Hysterectomy is a major surgical operation painful and expensive, but till recently it was the only way out for woman suffering from Menorrhagia (heavy bleeding during monthly periods), as continued heavy menstruation can lead to anemia, general feeling of weakness and more serious cases, cancer. For such patients Gehta or Ghosh’s Endometrial Hydro Thermal Ablation Technique will come as a welcome relief. This is a minimally invasive surgical procedure by which the inner–most lining of the uterus, known as the endometrium, is completely destroyed, resulting in total cessation of menstrual periods (Amenorrhea).
This innovative technique has been pioneered by Dr. Debdatta Ghosh, head of Gynecology and Obstetrics, Ruby Hall. Starting in March 1995, Dr. Ghosh has already used the technique on 104 patients had and reported a high degree of success. As Dr. Ghosh explains, ‘Removing a complete organ like the uterus results in morbidity. Attempts made in the sixties and seventies to destroy the endometrium with chemical or physical agents proved unsatisfactory. However, since the sixties several new methods, such as laser ablation and coagulation of resection of endometrium with electrocautery have proved effective and popular. Both these methods have certain limitations. They can cause trauma–causing complication like perforation and hemorrhage. Amenorrhea is achieved in less than 45 to 55%. There is also high cost of equipment maintenance and training.
The GEHTA procedure is relatively simple and the costs minimal. The materials required are the same as for dilatation and curettage. In addition, three balloons (made of high quality latex, usually condoms), three 25 ml plastic syringes, one three way stop cork, a stop watch, an electric kettle and a bowl full of ice water are all that are required.
The patient is given sedative to induce sleep followed by a local anesthesia administered intravenously. A thorough curettage of the endometrial cavity is made. Then the heated resistant balloon attached to one end of a flexible plastic tube is slowly inserted into the uterine cavity. The tube is injected with boiling hot water, which fills up the balloon. The hot water is maintained at a temperature of 840C to 860C. As it cools, every 30 seconds it is flushed out and fresh hot water injected. The procedure is completed after a total of 40–50 refillings, depending on the size of the uterus. A bowl of ice–cold water is kept in readiness for spraying in case of a balloon burst. The entire procedure takes just 45 to 60 minutes. The patient arrives in morning and is discharged by the evening. The underlying principal behind this procedure is that the heat destroys the inner lining of the uterus (endometrium), which is actually responsible or menstrual periods and, thus, there is an end to these monthly cycles. There is a mild pinkish discharge for a couple of days, followed by a watery discharge for two weeks and a complete cure by the fourth week. The patient does not require any bed rest and can resume her normal chores within a day or two. The cost of operation is very reasonable, just about one fourth of what is required for a Rs. 20,000–25,000 hysterectomy.
There are some other medical advantages which Dr. Ghosh points out, Because GEHTA does not require the use of general anesthesia, it can also safely be performed on women who have added medical problems such as hypertension, diabetes, lschemic heart, disease and renal diseases, “However, an ultrasound examination is done to rule out thyroid dysfunction, fibroids, tumors cysts and excessive enlargement of the uterus, in which case this procedure would not have the required effect. Out of the 104 cases that Dr. Ghosh has performed GEHTA, follow–up data is available for 100, 95 have proved completely successful. 86 have reported total cessation of the menstrual cycle while 9 have reported minimal bleeding, a very good success rate indeed compared to the other forms of oblation techniques.
Mrs. Anne Rosario, a school teacher, who underwent this procedure, is all praise for it. “I went to Dr. Ghosh’s clinic at 8 ‘o’ clock in the morning. Within half an hour, I was in the OT and fast asleep. I awoke at 4 ‘o’ clock and went home after an hour. I lived on the third floor and was able to climb up on my own, there was no problem at all. I even did the cooking the next day and in a few days I was back at my school. In fact, no one in school even knew that I had undergone this operation. The only discomfort was a slight cramp like pain for a couple of days and that was far less than what I had to suffer before. I am really happy that I came to know of this procedure from a friend”. It is more than two and a half years now since Dr. Ghosh has applied this procedure and there have been no complaints of any negative side effects. On the positive side, the ovaries remain intact and hence there is no hormonal imbalance.