Hysteroscopic bipolar surgery: a valuable progress or a technique under investigation?

PURPOSE OF REVIEW

Bipolar technology was introduced in the hysteroscopy field with resectoscopic loops and electrodes adaptable to mini-hysteroscopes. The use of isotonic saline as a distension medium and the proximity of electrodes reduce the risk of electrolyte imbalance and electrical burns. Delivering an electrosurgical device throughout mini-hysteroscopes avoids cervical dilatation, limiting uterine wall damages. The feasibility of outpatient interventions improves clinical outcomes and medical costs avoiding general anaesthesia. This review updates clinical experiences based on bipolar technology and evaluates whether it represents a reliable improvement in operative hysteroscopy.

RECENT FINDINGS

Bipolar and monopolar resectoscopic loops were compared in one randomized study, showing similar efficacy and safety. Inpatient mini-hysteroscopy by microelectrodes is effective in interventions usually accomplished by resectoscope. In one randomized study, bipolar metroplasty proved to be safer and more effective than resectoscopy. Outpatient operative hysteroscopy is a developing field and retrospective reports demonstrate its effectiveness and safety. No randomized studies assessed the clinical and economical improvements of office procedures with respect to resectoscopy.

SUMMARY

Safety and efficacy of bipolar surgery, with respect to monopolar instrumentation, is an assumption to be demonstrated. The main evolution derived from introduction of bipolar devices is probably represented by a safe shifting of inpatient procedures to the office, leading to saving of medical costs. In this field, evidence-based answers are required.