We read with interest the findings of Kevin Jones et al.1 on the use of the Gynelase device in endometrial laser intrauterine thermotherapy for the treatment of menorrhagia. We would like to highlight certain concerns.
First, it would have been informative to know what form the satisfaction questionnaire took and its contents, specifically what demographic factors were taken into account. It is well documented that satisfaction correlates closely with expectations, hence it would be expected that results would vary according to age, socio-economic status, education etc.2 Studies of the Short Form 36 (SF36) health questionnaire have shown that analysis of data at population levels are not as appropriate as when subgroup analysis is performed3. It has also been shown that higher rates of amenorrhoea following endometrial resection are found in the older age group4.
Secondly, we must not ignore the well-documented thermal increase on the serosal surface of the uterus during endometrial ablation as temperature rises of between 2°C and 6°C have been demonstrated5.
As the laser beam penetrates the uterine wall for a variable depth between 1 and 3.5 mm and possibly more, we feel it might be premature to assert that this procedure has a low complication rate, especially as it was such a small study. While the authors claim that the ELITT system does not require direct contact with the endometrium, further studies are needed to be done to ascertain the safety of this device when contact with the endometrium is very likely to occur, as is in the very retroverted uterus and also in situations when the uterine muscle layer is abnormally thin.