Second-generation endometrial ablation technologies: the hot liquid balloons

The Medical Devices Special Access Program in Canada: A Scoping Study

New health technologies enter Canadian healthcare organizations in various ways, and understanding them is essential to the development of a pan-Canadian Health Technology Management (HTM) Strategy, now a priority of governments across Canada. One way is through Health Canada's Medical Devices Special Access Program (MDSAP), which permits unlicensed devices to be obtained by healthcare professionals. However, the circumstances around and implications of the current use of this program are not clear. A scoping literature review was conducted to clarify these and identify important roles and issues related to the MDSAP. Limited information was found on the MDSAP. Nevertheless, three themes demonstrating the roles of the MDSAP in HTM emerged: arbiter in technology selection, a route to technology procurement and facilitator of health technology innovation. No information suggesting that MDSAP is used to circumvent licensing was found. Rather, it enables desired patient outcomes and product commercialization.

Long-term patient satisfaction with thermal balloon ablation for abnormal uterine bleeding

Background and Objective:

Thermal balloon ablation is a minimally invasive surgical technique that can be used to treat abnormal uterine bleeding/heavy menstrual bleeding (AUB/HMB). Most published studies to date provide information on short-term patient satisfaction and outcomes. The purpose of this study was to determine long-term patient satisfaction after thermal balloon endometrial ablation 7 to 10 years postoperatively in a population previously surveyed at the Penn State Milton S. Hershey Medical Center at 1 to 5 years postoperatively.

Methods:

Two-hundred fourteen patients were identified who underwent thermal balloon ablation at our institution between January 1, 2001 and December 31, 2004. These patients were mailed a 2-page survey asking for information on demographics, patient satisfaction, postoperative bleeding patterns, and the need for subsequent surgery. Satisfaction rates, amenorrhea rates, and the rates of women who required hysterectomy were calculated as percentages.

Results:

Ninety-seven patients returned completed surveys. The survey response rate was 62%, excluding 57 surveys that were returned as undeliverable. The follow-up interval was 93 to 129 months. Eighty-seven percent of respondents were satisfied with the results of their procedure compared with 88% in the original study. Subsequent hysterectomy was required in 21.6% of women after 7 to 10 years compared with 9% after the 1- to 5-year follow-up period. Of the 76 women who did not undergo hysterectomy, 58% reported amenorrhea and 35.5% reported minimal to light bleeding.

Conclusion:

This study demonstrates a consistently high patient satisfaction rate with thermal balloon ablation at our institution at 7 to 11 years postoperatively compared with 1 to 5 years postoperatively. The hysterectomy rate, however, was 2.4 times greater in the long-term follow-up period.

Characterizing Pressure and Flow Rate for Aqueous Immersion Surgery

Hemorrhage control during surgery remains a major clinical challenge for surgeons. Bleeding can affect the safety and efficacy of any surgical procedure. There are well-established methods to address this side-effect of surgery, but all current technologies require the surgeon to direct attention to hemostasis rather than the continuance of the procedure. We have developed a novel surgical method, titled aqueous immersion surgery (AIS), that is able to sustain a bloodless surgical field by providing a controlled hydraulic pressure (immersion pressure) on the bleeding site. Together with the replenishment of an immersion fluid (immersion flow rate), AIS maintains optical clarity of the surgical field. This numerical study was undertaken to investigate the influence of the rate exchange of the immersion fluid on the concentration of blood, hence optical clarity therein. A 3-dimensional multicomponent simulation was performed to evaluate the mixing of blood from an idealized arterial bleeding vessel under pulsatile conditions. With an increase in immersion pressure, bleeding was reduced and increased perfusion was observed. Additionally, the magnitude and direction of the flow field affected the deflection of the bleeding trajectory and, in turn, affected the removal rate of blood from the surgical field. For an idealized case, an optimal immersion flow rate was found for immersion pressures of 100 and 110 mm Hg. From this study, fluid dynamic guidelines are postulated to support future development of AIS.

Thermal balloon ablation versus laparoscopic supracervical hysterectomy for the surgical treatment of heavy menstrual bleeding: a randomized study

AIM

To compare postoperative outcomes and effects on quality of life following thermal balloon ablation (TBA) or laparoscopic supracervical hysterectomy (LSH) in women with heavy menstrual bleeding (HMB).

MATERIAL AND METHODS

Sixty-eight women requiring surgical treatment for HMB were randomly allocated into two treatment arms: TBA (n = 34) and LSH (n = 34). The randomization procedure was based on a computer-generated list. The primary outcome was a comparison of the effects on menstrual bleeding (Pictorial Blood Loss Assessment Chart [PBAC]) between the two procedures. The secondary outcome measures were quality of life, improvement of bleeding patterns, intensity of postoperative pain, and early postoperative complications. Continuous outcome variables were analyzed using Student's t-test. Discrete variables were analyzed with the χ2 test or Fisher's exact test. P < 0.05 was considered statistically significant.

RESULTS

The PBAC score was significantly reduced in both treatment groups. After LSH all women had amenorrhea. After TBA there was a significant improvement of bleeding frequency and length. The postoperative pain intensity at 24 h was significantly minor in women treated with TBA rather than with LSH. The Medical Outcomes Survey Short Form 36 (SF-36) score improved in both groups. However, LSH showed a negative impact on the emotional state. No intraoperative complications occurred, and no case was returned to the theatre in either group.

CONCLUSION

The effectiveness of TBA as a possible treatment of HMB is confirmed. However, LSH showed a definitive improvement of the symptoms, and a better life quality profile. Further controlled prospective studies are required for identifying the best surgical approach in women with HMB.