Bipolar laparoscopic needles for myoma coagulation.

STUDY OBJECTIVES

To describe the effectiveness in the clinical use of a new bipolar needle for performing laparoscopic coagulation of symptomatic uterine myomas, and to compare it with the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser.

DESIGN

Observational, comparative.

SETTING

Voluntary community hospital.

PATIENTS

Three hundred women, 150 in the Nd:YAG laser group and 150 in the bipolar needle group, who had symptomatic myomas no larger than 10 cm, responded to pretreatment with depot leuprolide, and were no longer interested in childbearing.

INTERVENTIONS

Myomas were pierced repeatedly with the bipolar needle to produce numerous cores of coagulation. An average of 30 to 50 passes were made.

MEASUREMENTS AND MAIN RESULTS

Myoma size and location were assessed by endovaginal ultrasound before preoperative treatment with depot leuprolide. The coagulating effect of the bipolar needle devascularized the myomas, and the resulting shrinkage was comparable with that produced by the Nd:YAG laser. Complications were infrequent, with no evidence of myoma regrowth 6 months after the procedure.

CONCLUSION

The bipolar needle was as effective as the Nd:YAG laser in coagulating symptomatic subserosal and intramural uterine myomas and achieving reduction in size of 50% to 70%, with no regrowth.