1. Uterine Balloon therapy
An alternatives to Hysterectomy

2. Dr. Sharda Jain
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar

3. Hysterectomy is the choice

4. Hysterectomy for Normal size
Ut.- Unjustified
Alternatives should be probed

6. Heavy menstrual bleeding
An important cause of morbidity
• It affects 1 in 5
or 1 in 3 women.
• 30% of women in
reproductive age group
suffer with Menorrhagia
• 60% of these women
will ultimately undergo
HYSTERECTOMY

7. Hysterectomy
• Second most
frequent surgical
procedure in women of
reproductive age group
• 90% for benign reasons
• Promptly offered
following a diagnosis.

8. Value Study(BJOG - 2004)
survey of outcomes of 37,000 hysterectomies
• Operative and
postoperative major
complication rate of
3.5% and 9 %
respectively were reported
• Postoperative
mortality of 0.38 /
1000.
• Psychological
implications 35-45%
•
Hysterectomy should not be taken up

10. We have to give- up herd following of
Uterus Removal

11. Dilemma!! of Treatment
Aim - Quality Personal life
- Family life
- Preserve the feminity of a women
- ↓ Frequent leave from office
Age
Severity
Fertility

12. Treatment of Heavy Periods
Individualized
• age
• need for contraception
• desire to retain uterus
• Nature and severity of complaints
• presence of any pelvic pathology
• outcome of previous treatment
• cost of treatment
• time away from work

13. Present Practice
TVS/D&C
Drugs
Another D&C
Hysterectomy

14. Options AvailableOptions Available
Mirena /
Endometrial Ablation
Drug therapyDrug therapy
Hysterectomy

15. Options available
Alternatives to Hysterectomy

16. NICE guideline (Jan 2007)
management of heavy menstrual bleeding
• If future childbearing is desired
LNG – IUS is the first line intervention
• If future child bearing is not
desired
Endometrial ablation

17. Uterine Balloon
Therapy

18. 10 minute
Solution
for
‘Heavy
Periods’
UBT

19. Day Care Procedure
• Definitive solution for patients
• Minimally Invasive
• High safety profile
• Requires minimal training
• Clinically proven (90-97%)
• Can be performed under LA
• COST EFFECTIVE
See to Believe it
UBT

20. • Long learning curveLong learning curve
•Succes rate 85%Succes rate 85%
• Re-surgery up to 30%Re-surgery up to 30% ..
•LO
FEAT
FIRST GENERATION ENDOMETRIAL ABLATIONFIRST GENERATION ENDOMETRIAL ABLATION
TECHNIQUESTECHNIQUES
(Hysteroscopic Techniques)(Hysteroscopic Techniques)
Given upGiven up by most expertsby most experts

21. No Ideal global endometrial
ablation technique - so far !!
•SSAFEAFE
•SSUCCESFULLUCCESFULL
•SSIMPLEIMPLE
•SSAVINGAVING

22. SEATSEAT
Second generation endometrial ablationSecond generation endometrial ablation
techniquestechniques

23. UTERINE BALLOON THERAPYUTERINE BALLOON THERAPY
SYSTEMSYSTEM
““UBT”UBT”
(GynecareThermachoice(GynecareThermachoiceRR
))
First global ablation technology to
receive FDA approval 1997
19971997

24. Therma choice of JJ
stopped operations of
gynae care products

25. NOVA SURE
of USA - yet to come
CAVATERM
Now in India

26. UBT - Thermocoagulation Principle
3 essential parameters
HEAT
TIME
PRESSURE
PERMANENT
TREATMENT OF DUB

27. UBT - Thermocoagulation Principle
The thermal coagulation principle
Combined action of pressure and heat
applied for a sufficient time
- Pressure: variable in different
machines
- Temperature: 78° C - 87 ° C
- Time: 8 - 10 minutes
 5-8 mm of the endometrium
and myometrium will be
destroyed during treatment
Endometrium
Myometrium
Basal
membrane
Functional
layer

28. Extensive Safety/Feasibility Study:Extensive Safety/Feasibility Study:
of UBTof UBT

29. Pre-Ablation

30. Post-Ablation

31. All Uterine Balloon Therapy
are Same
• 95 % success rate
• 50 % amenorrhic at 1
year
• Affects fertility
Pre-Ablation Post Ablation
Use of effective contraception
following procedure is must

