title: Clinical and health service implications of second generation endometrial ablation devices.
abstract: OBJECTIVE
  This review evaluates the current evidence on the efficacy, safety and cost-effectiveness of the ever-increasing number of second-generation endometrial ablation devices.
  
  
  RESULTS
  The literature covered by this review includes (1) evidence on long-term benefit, avoidance of hysterectomy and improvement in quality of life, (2) applicability of these techniques in the outpatient environment under local or no anaesthesia, (3) frequency and nature of early and delayed complications associated with these devices, (4) impact on clinical practice and the health service, and (5) implications for research.
  
  
  CONCLUSIONS
  Where appropriate, second-generation devices are rapidly becoming the first-line surgical choice for the management of heavy menstrual bleeding. This has both cost-savings and negative implications for the health service. There is also emerging evidence that improvement in quality of life is more relevant to women than amenorrhoea rates. What has come to light from this review is the lack of accurate data on adverse events rate, and the urgent need for a better appreciation of the frequency and nature of complications.
authors.affiliation: Department of Obstetrics and Gynaecology, Wales College of Medicine, Cardiff University, University Hospital of Wales and Vale NHS Trust, Cardiff, UK. amsonn@cf.ac.uk
authors.forename: Nazar N
authors.initials: NN
authors.lastname: Amso
mesh_terms: D000758:Anesthesia / Q000379:methods; D017115:Catheter Ablation / Q000295:instrumentation*; D002404:Catheterization / Q000295:instrumentation; D017679:Cryotherapy; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008872:Microwaves / Q000627:therapeutic use; D018579:Patient Selection