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Operation: Novasure Endometrial ablation

Insurance code: Q1702

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: Novasure endometrial ablation is offered to women who have been suffering from heavy periods for whom other non-surgical treatments such as the Mirena coil have not been successful or appropriate.
Description of procedure: An endometrial ablation with the Novasure equipment is a surgical manoeuvre which destroys the endometrial tissue inside the uterus responsible for producing periods. Removing this layer totally or in part either stops periods or reduces the volume of blood loss. The Novasure equipment uses high frequency microwave energy to achieve this. A surgical ‘wand’ is inserted into the uterine cavity. The position is checked and the electrical energy is then applied for about 90 seconds to destroy about 90% of the endometrial cavity.
Anaesthetic: These operations are normally carried out under a light general anaesthetic.

Length of stay: These operations are normally carried out as a day case but some patients prefer to stay overnight.

Post-operative management: A short course of anti-biotics is sometimes prescribed. Sex and tampon usage are avoided in the first 4 weeks to reduce the risk of infection.

Potential complications: Complications are fortunately rare. Heavy bleeding which occurs during the operation can usually be controlled by the insertion of a catheter into the uterus. The balloon on the catheter is filled up which provides pressure on the cavity and reduces bleeding. The catheter is removed the following day. If the catheter technique does not work it is sometimes necessary to carry out a hysterectomy to prevent heavy loss. This is fortunately rare. If the surgical wand perforates the uterine wall there is a risk of damage to structures inside the abdominal cavity. This is the rarest but the most important of the potential complications and if it occurs it is important to open the abdominal cavity and repair any damage that has occurred. In this situation it is usually necessary to carry out a hysterectomy with a five day stay and a six week convalescence. This complication occurs in fewer than 1/200 cases (0.5%).

Post-operative consultation
It is usual to have a post-operative consultation about three months after the surgery. By then it would be normal to have had three periods and possible to tell whether the operation has been successful. The overall satisfaction rate is over 95%.

Long term consideration
Heavy periods can stop for many years but then recur due to re-growth of the endometrium inside the uterus. This is fortunately rare but if it occurs a further endometrial ablation can be carried out. Periods can sometimes remain very light but can become very painful due to blood getting trapped inside the endometrial cavity and failing to drain out of the uterus. Dilating the cervix can sometimes relieve this problem. If this does not work a hysterectomy can be carried out as a final solution.

Return to normal activity and work
Most ladies require about three days off work and normal activity to recover although a few ladies will go back to work the next day and a few ladies will require a week off work.

Other websites to review:
Further relevant information is available via the following web sites:

Infomation on Novasure

Infomation on Endometrial Ablation