Aplicaciones del láser de diodo en el manejo ambulatorio de la patología endometrial

Abstract

Study Objective: To assess the efficacy of the Diode Laser in the office hysteroscopical treatment of non-malignant pathology._x000D_ Design: Longitudinal retrospective study (Canadian Task Force classification II-2)._x000D_ Setting: Office Hysteroscopy Unit of the Del Mar University Hospital_x000D_ Patients: We analyzed 1828 patients that were sent to our unit between 1/1/09 and 31/10/14. We included 742 polyps, 264 submucous myomas and 15 endometrial septum. _x000D_ Material and methods: Diagnostic-surgical hysteroscopy based on “see and treat” technique was performed to all the patients in an office setting, without any kind of anesthesia, no speculum and using vaginoscopy. When needed diode laser was used for the treatment of the different pathology. 673 polyps were included, 409 treated by mechanical instruments and 264 by diode laser. 224 patients with myomas were included, 44 treated by mechanical instruments and 180 by diode laser and 15 patients with complete septum, and 14 were treated with diode laser. After polypectomy or myoma enucleation, if the extraction was impossible, biopsy was performed and the mass left in the cavity._x000D_ Results: Global success rate for laser polypectomy was of 92%, all the polyps were > 10mm, no pain in 80.5% of the patients, and high pain in only 1.1%. 96 polyps were left in the cavity because of the size; only 2 cases require a second look after 2 month follow-up. 218 myomas in 180 patients were treated with diode laser. Depending on the myoma size or situation, 2 steps surgery was necessary. The global success rate was of 94.4% for G0, 91.1% for G1 and 56.5% for G2 fibroids. Because of the myoma volume, in 72 cases the mass was left in the cavity after biopsy and complete enucleation, with a 2 month follow up by ultrasound, 100% disappeared. A high tolerance to the procedure with a very low morbidity, no major complications were found. Of 15 complete septum 14 were treated successfully with laser, in 3 of the cases a second step was necessary. No pain in 86% of the patients, 7% low pain and 7% a moderated. We followed up 11 of the 14 patients, 7 deliveries (63%), 3 abortions (27%), and 1 case of a patient that arrived to menopause and decided not to become pregnant. The tratment with laser of all the pathologies was compared with other devices such us mechanical instruments, Versapoint, morcellators and a mini-resectoscope._x000D_ Conclusions: The use of Diode Laser for the hysteroscopical treatment of endometrial non-malignant pathology in an office setting has a high efficacy in the treatment of polyps, myomas and septum with a low morbidity rate. Our results are no inferior to other techniques or the use of other devices.

Date of Award	19 Jan 2016
Original language	Undefined/Unknown
Awarding Institution	Hospital del Mar
Supervisor	Ramon Carreras Collado (Director) & Gemma Mancebo Moreno (Director)