Page 29 - Aspire April -2023 Vol 8 / Issue 2

REPRODUCTIVE SURGERY SIG (includes Minimal Invasive Surgery)
Herbert Situmorang (Indonesia) Huang Xiaowu (China) Maria Antonia Habana (Philippines)
Although the evidence is still growing, this phenomenon seems to be similar in diode lasers. A study by Nappi and colleagues demonstrated the effect of combined stripping and diode-laser ablation of ovarian endometrioma. A decrease in AMH level was inevitable, but this decrease was shown to be close to initial pre-operative level. 3
Another study supports that a patient with ovarian cyst and low ovarian reserve receiving surgical ablative management could benefit from the surgery. 4 A further study identifies diode laser as a promising tool in treating deep endometriosis, be it shaving or excision of the bowel or ureter. This is due to its high precision, cutting and coagulation property. 5
In the field of hysteroscopy, the use of laser diode instead of the standard bipolar energy has delivered promising results in the office hysteroscopic resection of submucous myomas and endometrial polyps. Preliminary results show the surgery is cleaner with the diode laser, without the production of bubbles induced by ionization effect. 6
Moreover, this new laser enables it to respect surgical planes and it is able to tackle diseases in locations not easily accessible, for example tubal corners of the uterus. The clinical advantages can be rapid recovery, and low injury rates and low post-operative complications.
In a pilot study of 18 patients, Nappi and colleagues 7 used the diode laser for hysteroscopic metroplasty, demonstrating how the procedure was safe and feasible, potentially preventing the formation of intrauterine adhesions and reducing the risk of recurrences.
The same group also demonstrated the safety and effectiveness of the diode-laser hysteroscopic endometrial polypectomy in a prospective study on 300 women.
A randomized clinical trial has demonstrated how polypectomy with the diode laser resulted in fewer relapses and a higher procedure satisfaction rate compared to the bipolar energy system. 9
Haimovich studies also revealed the possibility of hysteroscopic enucleation of submucous myomas using diode laser in office setting with good results. 10
Will it replace conventional electrosurgery? Although the laser energy shows many potential benefits, its use is still limited by cost factors. Conventional electrosurgery remains the standard tool for many procedures while lasers are reemerging as popular energy in gynaecology surgery due to its precision and minimal damage to adjacent structure, properties that are most favoured in reproductive surgery.
1. DeLeon F, Baggish, M.,. Lasers in Gynaecology Glob libr women’s med, .2008.
2. U. Catena. AR, M.M.Ianieri., I. Romito., N.Vlahos., A. Danilidis., G. Scambia., S.Becker. Laser in gynaecology - Are they sill obsolete? Review of past, present and future applications. Facts View Vis Obgyn 2020;12(1):63-6. 3. Nappi L, Angioni, S., Sorrentino, F., Cinella, G., Lombardi, M., Greco, P., . Anti-Mullerian hormone trend evaluation after laparoscopic surgery of monolateral endometrioma using a new dual wavelengths laser system (DWLS) for hemostasis. Gynecol Endocrinol. 2015. 4. Pais AS, Flagothier, C., Tebache, L., Santos, T.A., Nisolle, M., . Impact of Surgical Management of Endometrioma on AMH Levels and Pregnancy Rates: A Review of Recent Literature. J Clin Med. 2021;3. 5. Angioni S, Nappi, L., Sorrentino, F., Peiretti, M., Daniilidis, A., Pontis, A., Tinelli, R., D’Alterio, M.N. Laparoscopic treatment of deep endometriosis using diode laser: our experience. Archives of Gynaecology and Obstetrics. 2021;304:1221-31. 6. Nappi L, Angioni, S., Sorrentino, F., Cinella, G., Lombardi, M., Greco, P.,. The use of laser in hysteroscopic surgery. Edizioni Minerva Medica. 2016;68:722-6. 7. Nappi L, Angioni, S., Sorrentino, F., Cinella, G., Lombardi, M., Greco, P.,. Hysteroscopic metroplasty for the septate uterus with diode laser: a pilot study. Eur J Obstet Gynecol Reprod Biol. 2016;206:302-5. 8. Nappi L, Angioni, S., Sorrentino, F., Cinella, G., Lombardi, M., Greco, P.,. Feasibility of hysteroscopic endometrial polypectomy using a new dual wavelengths laser system (DWLS): preliminary results of a pilot study. Arch Gynecol Obstet. 2017;295:3-7. 9. Domi?guez L, Berral, A., Palomares D, et. al., . Outpatient hysteroscopic polypectomy: bipolar energy system (Versapoint ® ) versus diode laser – randomized clinical trial. Gynecol Endocrinol. 2016;32:196-200. 10. Haimovich S, Yarto M, L., Avila J, U., et. al. Office Hysteroscopic Laser Enucleation of Submucous Myomas without Mass Extraction: A Case Series Study. . Biomed Res Int. 2015(905204).
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