Hysteroscopic resection, in appropriately selected cases, can provide excellent results
and eliminate the need for major surgery.
The first resectoscopes were unipolar electrodes that required non-electrolytic solutions
(such as glycine 1.5%, sorbitol or mannitol) to distend the uterine cavity. These
fluids have the potential to cause non-physiological excessive fluid absorption, causing
changes in serum electrolyte levels leading to hyponatraemic encephalopathy and brain
oedema. General fluid overload may cause pulmonary oedema, especially in elderly
patients or patients with right-sided heart failure, kidney or liver disease. During
the last decade, technological improvements have led to the production of new instruments
using bipolar rather than monopolar energy. The most important benefit of bipolar
resection is the use of saline solution rather than non-ionic distension media, as
well as the reduction of energy spread through the tissue during resection. In addition to the irrigation media used, the main difference between different types of equipment
is the loop size. Theoretically, smaller loops will cut more superficially and remove
a smaller amount of tissue. Consequently, it may be necessary to resect twice at
the same level to remove the basal layer. The endometrium has a remarkable ability
to regenerate and, in order to achieve an effective result, it is necessary to go beneath
the basalis or destroy the endometrium to a depth of at least 5 mm when considering
the early to mid-proliferative phase of the cycle.
Versapoint (Gynecare Inc, Menlo Park, CA, USA) bipolar equipment has been available
since 1999, and TCRiS (Olympus, Hamburg, Germany) bipolar equipment became
available in Europe in 2004. The loop size of TCRiS is smaller than that for monopolar
equipment, but larger than the Versapoint loop.