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
  • – 93% of patients would have the procedure again
  • – 88% would recommend the procedure to a friend
  • – Majority of patients treated are discharged within 30 minutes
  • – Thermablate patients reported lower pain levels both intra and post operatively compared to those treated with radio frequency ablation

TB Visual Analog Scale for pain

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.
    • Have a look at our GOKit, especially designed to provide you with the essentials in a light weight, simple to use single use tray with excellent quality
  • Equipment to perform a paracervical block
  • Cervical dilators up to 7mm (Or GOKit)
  • Sounding device (disposable or reusable) (Or GOKit)
  • Wing Needle 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:

Dr. George Vilos Recommended Outpatient Protocol
Local Anaesthesia Protocol Options

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. This procedure can be managed so that the patients is completely pain free (mild discomfort as with period pains is common after the procedure).

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, asking for current comfort levels through out the preparation and the 2 minute procedure.)
  • Designated recovery area with bed or reclining chair
  • Privacy both before and after procedure
  • Patient support as needed and requested

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.

Have a look at the main page for Thermablate and Wing Needle, as well as our excellent Gynae Outpatient Kit.

The ablation box kit with a Thermablate, WingNeedle, the covers and GOKit is everything we need to do our ablations in outpatients, and it is working like a charm! Now we can carry it everywhere!

Link to RCOGs elearning module on endometrial ablation and Thermablate