Ablation Surgery: What to Expect on the Day of Surgery

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Ablation surgery is technically a minimally invasive procedure, but your experience on the day of surgery will depend a lot on the type of ablation you will have, and how you handle the procedure.

Ablation can be done on an outpatient basis, but for more delicate ablations—like cardiac ablation—your doctor may want to keep you overnight for observation. Keep reading to find out what to expect on the day of your ablation.

Before the Surgery

Before your ablation surgery, your doctor will have run a number of tests to visualize the surgical area and identify the areas that need to be repaired or removed. You may have also have some blood work done to make sure you are healthy enough to have the procedure.

By the day of your procedure, your doctor should have all the information they need to do the surgery. The next step will be to get you prepared for the actual procedure. This may include the following steps:

  • Your nurse will take your vital signs, including blood pressure, heart rate, temperature, and oxygen level.
  • You will be placed on a machine to monitor these measurements throughout your surgery.
  • You will be asked to complete a pre-screening checklist to review your past medical history and any implanted devices.
  • Remove any metal objects, such as jewelry.
  • A nurse or other caregiver will insert a peripheral intravenous catheter (IV) for medications you will need during the surgery.
  • You may receive intravenous fluids before your surgery, particularly with a cardiac ablation.
  • Your nurse may insert a urinary (Foley) catheter, to collect and monitor your urine output during and after the surgery.
  • Depending on what type of ablation you will have, your skin will be prepared for the ablation catheter. For a cardiac ablation, this means and area of your groin will be shaved and prepared with a cleansing solution.

When you and your doctor are ready to begin the procedure, you will be taken to the procedure room and placed on a special table that is outfitted with X-ray or magnetic resonance imaging (MRI) tools. These tools guide your doctor with real-time images as the ablation is performed.

For more superficial ablation procedures, your doctor may simply be able to visualize the surgical field, especially in ablations involving the skin.

During the Surgery

The technique and process for your ablation will vary a lot depending on the part of the body where your ablation is being done. Generally, a hollow tube called an ablation catheter is inserted, and your doctor will use an X-ray or other imaging tool to find the problematic area.

Electrical impulses, fluids, or other methods are then used to reprogram or remove whatever tissue is causing you a problem. Below, you will find the steps of two types of ablation procedures—cardiac ablation and endometrial ablation.

Cardiac Ablation

You may experience these steps:

  • Once you are positioned on the operating table, you will be given medication to help you relax, or even general anesthesia to put you to sleep for the rest of the surgery.
  • When that medication has taken effect, your doctor will inject a numbing agent into the area where the catheter will be inserted. You may feel a small burning sensation as the numbing agent begins to work.
  • The catheter is usually inserted into the groin for a cardiac ablation, but your doctor may also use other large vessels in the arm or neck.
  • Tubing—or a sheath—will be inserted into the vessel your doctor has chosen, and a small catheter and wires will be inserted through the tubing until it reaches your heart.
  • Your doctor will use a type of X-ray, called fluoroscopy, to see the inside of your heart, and the catheters and wires that were inserted.
  • The catheter and imaging tools are used to locate abnormal signals called arrhythmias in your heart.
  • The areas that are emitting abnormal signals are marked with computer mapping and energy is delivered through the catheter.
  • This energy heats or freezes the tissue causing the abnormality, causing a lesion that will prevent abnormal signals from passing through this tissue in the future. Lesions are about one-fifth of an inch in size.
  • If you are awake, you may feel some discomfort as the ablation is performed. You may feel your heart speeding or slowing throughout the procedure.
  • If you are awake and feeling pain, tell your doctor. You should avoid taking deep breaths or moving during the procedure if you have not been placed under general anesthesia.
  • Once the ablation is complete, the medical team will perform a few tests or use certain medications to make sure your heart does not continue to transmit abnormal signals.
  • If your doctor is satisfied with the results, the catheter will be removed, and the insertion site will be closed with a dressing or surgical adhesive.
  • In most cases, pressure will be applied to the site with a weighted item called a sandbag to help prevent bleeding.
  • You will taken to a recovery area where you will be asked to lie fairly still for anywhere from one to six hours, and a team will monitor your heart rate and other vital signs.
  • The entire procedure should take between three and eight hours.

