OBJECTIVES: Traditional hysteroscopic endometrial ablation techniques are safe and effective though underutilized, mainly because of the procedures required specialized training and had perceived risks. Several new technologies have been developed; most of which are blind techniques. A review of the literature was undertaken to compare the efficacy, safety and acceptability of second- versus first-generation endometrial ablation techniques in DUB. METHODS: Medline, Current Contents, Cochrane Library, NHS Centre for Reviews and Dissemination and FDA Center for Devices and Radiological Health were searched from 1981 to March 2002. Bibliographies of relevant articles were screened. Industries and authors were contacted for information on published or unpublished data. Experts in the field were consulted. RCTs comparing endometrial ablation techniques in DUB were eligible for inclusion. Trials of techniques abandoned at the time of the review or not published in English or French were excluded. Outcomes were menstrual blood loss, satisfaction, quality of life, operative details, complications, and requirement for further surgery. RESULTS: Five RCTs were included. They evaluated five new technologies and assessed outcomes one year after surgery. One trial had long-term follow-up. Compared to first-generation techniques, new technologies had consistently shorter durations of surgery (11-27 min vs 15-40 min), more surgeries performed under local anesthesia (45-73 % vs 8-24 %), and fewer intraoperative complications (0-1,1 % vs 2,4-5,8 %). At 12 months, clinical outcomes results were similar between the 2 generations. Results remained similar, with little difference at three years compared with results at one year. CONCLUSION: There was no clear difference in clinical outcomes between second- and first-generation techniques. Advantages include ease of use, short operative time, choice of anesthesia and reduced risk of intraoperative complications. Risk of inadvertent perforation and subsequent injury to bowel exists. Long-term safety and efficacy, cost-effectiveness and safety in use by the general gynecologist remain to be studied.