Endometrial resection (TRCE) is a well-examined alternative therapy to hysterectomy in the treatment of menorrhagia that preserves the uterus at long term in at least 70% of patients. The technique and safety considerations are described and an overview of the existing evidence is given. Complication rates (2.5%) and performance of the personal series of 465 operative hysteroscopies including 244 endometrial resections with a follow-up of at least 18 months are shown. 3.3% of patients with endometrial resection needed a hysterectomy up to now (follow-up 18-90 months). The combination of endometrial resection and the insertion of the levonorgestrel hormone-releasing intrauterine device (LNG-IUD) is described. Especially in patients with adenomyosis, the combination of LNG-IUD with endometrial resection augments the success rate. 96 of 99 patients with the combined therapy (TRCE and LNG-IUD) and a follow-up of 18-48 months still have their uterus.
The purpose of this in vitro study was to investigate and compare effects of various laser types (CO2, Argon, Erbium:YAG, Erbium:YSGG, and Holmium:YAG) and laser beam transmission methods (optical lens and flexible fiber) on ovarian and uterine tissue of the pig. The Erbium laser radiation was transmitted through Zirconium fluoride fibers (ZrF4). To circumvent the low mechanical stability of these fibers, we developed a special microlens system, which refocuses the radiation and protects the distal end from damage. Tissue lesions were performed with 1 and 5 joule. Histologic analysis of acute Er:YAG laser lesions reveal precise cutting effects with a minimal thermal damage zone of 40 microns and a high damage resistance of the fiber microlens systems. The extent of thermal damage caused by the Erbium:YSGG and CO2 laser is about two times larger, whereas the Argon and Holmium laser tissue lesions show a damage of the surrounding tissue of 200-300 microns. This study suggests that for precise cutting and coagulation, Erbium and Holmium lasers transmitted via our modified fiber tip may render the use of these lasers possible in a wide range of laparoscopic surgery applications.
Treatment of suspicious ovarian masses requires the oophorectomy in toto without opening the tumor or cyst wall. We describe a laparoscopic technique for the in-toto-removal of clinically suspicious ovarian tumours without puncture or morcellation of the tumour before it is entirely brought outside of the abdominal wall and without performing any abdominal incision longer than 25 mm: Oophorectomy is performed by means of bipolar coagulation and the CO2-laser. A nylon bag (Lapsac, Cook Inc.) is inserted into the abdomen and the ovary is enclosed in this bag by pulling the drawstring. The drawstring is held with a needleholder while the posterior vaginal fornix is opened. The needleholder drives the drawstring out of the pelvis through the vagina; this manoeuvre only takes a short amount of time, therefore preventing loss of CO2-gas and of visibility. By pulling the drawstring from outside the vagina the bag can be easily removed with its unmorcellated content. There is no danger of the intestines being damaged by a grasping forceps. Such a problem could occur in the event of extraction through a posterior culdotomy under impaired visibility due to loss of CO2-gas. Because the bag itself serves as a closing valve of the vaginal opening, there is a good visibility all the time.
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