Response

Abstract

I 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 Vilos G.A. McCulloch S. Borg P. Zheng W. Denstedt J. Intended and stray radiofrequency electrical currents during resectoscopic surgery. J Am Assoc Gynecol Laparosc. 2000; 7: 55-63 Abstract Full Text PDF PubMed Scopus (29) Google Scholar 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. Consequently, I am at a loss to explain why he seems intent on undermining the results of our collective work. Simply put, with the current design of monopolar RF resectoscopes, there are a number of technical measures or modifications that, if applied by gynecologic surgeons, should minimize the incidence of lower genital tract burns. So, it is with more than some regret that I write this response. Mechanisms of thermal injury to the lower genital tract with radiofrequency resectoscopic surgeryJournal of Minimally Invasive GynecologyVol. 14Issue 3PreviewDr. Munro constructed a tissue model out of fresh round steak to simulate the uterus, contiguous posterior vaginal wall, and introitus.1 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. Full-Text PDF