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Thursday 11th May 2006

 

"Avoiding Hysterectomy: Treatment of Heavy Periods using the NovaSure System -  90 second treatment"

by Professor John Erian

 

The NovaSure System is the latest generation of devices that treats the lining of the womb (endometrium) in women with very heavy periods. The procedure takes approximately 90 seconds, and can be performed under a local anaesthetic as an outpatient procedure.  It does not require hospitalisation, and patients are typically able to resume their daily activities within 48 hours. Clinical studies indicate that hysterectomy (i.e. a major operation to removal of the womb) can be avoided in 97% of patients treated with the NovaSure system. It has been proven to be a safe and effective treatment of problematic heavy periods, yielding a high success rate with low recurrence rates.

 

Hysterectomy has been the leading treatment method for patients with unacceptably heavy periods (menorrhagia). Although effective it has a number of serious drawbacks including higher morbidity and mortality rates. It also has high procedure and care costs. Ablation of the lining of the uterus is becoming a more attractive and more popular alternative to hysterectomy. Different techniques have evolved since the mid 1980s. The first generation techniques such as lasers, roller ball and resection, although effective, are dependent on surgeons skills and had inherent risks. Second generation techniques are more user friendly and entail the placement of a device inside the uterine cavity which is machine activated and different sources of energy are used to destroy the lining of the womb.  The technology, procedural approach, treatment time, outcomes and risks associated with these procedures vary from one method to another. Large studies are continuously being carried out to assess the safety and efficacy of these systems.

 

The NovaSure system (Cytyc Surgical Products, Palo Alto, CA) consists of a single use, slender wand that is inserted through the vagina into the uterus. The procedure is customized for each patient by measuring the uterine length and width, allowing a precise setting for radiofrequency energy. One of the unique safety features of the Novasure system is the Cavity Integrity Assessment, which allows the Gynaecologist to check for potential perforations of the uterus before the ablation begins. The system will not allow energy to be delivered until this test is successfully passed. Once the test is passed and the procedure begins, safe radiofrequency energy is delivered to gently remove the lining of the uterus. The time of energy delivery typically takes only 90 seconds. Of note, the NovaSure system does not require any pre-treatment to thin the uterine lining, and patients can even be treated when actively menstruating.

 

The procedure is intended for use only in women who do not desire to have children because the likelihood of pregnancy is significantly decreased following the procedure. Pregnancy following ablation may be dangerous for both mother and foetus.  As with other ablation techniques the system is not suitable for patients who have had a previous classical Caesarean section or fibroids that have been removed where the cavity of the uterus had been entered.  It should not be used in patients with very small or very large cavities or in the presence of active pelvic infection. The system should not be used in patients with suspected endometrial cancer.

 

Long-term follow-up results demonstrate that use of the NovaSure system is safe and effective and should be considered as a system of choice in treatment of patients suffering from unacceptably heavy periods secondary to dysfunctional uterine bleeding (DUB) where no abnormalities have been found. The NovaSure system is an excellent alternative in the treatment of heavy periods so that hysterectomy can be avoided.

 

Worldwide more than 200,000 women have been treated using the NovaSure system which is now available in many NHS and private hospitals.   To find out more about the system and who is currently conducting the NovaSure procedure please refer to: www.novasure.com and visit ‘find a physician’

 

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