Electrosurgical Loop Research Articles

A new electrosurgical loop technique for laparoscopic supracervical hysterectomy

ObjectiveTo evaluate the reduction of operating time during supracervical laparoscopic hysterectomy using an electric loop.DesignProspective clinical study.SettingLausanne Endoscopic Center, Switzerland.Subjects30 women who underwent supracervical laparoscopic hysterectomy.InterventionA new electric loop has been designed, to separate the uterus from the cervix more quickly, by faster cutting, during supracervical hysterectomy.Main outcome measureThe time taken to separate the uterus from the cervix.ResultsThe preliminary evaluation indicates a reduction of time of at least 80%. Another advantage is the clean cut, and no complications to adjacent organs have been observed.ConclusionThe new loop allows an evident reduction of operating time during supracervical laparoscopic hysterectomy.

ELECTROSURGICAL LOOP EXCISION OF THE CERVIX

This article discusses the technique of cervical electrosurgical loop excision, which allows for treatment of premalignant conditions of the cervix. The primary goal of cervical loop excision is to provide a method of managing preneoplastic cervical conditions in a safe, effective manner while minimizing the chance of missing invasive cancer. Topics discussed include equipment and supplies, procedural pearls, complications, and so forth.

“See and Treat” Electrosurgical Loop Excision of the Cervical Transformation Zone

BACKGROUND See and treat electrosurgical loop excision of the cervical transformation zone (ELECTZ) is an excisional surgical procedure that enables simultaneous histologic diagnosis and treatment of premalignant cervical disease, thus eliminating the need for a preliminary cervical biopsy and an additional patient visit. Indications for the procedure include an abnormal cervical Papanicolaou (Pap) smear and a colposcopic impression of cervical intraepithelial neoplasia (CIN). The purpose of this study was to assess the see and treat ELECTZ procedure performed by family physicians. METHODS Women who were scheduled for colposcopic evaluation because of an abnormal cervical cytology report were enrolled from the practices of three family physician colposcopists located at three sites. The see and treat ELECTZ procedure was performed on patients with both abnormal Pap smear results and abnormal colposcopic findings. Procedural complications were documented. Subjects were evaluated at follow-up examinations during the first postoperative year to determine therapeutic cure. RESULTS See and treat ELECTZ was performed on 48 women. The histologic results from see and treat ELECTZ were normal for 36.1% of subjects. When subjects with a low-grade lesion on Pap smear were considered, 40.7% had normal loop histologic findings. Of women with a preoperative colposcopic impression of low-grade lesion, 54.2% had normal histologic results, and 12% of women with a high-grade colposcopic impression had normal histologic results (P<.001). When the colposcopic impression was reported as high-grade disease, 82% of loop specimens were reported as CIN 2 or 3. CONCLUSIONS Selective use of see and treat ELECTZ may be appropriate only when practiced by experienced colposcopists who are able to reliably differentiate low-grade from high-grade disease by means of colposcopy, and if cytologic and colposcopic findings unequivocally indicate high-grade cervical disease.

Vaginal estrogen administration to prevent cervical os obliteration following cervical conization in women with amenorrhea.

Our goal was to evaluate the use of vaginal estrogen cream in preventing cervical os obliteration in postmenopausal patients undergoing cervical cone biopsies. This study is a retrospective review of postmenopausal women who underwent cervical cone biopsies (laser or electrosurgical loop excision) in the author's practice. All patients were treated with 2 g of vaginal conjugated estrogen cream daily for 1 month following cone biopsy. The patients were seen 4 months later, and the cervix was evaluated. The percentage of women whose cervical os was patent, stenotic, or obliterated was compared to historical controls and, within this series, laser and electrosurgical loop excision groups were compared. Seventeen patients underwent conization (8 laser conizations, 9 electrosurgical loop excisions) and postcone treatment with estrogen cream. On average, the patients were 59.4 years old and 10.7 years postmenopausal. The follow-up interval ranged from 2 to 10 months, with a mean of 4.4 months. In 10 patients, the cervix was patent, in 4 it was stenotic, and in 3 it was obliterated. The transformation zone was visualized fully in three patients before the cone biopsy and in three different patients after the cone biopsy. The outcome for patients treated with vaginal estrogen was significantly better (p < .013) than that for historical controls not treated with vaginal estrogen. However, the laser and electrosurgical loop excision groups differed significantly. Four of the eight laser patients had previous cervical treatment, compared with one of nine for electrosurgical loop excision. The laser group was not different from historical controls with regard to stenosis or obliteration, but the electrosurgical loop excision group had significantly less stenosis or obliteration than did either (p < .016). No trend could be identified regarding the length of the cone specimen between the laser and electrosurgical loop excision groups. All 5 patients with previous cervical procedures (but only 2 of 12 without previous procedures) developed stenosis or obliteration. Larger randomized control trials are needed to determine if vaginal estrogen cream is beneficial in preventing cervical os obliteration in postmenopausal patients undergoing conization procedures; to compare laser and electrosurgical loop excision; and to determine the effect of previous cervical procedures on the rate of cervical os obliteration in these groups of patients.

