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Comparison of Resource Requirements of Minitouch and Thermachoice Ablation Procedures
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Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 to use, quick, and did not need cervical dilatation. Based on that experience, it was decided to offer the procedure as an outpatient service at a GP medical clinic where the author’s team performs other outpatient procedures. The first list had four ablations and eight to twelve diagnostic and minor operative hysteroscopies. In the next list, three ablations were performed in addition to other procedures. Patients: Patients undergoing Minitouch ablation procedures. Intervention: All procedures done under local anaesthesia by one gynecologist, a nurse, and a clinical social worker. Measurements and Main Results: There were no adverse events. No procedures were abandoned due to patient discomfort. Patient satisfaction was the main measure of procedure success. Available data on the 17 patients treated shows a 1/17 failure rate (94.1% success rate) at three to four months. The single failure was attributed to patient selection; the patient had a 12-13 cm sounding length cavity with multiple fibroids. Even though it was known that that ablation was likely to fail, Minitouch was tried due to its simplicity in a last attempt to avoid hysterectomy. Conclusion: Minitouch procedures were successfully incorporated in the GP clinic’s work flow, were performed under local anaesthesia, and needed limited resources. Safety and efficacy outcomes were excellent.
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Open Communications 24 - Hysteroscopy, Endometrial Ablation and Sterilization (3:25 PM - 5:05 PM) 4:57 PM – GROUP C
Comparison of Resource Requirements of Minitouch and Thermachoice Ablation Procedures Agarwal V. Lincoln County Hospital, Lincoln, Lincolnshire, United Kingdom
Figure 2: cesarean scar defect evolution in time.
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Open Communications 24 - Hysteroscopy, Endometrial Ablation and Sterilization (3:25 PM - 5:05 PM) 4:50 PM – GROUP C
Minitouch Endometrial Ablation Procedure as an Outpatient Service at a General Practitioner Clinic Shah P. The Gynaecology Partnership Ltd., St. Albans, Hertfordshire, United Kingdom Study Objective: To evaluate suitability of Minitouch procedures performed as an outpatient service at a general practitioner (GP) clinic. Design: Retrospective outcome analysis. Setting: A clinic room at the Gynaecology Partnership Limited, a GP clinic in London Colney. The room has a patient couch, Storz hysteroscopy stack, Alphascope hysteroscope, Versascope hysteroscopy system, and a Minitouch system. The recovery room has two chairs and a couch where patients can recover before discharge. The author’s team had performed 10 initial procedures under general anaesthesia at BMI Hendon Hospital. The procedure was found to be easy
Study Objective: Shortage of recovery beds limited us to doing only three endometrial ablation procedures per list. We trialed Minitouch since it could be performed without anaesthesia and patients recover without needing recovery beds. Resource requirements of Minitouch and Thermachoice procedures, especially during post-procedure recovery, are compared. Design: Observational. Setting: A large district general hospital in England. Patients: Patients undergoing Thermachoice or Minitouch procedures. Intervention: Thermachoice and Minitouch procedures. Measurements and Main Results: Thermachoice patients needed to come at least an hour pre-procedure when they were administered: Diclofenac, Ondansetron, Diazepam, Pethidine and a local anesthetic. All patients needed opioids post-procedure and typically two-three hours to recover. So, there was a significant workload for the nursing staff limiting us to three procedures per list. Novasure, trialed briefly, had similar requirements. In contrast, Minitouch patients are treated without any preparation other than pre-procedure analgesia. The procedure is simple, is done without dilatation, and in most cases, without anaesthesia. The recovery period is only about 15 minutes. Occasionally, one patient per clinic needs a recovery bed for not more than 30-40 minutes. We are able to perform six procedures per list. Four consultants and one nurse hysteroscopist have completed 56 Minitouch procedures without any adverse events. Followup from 37 patients shows 32 (86%) patients have significant bleeding improvement defined as lighter periods or amenorrhoea. Procedure pain scores (mean 7.5, SD 1.8) were comparable to period pain scores (mean 7.1, SD 2.7). Pain rapidly subsided after the treatment. Immediate post-procedure pain scores (mean 2.3, SD 2.3) and pain scores at discharge (mean 1.1, SD 2.0) were significantly lower. Conclusion: Minitouch is a simple procedure with a very short recovery and excellent outcomes. It needs significantly less resources compared to Thermachoice. A post-operative recovery area nurse is no longer needed. From a service point of view, these are obvious advantages.
