Hysteroscopic endometrial laser ablation - A novel approach for palliative management of endometrial cancer in inoperable patients.

Background: Endometrial cancer, the most common gynecologic malignancy in developed nations, poses substantial treatment challenges, particularly in patients with significant comorbidities or advanced obesity. Purpose: This manuscript introduces an innovative method that employs awake hysteroscopic endometrial laser ablation (HEA) as a palliative treatment for patients with endometrial cancer who were either inoperable or medically unfit to undergo general or regional anaesthesia for conventional therapies. Methods: A retrospective evaluation of patients diagnosed with endometrial cancer at a tertiary center from 2019 to 2024, focusing on those with symptomatic uterine bleeding, who failed previous treatment options and could not undergo surgical or standard palliative interventions due to high surgical risk. Results: In our study, three patients (n = 3) with severe medical conditions-high BMI and poor performance status-underwent awake HEA using a vaginoscopic approach, treating symptomatic vaginal bleeding effectively. The procedure allowed for rapid treatment, minimal recovery time, and enhanced quality of life. Histological analyses post-ablation indicated satisfactory outcomes, contributing to symptom relief and stabilization of patients' conditions. Conclusion: Our findings highlight the potential of conscious HEA as a palliative management strategy in high-risk patient populations, emphasizing its role when conventional therapies fail. This study underscores the importance of personalized treatment plans and multidisciplinary approaches in managing endometrial cancer, paving the way for further research into the safety and efficacy of HEA in similar cohorts.