“See and Treat” Electrosurgical Loop Excision

“See and Treat” Electrosurgical Loop Excision

Pap smears

The premalignant phase of cervical cancer is well recognized, easily detectable, and easily treated. Pap smears should be done annually in most womeN. but may be done less frequently in low risk women who have had three consecutive negative Pap smears. The evaluation of women with abnormal Pap smears should follow a careful stepwise approach. The Bethesda classification system is used for reporting cervical cytology. Because of the incidence of false-negative Pap smears, negative cytology should be repeated annually for three years before disease can be reliably excluded. Women with atypical smears are at risk for cervical dysplasia. Their evaluation should not be considered complete until they have had a negative colposcopy, three consecutive negative Pap smears, and/or a negative cervicography. Women with smears suspicious for squamous intraepithelial lesions should be evaluated with colposcopy and biopsy. If the colposcopy is satisfactory, women with low-grade disease may be followed closely with cytology and colposcopy. Women with high-grade disease may have transformation zone ablation with cryotherapy, laser vaporization. or electrosurgical loop excision. Women with an unsatisfactory colposcopy should have cervical conization. By using the protocols outlined above, significant disease can be recognized and treated, and unnecessary treatment can be avoided.

Loop electrosurgical excision with a laparoscopic electrode and carbon dioxide laser vaporization: Comparison of thermal injury characteristics in the rat uterine horn

OBJECTIVE: Our purpose was to compare the thermal intraperitoneal injury in lesions resulting from a monopolar electrosurgical loop electrode designed for laparoscopic surgery with similar lesions fashioned by carbon dioxide laser vaporization. STUDY DESIGN: A randomized, observer-blinded comparison was made of histopathologically measured thermal injury in rat uterine horns. The primary outcome measure was the depth of necrotic debris and coagulative necrosis in the lesions created by the two methods. RESULTS: The depth of coagulative necrois was similar in the laser vaporization (0.118 ± 0.028 mm) and the loop excision groups (0.165 ± 0.167 mm). However, the average amount of necrotic debris was greater in the lasered lesions (0.053 ± 0.019 mm) compared with those made with the loop electorde (0.013 ± 0.011 mm). CONCLUSIONS: The depth of coagulative necrosis in rat uterine lesions fashioned with a loop electrode is similar to that of lesions created by carbon dioxide vaporization at power densities comparable with those usually achieved at laparoscopic surgery. There is a greater amount of necrotic debris in the lasered lesions. This suggest that electrosurgical loops designed for laparoscopic surgery may have promise for the cost-effective excision of intraperitoneal tissue.

Predictive value of human papillomavirus type for histological diagnosis of women with cervical cytological abnormalities

In the past 10 years ablative treatment modalities for cervicalintraepithelial neoplasia have been replaced by electrosurgical loop excision of the transformation zone in many centres. Gynaecologists who master the electrosurgical technique are inclined to treat without biopsy. Concern has been expressed that this leads to overtreatment, as cytological abnormalities may result from benign reactive changes. The broad spectrum of different human papillomavirus types has recently been grouped on the basis of a phylogenetic or evolutionary tree. The main branches of this tree lead to specific groups of human papillomavirus types with similar tissue tropism and oncogenic potential. One of the main branches comprises type 16 and related viruses such as types 31 and 33. Human papillomavirus type 18 belongs to a separate main branch.1 We investigated whether analysis of human papillomavirus in cervical scrapes might help in the better selection of patients for loop …

Adverse Effect of Electrosurgical Loop Excision on Assignment of FIGO Stage in Cervical Cancer: Report of Two Cases

Electrosurgical loop conization of the cervix is a new procedure that is being rapidly accepted for treatment of cervical intraepithelial neoplasia (CIN). Concerns include fragmentation of the specimen that is frequently mandated by the size of the transformation zone and difficulty in using the largest electrosurgical loops. Two cases are presented that demonstrate the inability to accurately assign depth of invasion in cervical cancer when the focus of invasion is transected. As a result, the patient and physician were forced to decide on whether a radical hysterectomy and pelvic lymphadenectomy were needed based on incomplete information. It is recommended that electrosurgical loop conization be confined to patients where invasive carcinoma is not expected. The use of this new technique for patients with suspected invasive carcinoma needs further evaluation.

Biopsy diagnosis and conservative surgical treatment of adenomyosis

Study Objective. To diagnose adenomyosis by vaginal ultrasound and percutaneous or transcervical myometrial biopsy, and use the results to choose treatment and assess prognosis. Design. Evaluation of 31 consecutive women referred by other physicians. Setting. A private gynecologic practice. Patients. The women had menstrual symptoms that had not responded to medical treatment or uterine curettage. Interventions. Myometrial diagnosis was made by percutaneous ultrasound-guided needle biopsy, by transcervical electrosurgical loop biopsy at the time of endometrial resection, or by needle biopsy at the time of laparoscopy or laparotomy. Endometrial resection was performed in 15 patients, laparoscopic myometrial reduction in 7, and excision of adenomyotic myometrium or localized adenomyoma in 8. Measurements and Main Results. Cure was defined as relief of menorrhagia and dysmenorrhea. Endometrial resection cured menorrhagia in 12 of 15 patients but dysmenorrhea in only 3 of 8; myometrial excision cured 7 of 8, and myometrial reduction 4 of 7 women. Conclusions. Vaginal ultrasound combined with transabdominal or transcervical myometrial biopsy established the diagnosis of adenomyosis in all patients. Endometrial resection and myometrial reduction or excision reduced the need for hysterectomy to 30% in these women.