Hysteroscopic treatment of uterine bleeding with the Nd-YAG laser

J Dequesne
In: Lasers in Medical Science · 1987 · vol. 2(2) , pp. 73–76 · doi:10.1007/bf02594138 · W2004965547
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This preliminary study treated 45 patients with hysterectomy-indicated uterine bleeding using Nd:YAG laser hysteroscopy, with 80% achieving normal menstrual cycles after four cycles.

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The paper reports a preliminary outpatient study of 45 patients with uterine bleeding resistant to conventional treatment, after diagnostic hysteroscopy identified submucosal fibroids, intrauterine or cervical polyps (alone or with adenomyosis), or adenomyosis alone. Patients underwent hysteroscopic Nd-YAG laser treatment under paracervical anesthesia, with follow-up hysteroscopy at 6–10 weeks to confirm scar formation and functional endometrium without recurrence of the treated lesions. Menstrual cycle normalization was reported in 80% after a short follow-up period (four cycles), while limitations included loss to follow-up for two patients and that longer follow-up is needed to determine how many hysterectomies were avoided. This paper is centrally about endometriosis and/or adenomyosis — specifically adenomyosis, because adenomyosis (alone or associated with other lesions) was an included indication for Nd-YAG hysteroscopic treatment.

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Abstract

This preliminary study involves 45 patients, referred to us for hysterectomy, who complained of uterine bleeding that was resistant to conventional treatment. Prior to surgery, these patients had a diagnostic hysteroscopy which showed that the bleeding was due to submucosal fibroids, to intrauterine or cervical polyps, either alone or in association with adenomyosis, or to adenomyosis alone. These patients were treated as outpatients with the Nd-YAG laser, by using paracervical anaesthesia. In 80%, the menstrual cycle has returned to normal after a short follow-up (four cycles). Three patients required hysterectomy because hysteroscopy was impossible owing to multiple fibroids. Two patients have been lost to follow-up observations. In addition, there was a beneficial result on secondary dysmenorrhoea. Wherever necessary, uterine septa and synechiae were divided. Between six and 10 weeks after treatment, a follow-up hysteroscopy was performed. This confirmed that there was no recurrence of the underlying lesion, that the treated areas were scarred and that the endometrium in these areas was functional. Longer follow-up is necessary to assess the precise proportion of hysterectomies that can be avoided by using this technique. Similar content being viewed by others

References

Decherney P, Polan ML. Hysteroscopic management of intrauterine lesions and intractable uterine bleeding.Obstet Gynecol 1983,61:392 Goldrath MH, Fuller TA, Segal S. Laser photovaporization of endometrium for the treatment of menorrhagia.Am J Obstet Gynecol 1981,104:14 Gribomont. Complications anesthésiologiques de la chirurgie endoscopic et hystéroscopique au laser. 1st Laser Symposium, 29 November, U.C.L., Leuven, Belgium Asherman JG. Amenorrhea traumatica (atretica).J Obstet Gynaecol. Br Emp 1948,55:23–30 Rongy AJ. Radium therapy in benign uterine bleeding.J Mt Sinai Hosp 1947,14:569–75 Droegemueller W, Greer B, Makowski E. Cryosurgery in patients with dysfunctional uterine bleeding.Obstet Gynecol 1971,38:256–8 Droegemueller W, Makowski E, Macsalka R. Destruction of the endometrium by cryosurgery.Am J Obstet Gynecol 1971,110:467–9 Shenker JG, Polishuk WZ. Regeneration of rabbit endometrium following intrauterine instillation of chemical agents.Gynecol Invest 1973,4:1–13 Schellhas H, Helmut FMD, Burkhard W, Weppelmann, MD. The neodymium: YAG laser in the treatment of gynecologic malignancies.Lasers Surg Med 1983,3:225–9 Author information Authors and Affiliations Rights and permissions About this article Cite this article Dequesne, J. Hysteroscopic treatment of uterine bleeding with the Nd-YAG laser. Laser Med Sci 2, 73–76 (1987). https://doi.org/10.1007/BF02594138 Received: Issue date: DOI: https://doi.org/10.1007/BF02594138

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