[en] Both the electrical current of the resectoscope and the energy of the Nd:YAG laser have been effective tools in the destruction of endometrial tissue to a sufficient depth to avoid regeneration. GnRH-agonist therapy effects a decrease in the total uterine cavity area which facilitates surgical treatment and reduces the risk of fluid overload syndrome. The recurrence rate of meno/metrorrhagia is higher when the uterine cavity is more than 10 cm2. The use of GnRH-agonists represents an adjunct for preoperative reduction of submucosal myomas so that subsequent hysteroscopic myomectomy is possible. A two-step hysteroscopic therapy combined with GnRH-agonist therapy is performed when the largest portion of the submucosal myoma is located in the uterine wall. In cases of numerous submucosal and intramural myomas, a laparoscopic supracervical hysterectomy is performed because of the high risk of recurrence after the hysteroscopic procedure.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Donnez, Jacques
Polet, Roland
Anaf, V.
Mathieu, Pierre-Emmanuel
Casanas-Roux, Françoise
NISOLLE, Michelle ; Centre Hospitalier Universitaire de Liège - CHU > Gynécologie-Obstétrique CHR
Language :
English
Title :
Treatment of dysfunctional bleeding and fibroids by advanced endoscopic techniques with the Nd:YAG laser: from the present to the future.
Andreyko, Blumenfeld, Marschall (1988) Use of an agonistic analog of gonadotropin-releasing hormone (nafarelin) to treat leiomyomas: assessment by magnetic resonance imaging. American Journal of Obstetrics and Gynecology 158:903-910.
Baggish, Baltoyannis New techniques in laser ablation of the endometrium in high-risk patients 1988, 159:287-292.
DeCherney, Polan (1983) Hysteroscopic management of intrauterine lesions and intractable uterine bleeding. Obstetrics and Gynecology 61:392-397.
Dequesne (1989) Focal treatment of uterine bleeding and infertility with Nd: YAG laser and flexible hysteroscope. Journal of Gynecological Surgery 5:177-180.
Donnez, Nisolle (1989) Laser hysteroscopy in uterine bleeding: endometrial ablation and poplectomy. Laser Operative Laparoscopy and Hysteroscopy, Donnez J, Nauwelaerts Printing, Louvain; .
Donnez, Nisolle (1992) Hysteroscopic surgery. Current Opinion in Obstetrics and Gynecology 4:439-446.
Donnez, Nisolle (1993) LASH: laparoscopic supracervical hysterectomy. Journal of Gynecological Surgery 9:91-94.
Donnez, Schrurs, Gillerot (1989) Treatment of uterine fibroids with implants of gonadotropin-releasing hormone agonist: assessment by hysterography. Fertility and Sterility 51:947-950.
Donnez, Schrurs, Clerckx, Nisolle (1989) Les agonistes de la LH-RH une alternative dans le traitement de la myomatose utérine. Contrac Fertil Sex 17:47-49.
Donnez, Gillerot, Bourgonjon (1990) Neodynium: YAG laser hysteroscopy in large submucous fibroids. Fertility and Sterility 54:999-1003.
Donnez, Malvaux, Nisolle, Casanas-Roux (1990) Hysteroscopic sterilization with the Nd: YAG laser. Journal of Gynecological Surgery 6:149-153.
Donnez, Nisolle, Clerckx (1994) Advanced endoscopic techniques used in dysfunctional bleeding, fibroids and endometriosis, and the role of gonadotrophin-releasing hormone agonist treatment. British Journal of Obstetrics and Gynaecology 101:2-9.
Donnez, Nisolle, Gillerot (1994) Endometrial ablation with the Nd: YAG laser in dysfunctional bleeding: evaluation of the results according to the size of the uterine cavity. An Atlas of Laser Operative Laparoscopy and Hysteroscopy, Donnez J, Nisolle M, The Parthenon Publishing Group, New York; .
Donnez, Nisolle, Clerckx (1994) Hysteroscopic myomectomy. An Atlas of Laser Operative Laparoscopy and Hysteroscopy, Donnez J, Nisolle M, The Parthenon Publishing Group, New York; .
