Tactile Electrosurgical Ablation in Cases of Dysfunctional Uterine Bleeding (TEA)

December 30, 2015 updated by: Mostafa Hussein

Tactile Versus Hysteroscopic Electrosurgical Ablation in Cases of Dysfunctional Uterine Bleeding

Abnormal uterine bleeding (AUB) is any alteration in the pattern or volume of menstrual blood flow and heavy menstrual bleeding affects up to 30% of women at some time during their reproductive years. Abnormal menstruation can be due to conditions such as pregnancy complication uterine fibroids and adenomyosis, but in a large proportion of cases, the etiology is unclear, a condition generally referred to as dysfunctional uterine bleeding (DUB). Treatment options for DUB include symptomatic medical treatment or surgery, traditionally hysterectomy.

Hysteroscopically guided endometrial ablation methods have been shown to be effective and safe alternatives to hysterectomy for management of DUB. These methods require particular skills and experience and a long learning curve to be performed effectively and safely.

Through the past three decades DUB patients in Assiut university hospital were treated with either electrosurgical ablation or hysterectomy. When faced with hysteroscopic challenges during transcervical resection of the endometrium or rollerball coagulation, we used to shift to thermal balloon as backup method . However, expensive uterine balloon could not infrequently be afforded because of financial constrains and limited health resources . Therefore, another method was used as backup for hysteroscopic failures. It was first tried via insulating the conventional double-ended uterine curette then through a specially designed tactile electrosurgical ablation (TEA) probe.The technique of TEA is largely similar to the dilatation and curettage procedure both principally and practically. Hence, the basic requirements for its performance are the general awareness with electrosurgical principles and adequate experience in performing dilatation and curettage. TEA is done by specially designed tactile diathermy probe that carried the job of electrosurgical ablation without hysteroscopy or distension media first in an experimental session that clearly clarified the reproducibility of the depth of thermal damage and safety of the tactile electrosurgical ablator . Thereafter, TEA was successfully performed with satisfactory short and medium term outcomes for ten cases with DUB during an active, relentless bleeding attack. TEA is done under laparoscopic monitoring.

The aim of the present work is to present TEA as a simple, inexpensive, novel backup approach for treatment of DUB.

Study Overview

Study Type

Interventional

Enrollment (Actual)

108

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Assiut, Egypt
        • Woman's Health Hospital-Assiut University.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

40 years to 50 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Patients with dysfunctional uterine bleeding aged between 40 to 50 years
  • Unsuccessful medical treatment.
  • No intrauterine abnormalities.
  • Endometrial biopsy negative for atypia and cancer.
  • follicle stimulating hormone level not exceeds 30 mills-International unit
  • Family complete
  • Patients who are not candidate for hysterectomy because of medical or surgical risks.

Exclusion Criteria:

  • Coexisting gynecological pathology (e.g. uterovaginal prolapsed, ovarian pathology, pelvic inflammatory disease, cervical atypia).
  • Endometrial hyperplasia with atypia and cancer..
  • History or evidence of malignancy.
  • Hyperplasia in the endometrial biopsy.
  • Uterine size more than 12 weeks in size.
  • Women with caesarean or myomectomy scar

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Group 1"Tactile electrosurgical ablation"
Endometrial ablation will be done by Tactile electrosurgical ablation probe.
Other Names:
  • Transcervical resection of the endometrium
Active Comparator: Group 2 "Hysteroscopic endometrial ablation"
Hysteroscopic endometrial ablation will be done by trans-cervical resection of endometrium.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Satisfaction with the treatment at 12 month follow up
Time Frame: 12 moth
Satisfaction with the treatment will be measured at 1 year post procedure on 3-point scale-very satisfied, satisfied, and not satisfied.
12 moth
Change in menstrual status.
Time Frame: At 3, 6, 9, and12 months pot operatve.

Menstrual status will be reported as

  • Normal menstrual flow.
  • Light menstrual bleeding.
  • Heavy menstrual bleeding.
  • The need for hysterectomy.
At 3, 6, 9, and12 months pot operatve.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Acceptability of treatment
Time Frame: 4 weeks
Acceptability of the procedure will be assessed in 3- point scale as cure or acceptable improvement in symptoms, treatment acceptable and would recommend treatment to others or not acceptable
4 weeks
Changes in health related quality of life
Time Frame: At 3, 6, 9, and 12 months post operative.

Health-related quality of life parameters will be completed using

  • Short form-12 (SF12).
  • Life style questionnaires including Work affection will be measured by the number of days absence from the work due to menses as following, non ,non but work suffer, 1 day and >2 days.
  • sexual life affection will be measured in two point as no or yes.
At 3, 6, 9, and 12 months post operative.
Difference in operative time between the two groups in minutes.
Time Frame: 0-60 minutes
Difference in operative time is calculated using a stop watch.The zero minute is the time of starting the procedure. The stop watch is on at the zero minute then sopped at the end of the procedure.time of anesthesia is not included.
0-60 minutes
Reporting of any intro-operative complications.
Time Frame: 0-60 minutes.

Intro-operative complications includes

  • Cervical laceration.
  • Perforation of the uterus.
  • Hemorrhage
  • Fluid overload.
0-60 minutes.
Reporting of any technical complications.
Time Frame: 0-60 minutes

Technical complications for transcervical resection of the endometrium (TCRE) includes

  • Poor uterine distention.
  • Slow clearance of the debris.
  • Inefficient cutting.
  • Poor visualization.
  • problem of diathermy.
  • Problems with the camera.
  • problems with light source.

Technical complications for tactile electrosurgical ablation (TEA) includes

  • Insulation problem.
  • Connection problem.
  • Inefficient diathermy power.
0-60 minutes
Difference in post-operative pain score using visual analogue scale between the two groups.
Time Frame: 4 hours.
Difference in post-operative pain score using visual analogue scale from 1-10.
4 hours.
Time needed for post operative recovery (days) of pain, vaginal bleeding, vaginal discharge, till full recovery and till return to work.
Time Frame: 28 days post operative
28 days post operative
Length of hospital stay in days
Time Frame: up to 2 days
Length of hospital stay in days is calculated from the day of operation till day of discharge.
up to 2 days
Difference in the cost of the two surgical procedure.
Time Frame: up to one hour.
Direct cost of the surgical procedure itself is calculated.The cost of the TCRE procedure will include the cost paid for the hysteroscopic unit and the cost of glycine used as distension media.The cost of the TEA procedure will include the cost of laparoscopy, the cost of TEA probe, and the cost of diagnostic hysteroscopy. The cost of the investigations, anesthesia, pre and post operative treatments will be excluded from analysis as they are the same for both groups.
up to one hour.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Collaborators

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

April 1, 2010

Primary Completion (Actual)

December 1, 2014

Study Completion (Actual)

December 1, 2014

Study Registration Dates

First Submitted

January 22, 2014

First Submitted That Met QC Criteria

September 22, 2014

First Posted (Estimate)

September 25, 2014

Study Record Updates

Last Update Posted (Estimate)

January 1, 2016

Last Update Submitted That Met QC Criteria

December 30, 2015

Last Verified

December 1, 2015

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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