Myoma Uteri

myomauteri-1-0-25kapak

Operative Energy Instruments and Their Uses, Advantages and Disadvantages

Aslıhan Coşkun1
Hüseyin Levent Keskin2

1Ankara Etlik City Hospital, Department of Gynecology and Obstetric, Ankara, Türkiye
2Ankara Etlik City Hospital, University of Health Sciences, Department of Gynecology and Obstetric, Ankara, Türkiye

Coşkun A, Keskin HL. Operative Energy Instruments and Their Uses, Advantages and Disadvantages. Yavuz AF, ed. Myoma Uteri. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.205-217.

ABSTRACT

Treatment options for fibroid-related symptoms include expectant management, drug therapy, non-excisional procedures (ultrasound-guided radiofrequency ablation, magnetic resonance-guided high-intensity focused ultrasound), and surgical procedures (laparatomic, laparoscopic myomectomy and morcellation, hysteroscopic resection using monoor bipolar energy, hysteroscopic morcellation, and hysterectomy). Laparoscopic myomectomy is a minimally invasive method of surgically removing myomas, and used to remove FIGO type 2-7 myomas. The first step of laparoscopic myomectomy is to perform incision using monopolar electrocautery or ultrasonic scalpel to uterine wall to achieve the myoma(s). After removing the myoma(s) from the surrounding uterine tissue by blunt and sharp dissection (monopolar or bipolar electrosurgical scalpel or advanced bipolar energy devices or ultrasonic scalpel), there are also morcellation (electromechanical or power) methods that facilitate removal of the myoma pieces outside the abdomen. Hysteroscopic electroresection is used for FIGO type 0, 1 or 2. The technique traditionally used for hysteroscopic myomectomy is the wire loop with monopolar or bipolar resectoscope. The advantages of bipolar device are using the liquid medium is crystalloid solutions during the resection, thus the resection procedure time can be extended since the risk of hyponatremia and fluid overload due to the use of hypotonic solutions is low. Hysteroscopic morcellation is intended to technically facilitate the resection of myomas. It produces fewer tissue fragments and uses saline as the distension medium. With this cutting opening technique, intrauterine or submucosal myomas are mechanically fragmented into millimetric pieces by maneuvering the hysteroscope back and forth in direct hysteroscopic imaging without using energy modality, and the pieces are taken out of the uterus through the cannula through which the hysteroscope probe is passed. There are also some different techniques to reduce the size of myomas using energy, called as myolysis, without removing them. Laparoscopic myolysis has been performed using a number of energy sources, including bipolar electrosurgery, Nd:YAG laser, radiofrequency, and cryogenic probes. One of them is Laparoscopic Radiofrequency for Uterine Myoma, the cutting or reduction of myomas using energy. The other methods are Focused Ultrasound for Uterine Myoma, a noninvasive, thermoablative technique delivers ultrasound energy in multiple waves through the abdominal wall; MR Guided Focused Ultrasound, a high-intensity ultrasound energy to induce coagulative necrosis of myomas; Ultrasound Interstitial Thermal Therapy for the treatment of uterine myomas, a hyperthermia and high-temperature thermal therapy in the myoma, and Laser-induced Interstitial Thermotherapy, which is a diode laser technology often performed via hysteroscopy.

Keywords: Electrosurgery; Electrocoagulation laparoscopy; Hysteroscopy; Myomectomy; Morcellation

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