The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endometrial cyrotherapy for menorrhagia
Endometrial cryotherapy (or cryoablation) involves using cold temperatures to freeze and destroy the lining of the uterus (called endometrium). The procedure can be performed under general, regional or local anaesthesia, although sometimes no anaesthesia is required.
A probe (also called cryoprobe) is inserted through the vagina and cervix into the uterus and is cooled by passing either liquid nitrogen or a compressed gas mixture through it. The tip of the probe is the site of freezing and is placed in the top part of the uterus. Activating the freeze cycle of the probe generates an ice ball in the uterus which destroys the target area of endometrial tissue. The freeze cycle is followed by a heat (thaw) cycle which allows the probe to be removed. Ultrasound is used to monitor the position of the probe and depth of freezing across the endometrium. Additional freeze/thaw cycles may be repeated if necessary.
Q17.3 Endoscopic cryotherapy to lesion of uterus
Includes: Endoscopic cryotherapy of uterus
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.