Endometrial Ablation 

An endometrial ablation is less invasive than a cardiac ablation, but the general principle is still the same. Energy or some other force is used to destroy abnormal or malfunctioning tissue. Compare the steps of a cardiac ablation to an endometrial ablation below:

  • As with a cardiac ablation, you will be taken to a procedural area or surgical suite.
  • You will be given medication to help you relax, or you might receive either general anesthesia or an epidural for the surgery.
  • You will be positioned as you would for a pelvic exam and a speculum will be inserted into the vagina to help your doctor gain access to the cervix.
  • Your cervix will be cleaned using an antiseptic solution, and an opening will be created in the cervix using small rods.
  • A tool called a hysteroscope will be inserted through the opening and into the uterus.
  • Your doctor will feed the catheter and ablation tools through the hysteroscope.
  • The uterus may be filled with a liquid or gas to help your doctor see the inside of the uterus.
  • The type of energy that is used to destroy the endometrium will vary based on the method your doctor has chosen. You may feel some cramping as the ablation is performed.
  • The entire ablation procedure only takes about 10 minutes.
  • After the procedure, you will be taken to a recovery area as the effects of whatever anesthesia you have wear off.
  • If you did not have anesthesia, your doctor will still want you to rest and be monitored for about two hours after the procedure.

Endometrial Ablation Techniques

The various techniques that may be used include:

  • Electrocautery: An electric current is sent through a wire or rollerball.
  • Hydrothermal: Heated fluid is pumped into the uterus.
  • Balloon therapy: A this tune with a balloon at the end is inserted into the uterus. Fluid fills the balloon and is then heated until the lining is destroyed.
  • Radiofrequency ablation: Electrical mesh is placed into the uterus and expanded. Electrical currents are sent through the mesh.
  • Cryoablation: A probe that can reach a very low temperature is inserted to freeze the lining.
  • Microwave ablation: Microwave energy is transmitted through a probe.

After the Surgery

After your ablation procedure, nurses or other medical providers will observe you for any continued problems or complications. For more invasive ablation procedures, like a cardiac ablation, you will likely stay at least overnight but up to a few days in the hospital for observation.

For less invasive procedures, you can usually leave the same day—within hours of an endometrial ablation or minutes after more superficial procedures.

For cardiac ablation, some of the major complications you may be observed for include:

  • A continuation of the abnormal rhythm
  • New heart problems or abnormal rhythms
  • Problems related to anesthesia
  • Bleeding from the site where the catheter was inserted or the area where the ablation took place
  • Infection
  • Blood clots

With an endometrial ablation, your doctor will watch for excessive bleeding or other complications. Some bleeding and discharge are normal for at least several days after your ablation.

If you stay overnight in the hospital after your ablation, you will likely be moved from the surgical recovery area to a regular hospital room. If you will g home the same day, you will most likely be discharged directly from the recovery area.

You should have someone with you to drive you home after your surgery, and your doctor will give you instructions about follow-up care and visits.

A Word From Verywell

There is a lot of variation when it comes to ablation surgeries, but the overall principle is the same for each—abnormal tissue is destroyed to prevent further problems.

How involved the surgery is will be related to how sensitive the surgical area is, with ablations in the heart and brain among the most serious compared to ablations of the skin or other more superficial organs. Ask your doctor to review the plan for your specific ablation with you before the day of your surgery.

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Article Sources
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  1. University of Utah Health. What to expect before, during, & after cardiac ablation.

  2. Johns Hopkins Health. Catheter ablation.

  3. John Hopkins Medicine. Entrometrial ablation.