We would like to introduce the conization technique using the endoCUT mode of VIO3
® (ERBE, Tübingen, Germany), which is generally used for endoscopic polypectomy. EndoCUT an electro surgical unit mode for gastrointestinal endoscopic polypectomy developed in Germany in the 1990s [
1,
2]. This mode that repeats cuts and coagulation automatically, and there are three manually adjustable parameters: cutting duration, which regulates the length of the real cutting phase; cutting interval, which regulates the speed of cutting; and effect, which regulates voltage during the coagulation cycle (
Fig. 1). Each of these parameters can be adjusted individually.
It is possible to cut tissue controlling bleeding when the electrode snare is in close contact with the tissue because the electro surgical unit precisely measures the resistance of the tissue and contact of the electrode, and gives sparks during tissue cutting.
We describe in which situations can this be applied in gynecological surgery. While the electrode with AUT CUT mode closely contacts the tissue, the tissue is coagulated without a cutting effect in general, endoCUT enables a cutting and coagulation effect on the tissue, which can be applied to vaginal wall incisions, allowing conization and vaginal cuff formation.
In vaginal wall cutting, the electrode with endoCUT mode is placed in close contact with the vaginal wall, where it can resect the uterus by controlling bleeding. During vaginal cuff formation, it is possible to perform a vaginal wall incision while maintaining a hemostatic environment in a situation in which bleeding tends to occur.
We show this content in the
video. The close incision made endoCUT enables the tissue to be easily cut with the electrode is in very close contact, so there is no need to use supporting threads with visualization of the lesion. First, the incision is made with a margin of the lesion. A better field of view can be obtained using a smoke evacuator. In case of bleeding the length of the interval may be increased to extend the relative coagulation time. If there is further bleeding, soft coagulation may be used to stop the bleeding. Once tissue cutting has been performed to a certain extent, support threads are applied at two points only, and then the tissue cutting is continued. The tissue cutting should be completed on the right track because the electrode closely contacts the tissue, although mucus may prevent contact with the tissue. The cervical canal is often resected with cold knife, but I personally use endoCUT very often because it enables procedures to be performed without tissue carbonization. EndoCUT also minimizes tissue denaturation in terms of postoperative pathological examination.
The main advantage lower tissue carbonization is that it decreases delayed hemorrhage, in which carbonized tissue generally falls off after the surgery. Finally, the bleeding was managed with softCOAG, with a ball-type electrode in this case. Natural epithelialization was obtained 2 weeks after surgery. In conclusion, the endoCUT mode can be applied in gynecological surgeries such as cervical conization. Conization using endoCUT is more cost-effective than either ultrasound or laser. Moreover, the endoCUT is inexpensive not only at the time of its introduction, but also in terms of running costs over the course of its use. It can be utilized for surgical procedures in various disciplines. As described above, the endoCUT mode can be introduced in gynecological surgeries such as cervical conical resection.