Trans-Cervical Endometrial Resection (TCER) is used in A/E :
Ans. is b i.e. DUB Transcervical endometrial resection (Hysteroscopic endometrial ablation) is a technique for management of DUB. Aim of the procedure is to produce a therapeutic Asherman's syndrome and produce amenorrhea. It destroys the endometrium --4 formation of synchea Asherman syndrome --) amenorrhea. It is essential to destroy endometrial functionalis and basalis as well as 3mm of rnyometrial depth. Procedure : After appropriate inspection of the landmarks and endometrial cavity, a wire loop electrode is used to resect several strips of endornyometrium, to a depth of 4mm. Resected tissue is used for pathologic examination and documentation of the absence of cellular atypia. After a few strips are resected initially from the posterior uterine wall, resection of almost all the remaining surface with loop electrode by vaporisation is performed. The procedure should be performed soon after menstruation or the woman should be given progesterone. danazol or GnRH to suppress the endometrium. Result : Sho term and long term studies show amenorrhea rates of 20 - 50%, overall improved bleeding patterns (including amenorrhea) in 85 - 95%, with failure rates of 5 - 10% which requires additional surgery i.e. hysterectomy. Extra Edge: A COG recommends endometrial sampling prior to surgery. Women should with endometrial hyperplasia or cancer Absolution contraindications for endometrial ablation : Genital tract malignancy Women wishing to preserve their feility Pregnancy Expectation of amenorrhea Acute pelvic infection Prior uterine surgery - Classical cesarean delivery, transmural myomectomy -- Uterine size > 12wks Adenomyosis as TCRE causes dysmenorrhea
Endometriosis
DUB
Carcinoma endometrium
Submucous fibroid