1. Dr Muhammad El HennawyDr Muhammad El Hennawy
Ob/gyn ConsultantOb/gyn Consultant
Rass el barr central hospitalRass el barr central hospital
DumyattDumyatt –– EGYPTEGYPT
www.mmhennawy.co.nrwww.mmhennawy.co.nr
Balloon in uterus
Instead of Hysterectomy
)MTBEA(
2. MTBEAMTBEA
Modified Thermal BalloonModified Thermal Balloon
Endometrial AblationEndometrial Ablation
In Teatment of intractableIn Teatment of intractable
menorrhagia instead ofmenorrhagia instead of
HysterectomyHysterectomy
3. Endometrial AblationEndometrial Ablation
It is destruction of endometriumIt is destruction of endometrium
to sufficient depthto sufficient depth
to prevent regenerationto prevent regeneration
and to increase adhesion betweenand to increase adhesion between
anterior and posterior endometriumanterior and posterior endometrium
to decrease menstrual flow sufficientto decrease menstrual flow sufficient
to avoid Hysterectomyto avoid Hysterectomy
4. Methods of Endometrial AblationMethods of Endometrial Ablation
ResectoscopeResectoscope
LaserLaser
Circulating hot waterCirculating hot water
CryotherapyCryotherapy
Intracavitary radiumIntracavitary radium
5. AIMAIM
To evaluate clinical effect ofTo evaluate clinical effect of
Modified thermal Balloon System inModified thermal Balloon System in
ablation of endometrium in cases ofablation of endometrium in cases of
Menorrhagia as alternative toMenorrhagia as alternative to
HysterectomyHysterectomy
6. 3333CasesCases
during 2004during 2004 –– 20052005
33 cases33 cases
with menorrhagia more than 8 days more than 80 mlwith menorrhagia more than 8 days more than 80 ml
in day or affect general condition of womanin day or affect general condition of woman
failed treatment ( medical and hormonal treatment forfailed treatment ( medical and hormonal treatment for
6 months or d & c ) or not tolerate it6 months or d & c ) or not tolerate it
age ( 42age ( 42 –– 50 y )50 y )
complete her familycomplete her family
uterus length less than 12 weeks , uterine cavity lessuterus length less than 12 weeks , uterine cavity less
than 12 cm , more than 4 cm ( U/S )than 12 cm , more than 4 cm ( U/S )
Myometrial thichness more than 10 mm ( U/S )Myometrial thichness more than 10 mm ( U/S )
no uterine or pelvic pathology ( U/S )no uterine or pelvic pathology ( U/S )
informed consentinformed consent
7. preoperativepreoperative
patient after menses ( lowpatient after menses ( low
thickness of endometiumthickness of endometium((
testing of silicon foley cathetertesting of silicon foley catheter
size 18size 18 –– 2020
by inflation of balloon with 20 mlby inflation of balloon with 20 ml
boiled waterboiled water
also cut its tip above balloonalso cut its tip above balloon
boil water in cup with electricboil water in cup with electric
apparatus to 90 degreeapparatus to 90 degree
8. lithotomy positionlithotomy position
under general anaesthesia (ampoule valium +under general anaesthesia (ampoule valium +
1/2 to 1 gram intraval )1/2 to 1 gram intraval )
vaginal speculumvaginal speculum
volsellum to anterior lip of cervixvolsellum to anterior lip of cervix
measure length of uterine cavity by soundmeasure length of uterine cavity by sound
dilate cervix to 9 hegardilate cervix to 9 hegar
+ or - diagnostic hysteroscopy ( not done )+ or - diagnostic hysteroscopy ( not done )
do curettage of endometrium and preservedo curettage of endometrium and preserve
specimen to histopathology to diagnose anyspecimen to histopathology to diagnose any
abnormality and also to decrease thickness ofabnormality and also to decrease thickness of
endometriumendometrium
9. insert silicon foley catheterinsert silicon foley catheter
to the same length measured byto the same length measured by
soundsound
put a towel in vagina around foleyput a towel in vagina around foley
cathetercatheter
( 18( 18 –– 20 size ) to avoid burn of20 size ) to avoid burn of
vagina if balloon rupturevagina if balloon rupture
10. inflate balloon of catheter by boiled waterinflate balloon of catheter by boiled water
( boiled saline ) till feel resistance( boiled saline ) till feel resistance
(20(20 –– 40 ml ) with large syringe ( 840 ml ) with large syringe ( 8 –– 1010
ml still in catheter itself )ml still in catheter itself )
for 3 minutesfor 3 minutes
you can sure from its site under sonaryou can sure from its site under sonar
( NOT DONE )( NOT DONE )
deflate cooled water from balloon anddeflate cooled water from balloon and
repeat 3 times ( maximum 9 minutes )repeat 3 times ( maximum 9 minutes )
then deflate balloon , remove vaginalthen deflate balloon , remove vaginal
towel , remove volsellumtowel , remove volsellum
15. complicationcomplication
rupture of balloon with boiled waterrupture of balloon with boiled water
--- nothing occur--- nothing occur
( vaginal towel( vaginal towel –– no burn to vagina)no burn to vagina)
alsoalso
( boiled water coming quickly( boiled water coming quickly
through catheter from passage ofthrough catheter from passage of
urineurine ((
16. benefits over Hysterectomybenefits over Hysterectomy
preservation of uteruspreservation of uterus
avoid surgical incisionavoid surgical incision
17. benefits over Hysteroscopicbenefits over Hysteroscopic
ablationablation
similar results with simple cheapsimilar results with simple cheap
methodsmethods
18. conclusionconclusion
MTBEAMTBEA
safesafe
simplesimple
CheapCheap
avaliableavaliable
effectiveeffective
minimally invasiveminimally invasive
with minimal riskswith minimal risks
But need long follow upBut need long follow up
