Approximately 22% of women between ages 35-55 are affected by abnormal uterine bleeding. As a result, approximately 10-20% of office visits to a gynecologist are directly related to this condition. Endometrial Ablation is a procedure performed for women that have heavy and irregular menstrual periods. It works by destroying a layer of the Uterus called the Endometrium. Ablation means, “to remove by erosion, melting, evaporation, or vaporization. ” (Pick, Marchelle 2012) In many women it can cause them to stop menstrual bleeding, but in others it can reduce or help it become normal.
An Endometrial Ablation is 90 percent effective. In the rare cases that it doesn’t work, another surgery may be required. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used. There are five different ways to perform the ablation. There is Electrosurgery, Heat, Cryoablation, radiofrequency, and Microwave. In Electro surgery, there is a thin scope inserted into the vagina, and within the scope there is an instrument such as a spiked ball or wire loop that is heated and is used to carve furrows into the endometrium.
With, this procedure, general anesthesia is required. There a two different ways to use heat to destroy the lining of the uterus. First, there is free flowing hot fluid. The saline fluid has to be heated to 176 to 194 degrees F. It freely flows through the uterus to destroy the lining by burning it, causing scarring, this can be the most painful way to do an ablation, but it is also the most effective. Second, a balloon can be used.
A balloon device is inserted through the cervix, and then inflated with fluid heated to 188 degrees F. A balloon sometimes is not flexible enough to reach the entire endometrium. In Cryoablation, extreme cold is used. It works by creating ice balls that freezes and destroys the lining. An ultrasound machine is used to track the progress of the freezing. In some cases, multiple cycles of freezing need to be done depending on the size of the patient’s uterus. In microwaving, the doctor inserts a thin rod that emits microwaves, which raises the temperature of the tissue and the doctor moves the wand side to side while inserting and removing the wand continuously emitting microwaves.
With Radio-frequency, “A probe is inserted into the uterus through the cervix. The tip of the probe expands into a mesh-like device that sends radiofrequency energy into the lining. The energy and heat destroy the endometrial tissue, while suction is applied to remove it. ” (The American college of Obstetricians and Gynecologists April 2013). There are only a few reasons why a woman would need to get an Endometrial Ablation. “Menorrhagia is a condition in which a woman has extremely heavy or prolonged menstrual periods. Bleeding between periods is called abnormal uterine bleeding.
In some cases, bleeding may be so severe and relentless that daily activities become interrupted and anemia develops. “(John Hopkins Medicine). This procedure works the best on women that are pre-menopause, but after they are finished having children. The younger the patient is when they receive this procedure, the more likely the patient will need to have a repeat procedure or even a bigger chance that it won’t work at all. Depending on the cause of the bleeding, endometrial ablation may be suggested to destroy the lining of the uterus.
When endometrial lining is destroyed, it can no longer function correctly, and bleeding is lessened or it can even stop completely. With Endometrial Ablation there are some slight risks. The Doctor can accidental puncture the Uterus. Also, with heat ablations there are burn risks. The doctor can accidentally burn the uterus or the surface of the bowels. “After endometrial ablation, pregnancy is still possible in some women. However, these pregnancies may be a higher risk to both mother and baby. The pregnancy may end in miscarriage because the lining of the uterus has been damaged.
Women who want to become pregnant in the future should not have endometrial ablation”. (Mayo Clinic). Endometrial Ablation should only be done if a patient is done having children. There is also a chance to tear the opening of the uterus. The last risk for Endometrial Ablation is there can be build up of fluid in the lungs from the free flowing fluid ablations. Usually, an Endometrial Ablation only takes less than an hour to perform, but if there is any damage that is done, for Example, a puncture to the uterus further treatment is needed.
An hour stay can turn into a couple of days. It takes two days to recover from the Ablation, but if there are any complications, it can take up to two weeks to recover with additional procedures that might be needed. There are many things a Medical Assistant needs to do from start to finish with an Endometrial Ablation. The very first thing that needs to be done is to do a pre-authorization. Once the authorization is approve then, the appointment can be scheduled. When on the phone with the patient, the Medical Assistant needs to give them their pre-care instructions.
Once the appointment is set, and then the supplies need to be ordered if not kept in the office. When the day of the procedure comes is when the instruments and other supplies need to be set up to perform this procedure. A sterile field needs to be kept at all times since there is a high risk of infection. Also, the medical assistant needs to make sure that there is back ups for every instrument just in case something gets dropped, so things can run smoothly. Once, everything is set up and sterile, its time to bring the patient back and start to prep them for the procedure.
First, the medical assistant would take the patients vitals. Once, the vitals are taken is when you give them the postsurgical instructions and answer any question that the patient might have. The consent form needs to be signed at this point. Go over the consent form with the patient. When the consent form is signed the patient needs to change into a gown, assist them if needed. An IV needs to be set up for general anesthesia, depending on which procedure is used. The very last thing that needs to be done before the surgery is performed is putting the patient in the Lithotomy position.
During the procedure a medical assistant needs to make sure that things run smoothly for the doctor. The MA would need to assist with the catheter insertion. For example, hand him the catheter and the supplies needed to insert it. After, the catheter is inserted is when the procedure starts. The medical assistant would hand him the instruments needed to perform the ablation. For example, a vaginal speculum and the instruments for the right procedure technique. When the procedure is finished the medical assistant would help remove all instruments.
Postsurgery the Medical assistant would need to clean up the patient and help them get dressed if they need assistance. When the patient is dressed the medical assistant would need to take their vitals and make a follow-up appointment. The most important thing is to make sure that the patient knows is the numbers to the office in case they have any questions or concerns. When the patient is ready to go escort them out to the car and help them in. Now, that the patient is gone the medical assistant would need to go back to the room where the procedure was and clean and sanitize the room.
Next, you would take all the instruments and put them in the autoclave to sterilize them. When the room is clean and the instruments are in the autoclave the last thing to do is to update the patient’s chart. There are many different instruments that are used because there are five different techniques that need different instruments. The five instruments that are used in every technique are the Vaginal Speculum, Hysteroscope, Uterine dilator, Uterine Sound, and Tenaculum Forceps.
The instruments that are different per their technique are a sterile balloon for the balloon ablation, triangular mesh electrode for radiofrequency, and a probe that freezes for Cryoablation. In conclusion, there are many steps for achieving a successful ablation. The medical assistant is what helps the procedure to run smoothly and in a timely manner. It is important to follow each step completely and accurately. If things are not done accurately, then the patient can be at a bigger risk for something to go wrong.
