[Thermal injury and wound healing of the endometrium subsequent to minimally invasive transendoscopic use of Nd:YAG-laser-and electrosurgery in horses].

Abstract: Transendoscopic thermal preparation techniques like laser- or electrosurgery have proved to be most reliable for minimal invasive intrauterine surgery during operative hysteroscopy in mares. To determine the effect of Nd:YAG laser surgery on the endometrium and the complete uterine wall compared with electrosurgery, standard lesions were obtained by transendoscopic monopolar electrosurgery (loop electrode, cutting blade) and Nd:YAG laser surgery (contact, bare fibre, 25 Watt, exposure time four seconds, non contact, 80 Watt, exposure time four seconds) in five healthy mares on days d 0, 7, 14, 18 and 21. The gross effects were controlled endoscopically before the consecutive lesions were set. Following the last diathermic endometrial irritation, hysterectomy was performed under general anaesthesia. Recovery of the mares was uneventful. Specimens from the lesions were collected after dis-section of the uterus, fixed in formalin, routinely embedded and stained with H. E. for histological evaluation. The different energy forms caused tissue alterations of comparable quality but differing in degree. Most intensive peripheral hyperemia and tissue edema occurred on postoperative days three to seven. Non contact laser irradiation initiated maximal amount of fibrinous exudate. Lesions created with a loop electrode were superficial only and did only affect the endometrium. Preparation with an electrosurgical cutting blade or a laser bare fibre resulted in craterlike lesions lined by carbonisation and did involve deeper layers of the myometrium. The lesions caused by non contact laser irradiation affected all layers of the uterine wall. Three weeks postoperatively, reepithelization of the luminal epithelium was completed. The depth of thermal injury and coagulative necrosis, inflammatory reactions and scar formation was greater in lesions created by laser application compared with those set with a loop electrode at power densities comparable to those usually achieved at hysteroscopic surgery. The results suggest that an electrosurgical loop designed for operative hysteroscopy may be a reliable tool for diathermic resection of pathological endometrial structures like uterine cysts characterized by minimal thermal injuries and a short period of reconvalescence. Non contact laser irradiation may result in deep thermal injuries with the risk of delayed uterine perforation but may be profitable for treatment of partly intramural structures like an intramural leiomyoma.