A randomized trial comparing monopolar electrodes using glycine 1.5% with two different types of bipolar electrodes (TCRis, Versapoint) using saline, in hysteroscopic surgery

Objective: To compare three types of equipment during hysteroscopic resection. Design: A randomized study. Setting: Women's clinic at Ullevaal University Hospital, Oslo, Norway. Patient(s): Two hundred premenopausal women with menorrhagia caused by dysfunctional bleedings, fibroids, or polyps. Intervention(s): Hysteroscopic resection was performed either with monopolar electrodes using glycine 1.5% as irrigant or with two different types of bipolar electrodes (TCRis; Olympus, Hamburg, Germany and Versapoint; Gynecare, Menlo Park, CA) using saline as irrigant. Main Outcome Measure(s): Change in serum sodium as a result of irrigant consumption, operating time, and amount Of tissue removed. Result(s): A statistically significant reduction in mean serum sodium from 138.7 mmol/L to 133.8 mmol/L was seen in the monopolar group, compared with the case of the saline groups with no reduction. The amount of resected tissue in the monopolar and TCRis group was approximately 1.00 g/min, compared with 0.65 g/min in the Versapoint group. Loss of fluid during the procedure was significantly higher in the two bipolar groups. Conclusion(s): Bipolar electrodes appear to have a safer profile compared with monopolar electrodes because of the unchanged serum sodium. Irrigant consumption was significantly higher in the two bipolar groups, without any side effects during or after the procedure. Furthermore, the TCRis loop appears to be superior to the Versapoint loop, as regards operating time and amount of tissue removed. (Fertil Steril (R) 2009;91:1273-8. (C) 2009 by American Society for Reproductive Medicine.)