.
To facilitate this, the clinic should consider the following:
- – Adequate nursing support is essential to the success of the treatment
- – One nurse to assist the doctor and to ensure the patient is comfortable throughout the treatment (talking to the patient is key)
- – Designated recovery area with bed or reclining chair
- – Privacy both before and after procedure
- – Patient support as needed
1. Prasad P, Powell M. Prospective Observational Study of Thermablate Endometrial Ablation System as an Outpatient Procedure. J Min Invas Gynecol 2008; 15:476-479.
2. Hall M, Woodward Z. Outpatient Endometrial Ablation: Patient Reported Efficacy and Acceptability. Royal College of Obstetricians and Gynaecologists World Congress 2016; Poster Presentation.
3. Qaiser A, Chen BF, Powell MC. A Long Term Follow up of Results of Women undergoing an Office Based Thermablate Endometrial Ablation for the Treatment of Menorrhagia. Obstet Gynecol Int J 2016, 4(5): 00127.
4. Leyland N. Office Based Global Endometrial Ablation: Feasibility and Outcome for 3 Modalities. Journal of Obstetrics and GynaecologyCanada 2004; 26:S22.