Mechanisms of thermal injury to the lower genital tract with radiofrequency resectoscopic surgery

Abstract

Dr. Munro constructed a tissue model out of fresh round steak to simulate the uterus, contiguous posterior vaginal wall, and introitus. 1 Munro M.G. Mechanisms of thermal injury to the lower genital tract with radiofrequency resectoscopic surgery. J Minim Invasive Gynecol. 2006; 13: 36-42 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar He used a Storz 50 series (Karl Storz GmbH & Co., Tuttlingen, Germany) resectoscope to simulate the clinical procedure of hysteroscopic endometrial ablation using variable sizes of rollerballs and variable waveforms and power outputs. The model was not perfused with an irrigant solution. Based on the above model, Dr. Munro was able to cause visible blanching (burns) to the surrogate cervical, vaginal, and perineal tissue. He concluded: “The incidence of vaginal and perineal burns associated with unipolar radiofrequency (RF) resectoscopes can likely be minimized by careful attention to technique.” ResponseJournal of Minimally Invasive GynecologyVol. 14Issue 3PreviewI have respected and admired Dr. Vilos’ work, including that related to radiofrequency (RF) current diversion, but the content, tone, and goals of the above letter are enigmatic. Indeed, the work done in my laboratory was, in large part, inspired by his reporting of resectoscopic surgery–related lower genital tract burns and his initial evaluations of capacitative coupling on the external sheath of typical resectoscopes.1 I believe that, together, we have been able to make a contribution that could immediately save many patients the morbidity associated with such adverse events, by modification in technique and, potentially, the design of instrumentation. Full-Text PDF