Electrosurgical ablation of the endometrium in saline medium in postmenopausal women

Objective. To improve high-frequency hysteroresectoscopic electrosurgical (300 kHz) coagulant ablation of the endometrium, by comparatively assessing the use of monopolar ablation in dielectric medium and that of bipolar technology in saline solution. Subjects and methods. The investigation enrolled 100 postmenopausal women aged 50 to 71 years with uterine bleeding who had repeatedly undergone separately diagnostic dilatation and curettage. Endometrial pathology in the presence of atrophy was a criterion for inclusion into study groups. All the patients underwent laboratory, clinical, and gynecological examinations using a package of special diagnostic measures (ultrasonography, diagnostic hysteroscopy, and separately diagnostic dilatation and curettage and then a morphological examination of the removed material). They were subdivided into 2 groups according to monopolar or bipolar electrosurgical endometrial destruction. With monopolar technology, 5% glucose solution was used as an expansion medium (Group 1, n=50). Bipolar technology and 0.9% NaCl as an expansion medium were employed in Group 2 (n=50). Out of them, 8% had a cardiac pacemaker and 8% had metallic prostheses in the small pelvis. The endometrium was ablated using a 26Fr rigid two-way (continuous-flow) hysteroresectoscope (Olympus, Japan) with changeable mono- and bipolar passive working elements and roll electrodes in a coagulation mode. Surgery was performed under intravenous anesthesia with diprivan orfentanyl. The investigators intraoperatively estimated the levels of potassium, sodium, chlorine, intravasation, blood loss, and gas formation and the duration of intervention. All the patients received 5-day antibiotic therapy. They underwent small pelvic ultrasonography on days 1 and 5 postsurgery. Results. Both study groups showed no differences in the level of intravasation. Comparison of the levels the blood electrolytes potassium, sodium, and chlorine revealed that their values were in the normal range and the difference in their pre- and postoperative values was statistically insignificant. Conclusion. Monopolar (in 5% glucose) and bipolar (in saline solution - 0.9% NaCl) endometrial ablations were comparatively analyzed in postmenopausal women. Unlike the monopolar technology, the bipolar technology required the high output of an electricity generator and endometrial destruction was accompanied by high gas formation within the uterine cavity.

bipolar endometrial ablation, physiological solution, postmenopause