32. Uterine Balloon Therapy
Requires hospital stay only 4
hours
• Crampy feeling- 2-8 hours
• Mild pain – 2-14 days
• Vaginal discharge
( watery or blood stained – 2-14 days)

33. Patient Selection
• Unresponsive to medical therapy
• Completed family
• Normal pap smear
• Negative endometrial biopsy
• Cavity depth 6-12 cm thermachoice/
Novasure
• 4-10cm for cavaterm

34. Not fully Evaluated
• Large uterus (> 30 cc, >12 cm)
• Previously failed TCRE
• Repeat Endometrial Ablation
• Post Menopausal Bleeding

35. Factors Affecting
Failure Rate Increases
• ↓ 40 years
• Prolonged duration (↑ 10 years)
• RV uterus (6 fold)
• < Intrauterine pressure during therapy
(ideal > 160)

36. Factors Affecting
Failure Rate decreases
• Pre- operative medical therapy
Danazol /gnRH - G
• Post Operative therapy with injection
Depo-provera 3 monthly for 4-6 injections
(95 to 99%)

37. INTERNATIONAL MULTI-CENTER STUDY
PATIENTS WITH AT LEAST 24 MONTH FOLLOW-UP
INTERNATIONAL MULTI-CENTER STUDY
PATIENTS WITH AT LEAST 24 MONTH FOLLOW-UP
8 min treatment; >150 mmHg Start Pressure
Hypomenorrhea
38%
Amenorrhea /spotting
36%
Minimal or no
reduction in
menses 4.0%
22%
NormalperiodsNormalperiods

38. OVER 2 million / yr
procedures are done in USA alone
We Have Largest No. of Cases of UBT in India
Updated on 1/8/2014

39. • Proliferative Endometrium – 197
• Disorderd Secretory Endometrium – 41
• Simple Hyperplasia – 674
• Complex Hyperplasia without Atypia- 30
Post Menopausal Bleeding – 209
• Proliferative Endometrium
• Simple Hyperplasia
Poor surgical risk - 263
N – 1508N – 1508 (Success Rate – 99%)(Success Rate – 99%)
Updated on 1/8/2014Updated on 1/8/2014

40. UBT’s
Biggest Use
Is for patients who are
high risk for surgery

41. UTERINE BALLOON THERAPY IN
POOR SURGICAL RISK CASES
I.E.PALLIATIVE TREATMENT
• Morbid Obesity, Diabetic, Hypertensive, Fibroids
(95-126 kg)
• Chronic Renal failure
• Poor Cardiac Reserve
• I.T.P. For BM Transpant
(Pancytopenia & CML)
• RHD (valve replacement)
N-263 cases
Compiled on 1/8/2014Compiled on 1/8/2014

42. Hysterectomy needed in – 2
(Both with fibroids)
Repeat Balloon Therapy – 3

43. Our Experience
UBT v/s Mirena
Great
Great
Great
4th
Month
Jaan Nikaal
Deta Hai
Really
troublesome
Now we have learnt To overcome the problems
of Mirena in the firs 3 – 6 months

44. KJ Carlson, NEJM 328:856,
1993
HYSTERECTOMY
as Treatment
Should be last resort

45. Uterine Balloon Therapy is thus a newUterine Balloon Therapy is thus a new
horizon to your patient and yourself.horizon to your patient and yourself.
Once family is completedOnce family is completed
BE BOLD, WALK ALONG NEW
PATHS
EXPERIENCE IT YOURSELF

46. UBT - Cavaterm™
Endometrial Ablation Method NOW In INDIA
What is Cavaterm ?
• Minimally invasive therapy for the
treatment of DUB
• Thermal balloon ablation of the
endometrium
• Using pressure and heat for 10 minutes
to treat DUB
• System consisting of a Cavabox and a
single use catheter
The Cavaterm™ System

47. Cavaterm™
Evolution of a successful system
•Quick to learn and easy to use
method to treat DUB
•Used since 1993
• Ongoing product development and
innovations based on users feedback
Now we have 3rd génération

48. UBT - Cavaterm™
Contraindications
 Undiagnosed uterine bleeding
 Ongoing infection
 Pregnancy or desire to become pregnant
 Doubts regarding uterine wall strength
 Gross uterine abnormalities
 Endometrial atypical cells
 Uterine cavities > 10 cm and < 4 cm
 Cervical canal longer than 6 cm

49. ADDRESS
11 Gagan Vihar, Near Karkari
Morh Flyover, Delhi - 51
CONTACT US
9650588339, 011-22414049,
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com
&
Thank You