Tuma (total uterine mucosal ablation): A technique of endometrial excision under pelviscopic control

L Mettler, Erick Alvarez-Rodas, K. Semm
In: Minimally Invasive Therapy · 1995 · vol. 4(2) , pp. 99–104 · doi:10.3109/13645709509152765 · W2130785930
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This retrospective review evaluated 24 cases of total uterine mucosal ablation (TUMA), finding it a minimally invasive technique with low blood loss and operative time, few complications, and good oncologic and quality-of-life potential for patients with abnormal uterine bleeding.

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Abstract

SummaryWe conducted a retrospective chart review on the first 24 cases of total uterine mucosal ablation (TUMA), a technique of endometrial excision under pelviscopic control, which was introduced by Semm in 1992 [18]. The procedures were performed between January 1993 and December 1994, in the Department of Obstetrics and Gynecology of the University of Kiel. Using a cervix coring device—calibrated uterine resection tool (CURT)—the objective was to preserve the pelvic urodiaphragm structures, their anatomic relations and blood supply, and the neural functions associated with female sexuality. This would produce a better quality of life for those patients who require intervention because of abnormal uterine bleeding, which persisted after medical or surgical treatment, and those who, for various reasons, still want to preserve the uterus. The patients were aged 33–50 yr with a mean of 36 yr. The mean estimated blood loss associated with TUMA was 44.6 ml, and the mean operative time was 33.3 min. There were two complications (8.3%), promptly identified and treated without further problems. Histological studies on the cored out cylinder specimens showed in all cases a dysynchronous endometrium proliferation, and in nine cases (37.5%) mild foci of adenomyosis were also detected. Glands reaching the edge of the myometrium were never detected. In all cases the squamocolumnar transformation zone was totally excised. With this minimally invasive technique we observed several advantages to the patient without greater difficulties to the surgical procedure itself. This is a conservative operation that ends menstruation and may protect against cervical and endometrial cancers.

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adenomyosis

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