A new bipolar system for performing operative hysteroscopy in normal saline

We evaluated the efficacy and safety of the VersaPoint bipolar vaporization system during hysteroscopic treatment of 10 women with symptomatic submuco us leiomyomata, endometrial polyps, uterine septa, and synechiae in a prosp ective, uncontrolled pilot study at two Canadian university-affiliated teac hing hospitals. Patients were two women with recurrent pregnancy loss assoc iated with a diagnosis of uterine septa, one with infertility, one with rec urrent pregnancy loss and synechiae and six with menorrhagia associated wit h either leiomyomata or endometrial polyps. Electrodes were inserted throug h a 5F operating channel of a 15F cystoscope, and a 17 or 21F hysteroscope. Three electrodes were used: ball, twizzle, and spring. Power settings rang ed from 50 W (desiccation mode) to 200 W (vapor cut mode). Normal saline wa s used as the distention medium in all cases. Either general anesthesia or intravenous sedation with paracervical block was used. There were no major complications such as uterine perforation, excessive bleeding, fluid overlo ad, or thermal injury The amount of normal saline used varied considerably from 0.5 to 20 L. The maximum amount of saline absorbed was 900 ml in a cas e involving resection of 4.5- and 2.0-cm leiomyomata that lasted 115 minute s. Mild cramping, vaginal breeding, and discharge in the first 2 to 3 days were relieved by norrsteroidal antiinflammatory agents. No patients were re admitted up to 6 weeks after the procedure. Preliminary results of this pil ot study support the safety of the VersaPoint bipolar vaporization system, although its long-term efficacy remains to be determined. It appears to be well tolerated by some women using conscious sedation and paracervical bloc k. Therefore, it can potentially be used in an office setting as well as in symptomatic patients who are at risk from a general anesthetic.