Comparison of monopolar and bipolar resectoscopes for endomyometrial resection ablation for abnormal uterine bleeding

Abstract

Objective: To compare endomyometrial resection ablation (ERA) outcome parameters in patients undergoing monopolar ERA (MERA), or ERA with a bipolar resectoscope (BERA). Design: Review of prospective surgical outcomes data-base. Materials/Methods: Patients undergoing ERA from February, 1999, to February, 2002. Women with abnormal uterine bleeding were offered ERA if they no longer desired reproduction and had no indication for operative laparoscopy. Patients were entered into a prospective data-base to track surgical parameters and patient outcome. Data was tracked peri-operatively, and post operatively at 6 weeks, 6 months and annually. Results: 111 cases were available for review, 58 MERA and 53 BERA. There was no statistical difference in operative time (MERA, 22 ± 2 min vs. BERA, 26 ± 2 min, p = NS). Differences were found in calculated fluid deficit (MERA, 452 ± 8 cc vs. BERA, 1594 ± 73 cc, p <0.001) and additional operative procedures (MERA, 22 (38%) vs. BERA, 36(68%), p <0.05. Operative complications occurred in 4 (7%) MERA cases. Two patients required 30 cc balloons post operatively to tamponade bleeding, one case was terminated due to excessive glycine absorption, and one case was cancelled secondary to perforation. Four (8%) BERA complications were reported. Two patients with fluid overload required diuretic in order to complete ablation, one patient required a 30 cc balloon to tamponade bleeding, and one cancellation for perforation occurred. Amenorrhea rates were calculated by life table actuarial analysis and were similar (MERA 83% vs. BERA 86%, p = NS). Conclusions: BERA is comparable to MERA in operative time and amenorrhea rate. Cancellation due to fluid overload can be avoided with BERA.