In surgery, the purpose of which is to restore or preserve reproductive function, hemostasis and minimal tissue trauma are of paramount importance. Techniques that minimize postoperative bleeding and tissue necrosis should produce fewer adhesions to compromise reproductive function, and thus offer improved results.
Of the various mechanical factors contributing to female infertility, the two most common are pelvic adhesive disease and endometriosis. Several studies have reported results achieved by the use of either CO2 laser or electrosurgery in the treatment of these conditions, but only a few have directly compared the two modalities.
Tulandi and Vilos performed salpingostomy in 67 patients with distal tubal occlusion using either CO2 laser at 5000 to 10,000 W/cm2 or unipolar electrosurgery, and showed that the intrauterine pregnancy rates in both groups were similar. The same group of investigators,performing salpingoovariolysis for pelvic adhesions with either CO2 laser or electrosurgery showed similar intrauterine pregnancy rates. In an earlier study, Tulandi and colleagues ,performed salpingostomy with either CO2 laser 5000 to 10,000 W/cm2 or bipolar electrosurgery, and showed similar intrauterine pregnancy rates after 1 year of follow-up.
The results of studies of the surgical management of endometriosis indicate that when the disease is appropriately staged, there appears to be no significant difference in outcome whether the CO2 laser or electrosurgery is used.
There are several potential problems when interpreting results of studies of this nature. Study design, randomization, and staging of disease vary between studies. Moreover, in the case of pelvic inflammatory disease, the degree of damage and subsequent function of the endosalpinx is never known.
CLINICAL RESULTS IN GENERAL GYNECOLOGIC SURGERY
Several studies have examined the role of electrosurgery in abdominal wall incision in humans. In a large, prospective, unrandomized, uncontrolled study of 23,649 surgical wounds, Cruse and Foord found that use of the electrosurgical knife doubled the infection rate across all categories of operations. In a prospective, randomized study of 88 cholecystectomy incisions, Pearlman and associates25 determined that electrosurgical incisions were faster to perform, and more hemostatic than incisions made with either a scalpel
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