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14 recordsLinked to original sources
PubMed1993

Acute tissue effects during transcervical endometrial resection.

The acute tissue effects of transcervical endometrial resection (TCRE) with a standard Iglesias resectoscope using glycine 1.5% for irrigation were studied in 8 women prior to hysterectomy. Combinations of 80 or 120 W cutting current with blend 1 or 2 were applied for endometrial resection, preceded by cornual endometrial coagulation with the roller ball electrode with a coagulation effect of 40 or 60 W. The temperature was measured at the uterine vessels, ovarian ligaments and serosal surface. The increase in temperature at the serosal surface was 2.0 degrees C during cornual coagulation and 0.3 degrees C during endometrial resection, independent of the current effect applied. The maximum depth of tissue damage was 1.7 mm. No change in temperature was found at the uterine vessels or ovarian ligaments. The tissue destruction and the increase in temperature of the uterine surface are minimal, and TCRE offers excellent histological material. Careful coagulation/resection in the cornual and isthmus regions is recommended.

Adult↗
PubMed1986

Microsurgical reversal of sterilization: a six-year study.

A prospective study of 113 personal consecutive microsurgical reversals of female sterilization during the 6-year period from 1979 to 1984 was carried out to determine factors affecting the pregnancy rate. The sterilizations were performed by laparoscopic unipolar coagulation in 54% of the patients, by the Pomeroy technique in 28%, by fimbriectomy in 8%, by the Irving operation in 5%, and by clips or rings in 4%. In the group with no minimum follow-up period, 50% had intrauterine pregnancies and 5% had ectopic gestations. Eighty-nine patients had at least 12 months of follow-up after reversal surgery. This group is studied in detail. Factors affecting the pregnancy rate were length of tube, type of sterilization performed, anastomotic site, and availability of both tubes for reconstruction. Age, parity, and interval from sterilization to reversal surgery did not affect the pregnancy rate. Fifty percent of the intrauterine pregnancies were conceived within 6 months of reversal surgery.

Abortion, Spontaneous↗
PubMed1978

Cryocoagulation of the endometrium at the uterine cornua.

A cryoprobe that will produce coagulation necrosis and subsequent scar formation of the cornual areas of the uterus has been tested. A discussion is made of the developmental program, including the design of the instrument, efficacy and safety testing in baboons, and preliminary investigations of the safety of this procedure in man.

Animals↗
PubMed1997

Cornual pregnancy successfully treated laparoscopically with fibrin glue hemostasis.

BACKGROUND: Conventionally, cornual pregnancy has been treated by cornual resection or hysterectomy at laparotomy because it is usually hard to achieve hemostasis of the myometrial wound. We describe laparoscopic treatment with fibrin glue hemostasis in a woman with cornual pregnancy following salpingectomy. CASE: A 39-year-old woman who had a history of tubal pregnancy treated by salpingectomy presented with abdominal pain 6 weeks after her last menstrual period. Clinical and laparoscopic findings established a diagnosis of right cornual pregnancy. The products of gestation were removed laparoscopically, and the bleeding area of myometrium was first coagulated using bipolar forceps and then sealed by fibrin glue. CONCLUSION: Laparoscopy appears to be a safe alternative for patients with early cornual pregnancy, and fibrin glue is useful for achieving hemostasis of oozing myometrial wounds.

Adult↗
PubMed2000

Thermal endometrial ablation: a simple technique.

BACKGROUND: To evaluate the effectiveness and safety of a technique for thermal endometrial ablation. METHOD: The study was carried out in three steps; step I on 10 fresh uterine specimens, step II on 14 intact uteri during hysterectomy and step III in five patients, two weeks prior to hysterectomy. A simple device comprising a Foley catheter No. 14F, a three way cannula and a 20 cc syringe was used for the procedure. The balloon of the catheter was inflated within the uterine cavity with boiling normal saline for 9 minutes. Uterine cavity and serosal temperature was recorded during the procedure. Thermal injury was assessed by gross and histological examination of the specimens. RESULTS: The mean maximum endometrial cavity temperature was 91 degrees C whereas serosal temperatures in steps I and II were 34 degrees C and 35.9 degrees C respectively. None of the balloons ruptured in any of the steps and there were no complications. In 13 of 14 specimens in step II, there was a zone of hyperemia with a depth of 3 to 7 mm. The corresponding histological picture was extensive hemorrhage and fragmentation of glands throughout the endometrium including the cornual regions. Consistent findings were noted in step III in which all but one showed extensive coagulative necrosis of the whole of endometrium with edema of the underlying myometrium. There was a statistically significant positive correlation between the volume of fluid injected and depth of hyperemia. CONCLUSION: This technique could be a simple, effective, inexpensive and safe alternative to hysteroscopic endometrial ablation.

