Radial Fiber Laser for Hysteroscopic Endometrial Ablation in Medical-Treatment-Resistant Menorrhagia

Keywords:Radial Fiber Laser  Time:25-08-2026

Introduction

Menorrhagia remains one of the commonest reasons a woman is referred to a gynecologic surgeon. After decades in which hysterectomy was the default definitive solution, endometrial ablation has established itself as a minimally effective alternative for patients who have completed childbearing and who no longer wish to pursue hormonal or intrauterine medical therapy.

The principle is deceptively simple: destroy enough of the basal and functional endometrium to reduce or abolish menstrual bleeding, while preserving the uterus and avoiding the morbidity of major abdominal or vaginal surgery.

What has always interested me, however, is the geometry of the treatment zone. The endometrial cavity is not a flat plane; it is a three-dimensional, often triangular or pear-shaped cavity with anterior, posterior, and lateral walls. Any energy source that fires in a single forward direction must be swept, retracted, and re-angled by the operator to cover the whole surface, which introduces variability in contact time, depth of injury, and completeness of ablation.

A device that emits energy radially, in a full 360-degree ring around its tip, is conceptually better matched to the anatomy. In this observational series we evaluated the clinical outcomes of hysteroscopic endometrial ablation performed with a Medfibers Radial Fiber Laser system delivering a circumferential beam through a disposable 360-degree radial-emitting fiber.

Material and Methods

Between September 2023 and May 2025, 48 women aged 38 to 52 years (mean 44.3 years) with documented menorrhagia unresponsive to at least six months of medical therapy were prospectively enrolled. Exclusion criteria included current pregnancy, desire for future fertility, uterine cavity length greater than 12 cm on saline-infusion sonography, active pelvic infection, and known coagulopathy. All patients underwent diagnostic hysteroscopy at the same session to exclude endometrial polyps or submucous myomas that would have required resection before ablation.

The procedure was performed under short general anesthesia or conscious sedation with paracervical block. A 26-French continuous-flow operative hysteroscope with a 5-French working channel was introduced, and the cavity was distended with normal saline. A sterile radial-emitting laser fiber (SMA905 connector, 3 m working length, 600 μm core diameter) was passed through the working channel.

The laser platform was set to a quasi-contact vaporization mode at 30 W, with the fiber tip advanced from the fundus toward the internal os in a slow, controlled withdrawal. Because the energy ring extends perpendicular to the fiber axis, no deliberate sweeping motion was required; instead, the surgeon paused for three to four seconds at each level before withdrawing the tip by approximately 5 mm. Total laser activation time ranged from 90 to 140 seconds per patient.

Menstrual blood loss was quantified with the Pictorial Blood Loss Assessment Chart (PBAC), patient satisfaction with a 5-point Likert scale, and procedural complications were recorded at discharge and at each follow-up visit. Follow-up assessments were scheduled at 6 weeks, 6 months, and 12 months.

Results

Forty-six of 48 procedures (95.8%) were completed hysteroscopically without conversion to another modality. Mean operative time from hysteroscope insertion to removal was 18.4 minutes (range 12–29 minutes). No patient required blood transfusion, and there were no uterine perforations or cervical lacerations. Three patients developed transient lower abdominal cramping that resolved within 48 hours; one patient had a delayed postoperative urinary tract infection treated orally.

The PBAC reduction was statistically significant at both 6 and 12 months (p < 0.001). The two patients who required hysterectomy at 11 and 13 months both had adenomyosis evident on preoperative imaging that had been considered mild; neither had satisfied the typical exclusion criterion for cavity distortion.

Discussion

The data suggest that a radial emission profile can produce a reasonably uniform endometrial injury without the operator-dependent sweeping pattern required by some forward-firing devices.

In our cohort, the rate of amenorrhea or hypomenorrhea reached 89.6% at 12 months, which compares favorably with published series using rollerball resectoscopy or bipolar radiofrequency ablation . I would caution, however, that this was a single-arm observational study without direct comparison against those technologies; a randomized non-inferiority trial would be needed before claiming equivalence.

From a practical standpoint, the radial geometry was particularly useful at the uterine fundus and cornual recesses, where keeping a forward-firing fiber perpendicular to the surface is awkward. The risk of overtreatment at one focus and undertreatment at another appeared reduced because the energy ring treats all quadrants simultaneously as the fiber is withdrawn. Whether this translates into lower long-term failure rates will require longer follow-up, but the early satisfaction rate of 85.4% is encouraging.

The radial fiber we used is the same platform that has been reported for radial laser turbinate reduction and arthroscopic radial laser synovectomy, underscoring the versatility of a 360-degree delivery tip when the target pathology is circumferential.