Endometrial ablation, which involves destroying the lining of the uterus, has recently evolved from a one-day outpatient surgery to an in-office procedure. Last fall, after receiving approval from the insurance carriers, William M. Johnson III, MD of OB/GYN Associates of Alabama was the first doctor in the state of Alabama to do an in-office endometrial ablation. Johnson, who has used several types of ablation systems in the operating room, picked the Thermachoice treatment for the in-office procedure because, according to Johnson, with Thermachoice a surgeon only has to dilate the cervix three millimeters to insert the catheter. "There is less pain with this procedure," he says. "And I think the statistics show comparable results for all the modalities for ablation." At this time, the physicians at OB/GYN Associates of Alabama have done approximately twenty in-office endometrial ablations and the feedback has been positive. "The patients are thrilled to find out that they can have this ablation procedure done without having to go through the hassle of typical surgeries. They've tolerated it very well," Johnson says. Patients take Motrin at home for two days prior to the procedure. After they arrive at the office, they are given 10 milligrams of Valium and 60 milligrams of Toradol one hour before the procedure. "Then we administer a paracervical block, which is the local anesthetic," Johnson says. "This is what has allowed us to do the procedure in-office. It's a different technique of paracervical block than I've ever done before. It's a deep paracervical block. We go 1 ½ inches into the cervix and we put 10 cc of local anesthetic on each side, so it's a large volume deep paracervical block." 10 minutes after the block is administered, the surgeons do a hysteroscopy, as in one-day surgery, scanning the uterus to make sure there are no big growths or polyps. Then they begin the ablation, inserting a balloon catheter inside the uterine cavity. The balloon is connected to a heat source, which brings water up to 87 degrees Celsius, near boiling, for an eight-minute treatment cycle. The heat destroys the endometrium, which is the lining of the uterus. The whole procedure takes about 30 minutes. After another 30 minutes of observation, patients can return home. "We do most patients on Friday mornings and they go to work on Monday," Johnson says. He adds, "it's a very safe, effective in-office treatment as an alternative to hysterectomy for management of abnormal bleeding problems. It's most effective for women who have a normal sized uterus and do not have fibroid tumors in their uterus." According to Johnson, use of the in-office procedure is spreading, with several local OB/GYN physicians beginning to use it. May 2007