Operative hysteroscopy for infertility using normal saline solution and a coaxial bipolar electrode: a pilot study

The efficacy and safety of a coaxial bipolar electrode surgical system used to treat surgically remediable infertility conditions was investigated. After gaining initial experience with 50 patients with perimenopausal menorrhagia, 40 infertile patients with submucous myomas (n = 12), uterine septum (n = 12), uterine adhesions (n = 11), and uterine hypoplasia (n = 5) were treated. Bipolar electrodes were inserted through a `5' French operating channel of a 5.5 mm hysteroscope without cervical dilatation. Three electrodes were used: ball, twizzle and spring. Power settings ranged from 50 W (desiccation mode) to 200 W (vapour cut mode). Normal saline was used as the distension medium. All the procedures were completed within 30 min using a 1 l bag of normal saline solution. No episodes of cervical laceration, uterine perforation, haemorrhage, fluid overload or thermal injury occurred. Mild cramping, vaginal bleeding and vaginal discharge were common during the first week. No patients were readmitted. This new surgical approach appears to be well tolerated, safe, and is an effective alternative to conventional hysteroscopic surgery in the treatment of intrauterine lesions.