Serum levels of endometrial proteins during transcervical resection of the endometrium

Abstract

Objective To study the potential for dissemination of endometrial tissue substances during transcervical resection of the endometrium (TCRE). Design Prospective study. Setting One university and two county hospitals. Participants Forty‐eight women with dysfunctional bleeding. Interventions The serum levels of two endometrial proteins, insulin‐like growth factor binding protein‐1 (IGFBP‐1) and placental protein 14 (PP14), were measured before and every 10 min during the operations. Blood loss was also measured by a photometer together with absorption of the irrigating fluid containing glycine 1.5% and ethanol 1% by expired‐breath tests, and serum sodium and volumetric fluid balances. Main outcome measures Linear correlations between changes in IGFBP‐1 and PP14 during TCRE and operating parameters such as operating time, blood loss and fluid absorption. Results The baseline levels of IGFBP‐1 were normal but PP14 could only be detected in one third of the patients, which was due, in part, to pre‐operative treatment with danazol. The highest levels of IGFBP‐1 and PP14 during surgery correlated positively with the baseline concentrations. Fluid absorption (median 405 ml, range 0–2177) was the only surgical factor associated with increasing serum levels of endometrial proteins. Conclusion Absorption of the solution used to irrigate the uterus is associated with dissemination of endometrial products in the bloodstream during TCRE.

Endometrial ablation with a vaporizing electrode

“…Endometrial resection is considered a valid and cost-effective conservative surgical alternative in the treatment of dysfunctional uterine bleeding but it requires adequate hysteroscopic experience and C Acta Obstet Gynecol Scand 77 (1998) may cause serious problems (1)(2)(3)(4)(5)(6)(7)(8)(9). Complications with the use of the cutting loop include uterine perforation, damage to adjacent organs, hemorrhage, fluid overload, air embolism, and death (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)18).…”

“…C Acta Obstet Gynecol Scand 77 (1998) ting loop remains a potentially severe complication (2)(3)(4)(5)(6)(7)(8)(9). The use of a spherical roller-ball electrode results in coagulation of the tissues with immediate hemostatic vaso-occlusion.…”

Endometrial ablation with a vaporizing electrode

“…Endometrial resection is considered a valid and cost-effective conservative surgical alternative in the treatment of dysfunctional uterine bleeding but it requires adequate hysteroscopic experience and C Acta Obstet Gynecol Scand 77 (1998) may cause serious problems (1)(2)(3)(4)(5)(6)(7)(8)(9). Complications with the use of the cutting loop include uterine perforation, damage to adjacent organs, hemorrhage, fluid overload, air embolism, and death (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)18). A combination of technical properties specific to the loop (it easily cuts through myometrium and sections myometrial vessels with direct exposure of the venous lumen to irrigating fluid or room air (11,18) and limited hysteroscopic experience probably account for most of the reported accidents.…”