Obstet Gynecol Sci Search

CLOSE


Obstet Gynecol Sci > Volume 66(6); 2023 > Article
Tamate, Matsuura, and Saito: Cervical conization with endoCUT mode applying gastrointestinal endoscopic polypectomy technique

Abstract

Objective

To show how endoCUT mode can be safely managed with cervical conization.

Methods

Demonstration of the technique and explanation of endoCUT and soft coagulation mode with narrated video footage. Cervical conization is a therapeutic and diagnostic procedure performed for the diagnosis of cervical intraepithelial lesions and cervical cancer. Specific methods include cold scalpel, ultrasonically activated device and laser, and loop electrosurgical excision procedure (LEEP), which involves transpiration and partial excision. The endoCUT mode and soft coagulation in VIO3® (ERBE, Tübingen, Germany) were used to perform cervical conical resection safely and at low cost. The endoCUT mode was originally developed for polypectomy in gastrointestinal endoscopy, where no counter traction can be applied.

Results

The endoCUT mode approach to cervical conization with several key strategies to minimize blood loss and ensure safety: 1) incisions can be made in close contact; 2) resection can be performed with minimal contact with the lesion; 3) control of bleeding from the resected transection by soft coagulation; and 4) low running cost of endoCUT mode.

Conclusion

Conventionally, cervical conical resection has been performed by using a device capable of making a close incision (cold scalpel, ultrasonically activated device and laser, and LEEP etc.), but there have been issues with bleeding control and cost. Here, we present a new technique using the endoCUT mode and several strategies for safe and effective resection.

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.

Notes

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

This study mainly involves the use of devices, and the Sapporo Medical University Ethics Review Committee determined that no application was required.

Patient consent

The study procedures were explained to all subjects in advance, written informed consent was obtained.

Funding information

All authors have no conflicts of interest to disclose, except as noted above.

Video clip

Video can be found with this article online at https://doi.org/10.5468/ogs.23066.

Fig. 1
Principle of endoCUT. This mode can repeat cut and coagulation automatically, and there are three manually adjustable parameters: cutting duration, cutting interval and effect.
ogs-23066f1.jpg

References

1. Iwasaki E, Minami K, Itoi T, Yamamoto K, Tsuji S, Sofuni A, et al. Impact of electrical pulse cut mode during endoscopic papillectomy: pilot randomized clinical trial. Dig Endosc 2020;32:127-35.
crossref pmid pdf
2. Pohl H, Grimm IS, Moyer MT, Hasan MK, Pleskow D, Elmunzer BJ, et al. Effects of blended (yellow) vs forced coagulation (blue) currents on adverse events, complete resection, or polyp recurrence after polypectomy in a large randomized trial. Gastroenterology 2020;159:119-28e2.
crossref pmid pmc
TOOLS
Share :
Facebook Twitter Linked In Google+ Line it
METRICS Graph View
  • 0 Crossref
  •     Scopus
  • 2,486 View
  • 110 Download
Related articles in Obstet Gynecol Sci


ABOUT
ARTICLE & TOPICS
Article category

Browse all articles >

Topics

Browse all articles >

BROWSE ARTICLES
POLICY
FOR CONTRIBUTORS
Editorial Office
4th Floor, 36 Gangnam-daero 132-gil, Gangnam-gu, Seoul 06044, Korea.
Tel: +82-2-2266-7238    Fax: +82-2-3445-2440    E-mail: journal@ogscience.org                

Copyright © 2024 by Korean Society of Obstetrics and Gynecology.

Developed in M2PI

Close layer
prev next