Endometrial ablation using hysteroscopic instillation of hot saline solution into the uterus

Hysteroscopic surgery

Hysteroscopy and visually directed endometrial sampling have replaced blind curettage for the diagnosis of endometrial disease. Hysteroscopy can be used to detect endometrial cancer and various premalignant lesions, as well as to diagnose intrauterine polyps and submucous fibroids. It can also be used to locate lost intrauterine devices, assess the shape and size of the endometrial cavity during an infertility work-up and to visualise intrauterine septae and adhesions. If the hysteroscopist possesses special skills and training, it can be used to perform intrauterine sterilisation by occluding the tubal ostia. The ability to perform endometrial ablation as an alternative to hysterectomy in patients with menorrhagia has led to reduction in the number of hysterectomies performed. Long-term follow-up has confirmed the success of this procedure, but it is not without complications. The inherent dangers and complications of endometrial ablation and the considerable skill and training it requires has led to the development of numerous second-generation devices, which can involve balloons that are heated with circulating fluid, impedance-controlled endometrial ablation or surface electrodes, heated fluid running through the hysteroscope under direct vision or the use of microwaves or cryotherapy. This chapter reviews the techniques, potential complications and evidence for the effectiveness of the common diagnostic and therapeutic hysteroscopic procedures.

Ex vivo investigation of the use of hydrothermal energy to induce chondrocyte necrosis in articular cartilage of the metacarpophalangeal and metatarsophalangeal joints of horses

OBJECTIVE

To evaluate the use of hydrothermal ablation of articular cartilage for arthrodesis in horses through investigation of the effects of joint lavage with physiologic saline (0.9% NaCI) solution (80 degrees C) for various treatment times on chondrocyte viability in the articular cartilage of the metacarpophalangeal and metatarsophalangeal joints of cadaveric horse limbs. Sample Population-7 pairs of metacarpophalangeal and 8 pairs of metatarsophalangeal joints from 8 Thoroughbreds.

PROCEDURE

The horses were euthanatized for reasons unrelated to musculoskeletal disease. On a random basis, 1 joint of each pair underwent intra-articular lavage for 5, 10, or 15 minutes with heated saline solution (80 degrees C); the other joint underwent sham treatment of similar duration with saline solution at 22 degrees C (control). Cartilage samples from the distal articular surface of metacarpus III (or metatarsus III), the proximal surface of the proximal phalanx, and the lateral and medial proximal sesamoid bones were assessed for chondrocyte viability via confocal microscopy and viability staining following enzymatic digestion.

RESULTS

Compared with the control joints, findings of both viability assays indicated that the percentage of sites containing viable chondrocytes in heat-treated joints was decreased. Treatment hazard ratios of 0.048 (confocal microscopy) and 0.2 (digestion assay) were estimated. Histologically, periarticular soft tissues had minimal detrimental effects after heat treatment.

CONCLUSIONS AND CLINICAL RELEVANCE

Ex vivo intra-articular lavage with saline solution at 80 degrees C resulted in the death of almost all articular chondrocytes in the joint. This technique may be a satisfactory method for extensive cartilage ablation when performing arthrodesis by minimally invasive techniques.