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 to use, quick, and did not need cervical dilatation. Based on that experience, it was decided to offer the procedure as an outpatient service at a GP medical clinic where the author’s team performs other outpatient procedures. The first list had four ablations and eight to twelve diagnostic and minor operative hysteroscopies. In the next list, three ablations were performed in addition to other procedures. Patients: Patients undergoing Minitouch ablation procedures. Intervention: All procedures done under local anaesthesia by one gynecologist, a nurse, and a clinical social worker. Measurements and Main Results: There were no adverse events. No procedures were abandoned due to patient discomfort. Patient satisfaction was the main measure of procedure success. Available data on the 17 patients treated shows a 1/17 failure rate (94.1% success rate) at three to four months. The single failure was attributed to patient selection; the patient had a 12-13 cm sounding length cavity with multiple fibroids. Even though it was known that that ablation was likely to fail, Minitouch was tried due to its simplicity in a last attempt to avoid hysterectomy. Conclusion: Minitouch procedures were successfully incorporated in the GP clinic’s work flow, were performed under local anaesthesia, and needed limited resources. Safety and efficacy outcomes were excellent.
276
Open Communications 24 - Hysteroscopy, Endometrial Ablation and Sterilization (3:25 PM - 5:05 PM) 4:57 PM – GROUP C
Comparison of Resource Requirements of Minitouch and Thermachoice Ablation Procedures Agarwal V. Lincoln County Hospital, Lincoln, Lincolnshire, United Kingdom
Figure 2: cesarean scar defect evolution in time.
275
Open Communications 24 - Hysteroscopy, Endometrial Ablation and Sterilization (3:25 PM - 5:05 PM) 4:50 PM – GROUP C
Minitouch Endometrial Ablation Procedure as an Outpatient Service at a General Practitioner Clinic Shah P. The Gynaecology Partnership Ltd., St. Albans, Hertfordshire, United Kingdom Study Objective: To evaluate suitability of Minitouch procedures performed as an outpatient service at a general practitioner (GP) clinic. Design: Retrospective outcome analysis. Setting: A clinic room at the Gynaecology Partnership Limited, a GP clinic in London Colney. The room has a patient couch, Storz hysteroscopy stack, Alphascope hysteroscope, Versascope hysteroscopy system, and a Minitouch system. The recovery room has two chairs and a couch where patients can recover before discharge. The author’s team had performed 10 initial procedures under general anaesthesia at BMI Hendon Hospital. The procedure was found to be easy
Study Objective: Shortage of recovery beds limited us to doing only three endometrial ablation procedures per list. We trialed Minitouch since it could be performed without anaesthesia and patients recover without needing recovery beds. Resource requirements of Minitouch and Thermachoice procedures, especially during post-procedure recovery, are compared. Design: Observational. Setting: A large district general hospital in England. Patients: Patients undergoing Thermachoice or Minitouch procedures. Intervention: Thermachoice and Minitouch procedures. Measurements and Main Results: Thermachoice patients needed to come at least an hour pre-procedure when they were administered: Diclofenac, Ondansetron, Diazepam, Pethidine and a local anesthetic. All patients needed opioids post-procedure and typically two-three hours to recover. So, there was a significant workload for the nursing staff limiting us to three procedures per list. Novasure, trialed briefly, had similar requirements. In contrast, Minitouch patients are treated without any preparation other than pre-procedure analgesia. The procedure is simple, is done without dilatation, and in most cases, without anaesthesia. The recovery period is only about 15 minutes. Occasionally, one patient per clinic needs a recovery bed for not more than 30-40 minutes. We are able to perform six procedures per list. Four consultants and one nurse hysteroscopist have completed 56 Minitouch procedures without any adverse events. Followup from 37 patients shows 32 (86%) patients have significant bleeding improvement defined as lighter periods or amenorrhoea. Procedure pain scores (mean 7.5, SD 1.8) were comparable to period pain scores (mean 7.1, SD 2.7). Pain rapidly subsided after the treatment. Immediate post-procedure pain scores (mean 2.3, SD 2.3) and pain scores at discharge (mean 1.1, SD 2.0) were significantly lower. Conclusion: Minitouch is a simple procedure with a very short recovery and excellent outcomes. It needs significantly less resources compared to Thermachoice. A post-operative recovery area nurse is no longer needed. From a service point of view, these are obvious advantages.