Catheter Ablation↗
PubMed1994

Laparoscopic Resection of a Cornual Pregnancy: A First Case Report

Laparoscopic surgery is currently the preferred diagnostic and treatment modality for ectopic pregnancy (EP). Cornual pregnancy, a rare and dangerous form of EP, is usually treated by cornual resection or hysterectomy. We report the first case to be treated by laparoscopic surgery. A 27 year old, gravida 3 para 2, was diagnosed with a nine week right cornual pregnancy. Laparoscopy revealed a 3 x 4 cm bulge into the right cornual area. Both fallopian tubes were otherwise normal. The uterus was fixed by a grasping forceps and the right tube and ovarian ligament were coagulated to reduce the blood supply. The gestational area was entered via a 1 cm incision using unipolar scissors and electrocoagulation. The pregnancy contents were suctioned; cavity margins and placental bed were coagulated until hemostasis was secured. The uterus contracted. The posterior leaf of the broad ligament was flapped over the incision site and attached by coagulation points. Postoperative course was uneventful. A hysterosalpingogram performed 4 months post surgery revealed a normal uterine cavity and blocked right tube.

Journal Article↗
PubMed1992

Uterine surface temperature changes caused by electrosurgical endometrial coagulation.

To assess the risk for transmural thermal injury to abdominal viscera during electrosurgical ablation of the endometrium, thermocouples were laparoscopically directed to the surface of the uterus at the time of endometrial ablation. A 2- or 5-mm ball, or a barrel electrode directed through a urologic resectoscope was placed in the cornual area, and current varying from 50 to 150 W of unmodulated ("cutting") or modulated ("coag") current was applied for five seconds without moving the electrode. The resultant temperature rise of the uterine serosa did not exceed 6 degrees C.

Burns↗
PubMed1995

The tissue and thermal effects of electrosurgery in the uterine cavity.

A brief outline of the physics associated with the production of electrosurgical wave-forms has been described. The conversion of electrical to thermal energy in electrosurgical techniques has demonstrable tissue and thermal actions and these were discussed in greater detail. In vitro electroresection was associated with a narrow ZTN underlying the electrode that did not vary with power output, but was related to duration of exposure. For blend 2 cutting output the mean ZTN ranged from 0.97 to 1.40 mm for a single sweep of the electrode. With longer time increments this ZTN increased to 2.20 mm. Coagulation by desiccation, in vitro, resulted in a depth of destruction of 3.24-3.49 mm that did not vary with power output or duration of exposure. Fulguration only achieved a depth of destruction of up to 1.78 mm that was related to time. This confined-ZTN in the fulguration mode was felt to be too narrow to destroy the deeply seated myometrial gland elements. Thermal transmission through blocks of human uterine tissue, in vitro, has been demonstrated. Resection generated a maximum rise of 5.8 degrees C at 12 mm from the electrode, with desiccation, a maximum of 4.0 degrees C. It was also demonstrated that resection and desiccation have differing thermal profiles, the latter being more confined in nature. Both power output and duration of exposure in resection are important factors, in vitro, with regard to heat generation. Duration of exposure during desiccation is important in terms of heat generation, but not power output. Repetitive electrosurgical insults have a cumulative effect on the thermal profile in vitro. The underlying damage to uterine tissue during electrosurgery in vivo has been established. In electroresection the zone of thermal necrosis was related to duration of exposure, whereas in electrodesiccation the damage appeared confined, self-limiting, and not time-related. The lack of clinically significant demonstrable thermal transmission through the uterus was important. However, excessively prolonged application of electrosurgical energy (greater than 5 seconds) in the narrow regions of the uterus, especially with electroresection, could still be potentially dangerous. The use of the desiccation mode in the cornual regions is recommended for three reasons; the loop electrode has greater potential for perforation in this thin region (because of its diameter); the desiccating mode appeared to have a clearly defined, consistent ZTN that did not alter appreciably; and the thermal imaging of the ball electrode, in vitro, demonstrated the more confined nature of its thermal profile compared to the loop electrode.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrosurgery↗