Comparison of Bipolar Electrocoagulation and Nd:YAG Laser Coagulation for Symptomatic Reduction of Uterine Myomas.

In 1991 and 1992, we presented a review of our experience using Nd:YAG laser fiber and bipolar needles to coagulate uterine myomas laparoscopically. We now present a comparison study of the Nd:YAG laser vs. bipolar coagulation needles for laparoscopic reduction of symptomatic uterine myomas. Since October 1990, we have performed over 300 cases of laparoscopic coagulation of symptomatic uterine myomas. The technique includes reduction of uterine and myomata size using depot leuprolide for a three to four month period of time. Hysteroscopic examination and endometrial sampling is performed during this preoperative period. The Nd:YAG laser fiber is a 600 micron bare fiber combined with a 50 watt Nd:YAG laser. The bi-polar needle is made in 30 and 45 mm lengths. The needles measure 5 cm in length and are inserted through a 5.5-mm trocar. Coagulation effect is measured by a standard ammeter. Myoma shrinkage is measured by pre- and post-operative vaginal ultrasound examination. Results reveal additional shrinkage 50-70% beyond the leuprolide effect. No myoma regrowth has been noted in this 3 year period. Minimal follow-up was 12 months. For patients with significant uterine bleeding, endometrial ablation is carried out at the same time.