Donnez, Polet, Mathieu (1994) Nd: YAG laser ITT multifiber device (The Donnez device): a potential new modality for endometrial ablation by interstitial hyperthermia. An Atlas of Laser Operative Laparoscopy and Hysteroscopy, Donnez J, Nisolle M, The Parthenon Publishing Group, New York; .
Friedman, Barbieri, Doubilet (1988) A randomized, double-blind trial of gonadotropin releasing-hormone agonist (leuprolide) with or without medroxyprogesterone acetate in the treatment of leiomyomata uteri. Fertility and Sterility 49:404-409.
Gallinat (1993) Hysteroscopic treatment of submucous fibroids using the Nd: YAG laser and modern electrical equipment. Endoscopic Surgery in Gynecology, Lueken RP, Gallinat A, Demeter Verlag GmbH, Berlin; .
Gallinat (1993) Endometrial ablation using the Nd: YAG laser in CO2 hysteroscopy. Endoscopic Surgery in Gynecology, Lueken RP, Gallinat A, Demeter Verlag GmbH, Berlin; .
Gallinat, Lueken, Moller The use of the Nd: YAG laser in gynecological endoscopy, Laser Brief no. 14, MBB Medizintecknik GmbH.; 1989.
Garry, Erian, Grochmal (1991) A multi-centre collaborative study into the treatment of menorrhagia by Nd-YAG laser ablation of the endometrium. BJOG: An International Journal of Obstetrics and Gynaecology 48:357-362.
Goldrath, Fuller, Segel (1981) Laser photovaporization of endometrium for the treatment of menorrhagia. Journal of Obstetrics and Gynecology 140:14-19.
Goldrath (1985) Hysteroscopic laser surgery. Basic and Advanced Laser Surgery in Gynecology, Baggish MS, Appleton-Century-Crofts, Norwalk, CT; .
Hallez, Netteer, Cartier (1987) Methodical intrauterine resection. American Journal of Obstetrics and Gynecology 156:1080-1084.
Hamou (1993) Electroesection of fibroids in endoscopic surgery for gynecologists. Endoscopic Surgery for Gynecologists, Sutton C, Diamond M, W.B. Saunders & Company, London; .
Healy, Fraser, Lawson (1984) Shrinkage of a uterine fibroid after subcutaneous infusion of a LH-RH agonist. British Medical Journal 209:1267-1268.
Loffer (1988) Laser ablation of the endometrium. Obstetrics and Gynecology Clinics of North America 15:17.
Lomano (1988) Photocoagulation of the endometrium with the Nd: YAG laser for the treatment of menorrhagia. Journal of Reproductive Medicine 31:148-150.
Maheux, Guilloteau, Lemay (1985) Luteinizing hormone-releasing hormone agonist and uterine leiomyoma: pilot study. American Journal of Obstetrics and Gynecology 152:1034-1038.
Matta, Stabile, Shaw, Campbell (1988) Doppler assessment of uterine blood flow changes in patients with fibroids receiving the gonadotropin-releasing hormone agonist Buserelin. Fertility and Sterility 49:1083-1085.
Neuwirth (1983) Hysteroscopic management of symptomatic submucous fibroids. Obstetrics and Gynecology 65:509-511.
Nisolle, Grandjean, Gillerot, Donnez (1991) Endometrial ablation with the Nd-YAG laser in dysfunctional bleeding. Minimally Invasive Therapy & Allied Technologies 1:35-39.
Van Boven, Singelyn, Donnez, Gribomont (1989) Dilution hyponatremia associated with intrauterine endoscopic laser surgery. Anesthesiology 3:449-450.
Vancaillie (1989) Electrocoagulation of the endometrium with the ball-end resectoscope. Obstetrics and Gynecology 74:425-427.
Weibel (1979) Practical methods for biological morphometry. Stereogical Methods , Weibel ER, Academic Press, Bern; 1.
