Benign Intrauterine Pathologies

Olympus provides gynecologists with a vast variety of innovative minimally invasive solutions to treat benign intrauterine pathologies.

Laparoscopic Myomectomy

Symptom Management for Myomas

The primary indication for laparoscopic myomectomy is symptom management, most often abnormal uterine bleeding or bulk symptoms. Laparoscopic myomectomy should be considered the intervention of choice for all myomas not amenable to medical therapy or hysteroscopic resection. 1 2 3 4 5 6

Identification of Natural Dissection Plane

Although the tissue within myomas is hypoxic, myomas are also characterized by an aberrant production of angiogenic factors, which is why surgery has the potential to incur substantial blood loss. The identification of the natural dissection plane with the help of 3D vision decreases the risk of bleeding. Moreover, the approach to the correct plane makes the enucleation of the mass easier and therefore reduces operative time.
13 14 15 16 17 18

Easier Suturing Thanks to 3D Imaging

Using 3D during the surgical step of suturing allows the surgeon to have a better control of the needle and suture material as well as measure more accurately the amount of tissue to be sutured.

The 3D vision also facilitates the knotting due to the correct vision of the different sewing threads. Especially young surgeons benefit from 3D vision during this step. 19 20 21 22 23 24 25 26 27 28 29

ENDOEYE 3D Product Details

Achieving High Quality of Surgery

The laparoscopic endoscope ENDOEYE 3D provides the surgeon with a depth perception that supports him in achieving a high quality of surgery. It also:

  • Reduces operating time.
  • Increases confidence during procedures.
  • Reduces the laparoscopic learning curve.
    30 31 32 33 34 35 36 37 38 39 40

ENDOEYE 3D Product Details

Avoiding Blood Loss during Myoma Enucleation

In laparoscopic myomectomy, a meticulous dissection of the myoma out of its pseudocapsule is necessary in order to minimize blood loss. 1
Therefore an efficient instrument is needed that fulfils the requirements of demanding procedure steps. The advanced energy device THUNDERBEAT Type S has a fine and curved jaw for easy myoma enucleation, and with its SEAL mode coagulates bleedings efficiently with minimal thermal spread. 41 42 43 44 45 46

THUNDERBEAT Type S Details

Hysteroscopic Myomectomy

Hysteroscopic Myomectomy

Benign intrauterine pathologies such as myomas can be effectively removed via resection. The large 4mm VERSAPOINT bipolar resection loop is ideal for fast cutting, especially for multiple myomas. The small 2.5mm loop enables more precise cutting.

Outpatient Hysteroscopy

The Outpatient Sheath in combination with the VERSAPOINT 5 Fr bipolar electrodes may reduce discomfort of the patient while treating complex hysteroscopic procedures. Each tip is designed to provide a specific tissue interaction. 35

The VERSAPOINT Twizzle Tip provides precise and safe vaporization and needle-like cutting. It is ideal for small myomas at the base and for excising in areas of confined space. 39

Submucous Myomas

Submucous myomas of <1.5 cm with prevalent intracavitary development
(Grade 0, 1) can be removed with the Twizzle electrode in an outpatient setting.
Grade 1 and 2 submucous myomas can in a first step be prepared in an office setting with the Twizzle by performing an incision of the endometrial mucosa up to the precise identification of the cleavage surface between the myoma and pseudocapsule (OPPIuM technique). In this way, the subsequent total removal of the lesion via the VERSAPOINT loop is facilitated. 35

Safe Office hysteroscopic surgery with Bipolar Technology

Bipolar technology allows for the use of saline solution rather than nonionic distension media (e.g., glycine, sorbitol, mannitol), plus reducing the energy spread through the tissue during resection. In addition, the use of 5 Fr bipolar electrodes allows for the treatment of intrauterine pathologies in an office setting. 36

Safe removal of submucosal myomas through resection

The PLASMA hystero-resection system allows for easy and safe treatment due to the low operating temperature and minimal thermal spread of the PLASMA. 37 38 39 40

The PlasmaLoop and PlasmaBand ensure a safe removal of submucosal myomas through resection. Depending on the myoma size, different loop sizes can be used. With the loop electrode, myoma chips can easily be removed. The band electrode is more robust, which can be especially beneficial for hard myoma tissue.

PLASMA System Product Details

Laparoscopic and Vaginal Hysterectomy

Multiple Advantages of Hybrid Technology in Hysterectomy

An effective sealing of the uterine artery is key in hysterectomy. However, an innovative advanced energy device like THUNDERBEAT Type S for laparoscopic hysterectomy and THUNDERBEAT Open Extended Jaw for vaginal hysterectomy have many more advantages, for example:

  • Effective sealing of the uterine artery through advanced bipolar energy.
  • Advanced bipolar energy serves as bipolar clamp for secondary hemostasis.
    37 38

THUNDERBEAT Type S Details

Safe, Precise, Fast Surgery with Hybrid Energy

  • Precise dissection for the preparation of the parametrium and for exposing the exact borders of structures such as vessels and nerves. 43
  • Saves time and costs due to high operating speed. 44
  • No instrument changes: one instrument for the entire procedure.

Laparoscopic Supracervical Hysterectomy​

Reducing the Operating Time during a LASH Procedure

Using a bipolar loop during a LASH procedure for the amputation of the uterus from the cervix reduces the operating time 1 significantly. In addition, the PK LAP LOOP has multiple advantages:

  • No bleeding thanks to bipolar technology.
  • Greater confidence due to easy and ergonomic handling. 57
  • Very beneficial especially for big uteruses.

PK Lap Loop Product Details

moresolution

Laparoscopic Power Morcellator
Especially during the morcellation of calcified tissue, a consistent good performance of the cutting blades is required. The moresolution morcellator is easy to assemble and guarantees a smooth and fast morcellation of calcified tissue.

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Hysteroscopic Polypectomy

Hysteroscopic Polypectomy – with Bipolar Electrosurgery System of VERSAPOINT

The SEE & TREAT solution not only allows for the diagnosis of intrauterine pathologies but also to their direct treatment. With the use of 5 Fr bipolar electrodes, the number of pathologic conditions treated in office hysteroscopy has increased significantly as the discomfort of the patient has been reduced, allowing for significant potential cost savings. 36

Polypectomy in Outpatient Hysteroscopy

Smaller and larger cervical polyps can easily be removed with the VERSAPOINT Twizzle or Spring electrode by cutting their fibrotic base. The Twizzle tip, which is ideal for outpatient hysteroscopy, is designed for controlled vaporization and needle-like cutting by providing a unique and precise cutting effect. Therefore, the Twizzle allows the surgeon to work closer to the myometrium with a lower power setting and resulting in less patient discomfort. 36

Outpatient Sheath —Easy Insertion and Special Outflow Design

For an outpatient setting, mostly without anesthesia. The outpatient sheath has a special 8-shape profile design where the outflow is realized via an outer sheath groove. It is designed for diagnostic and small therapeutic procedures.

Efficient Polyp Removal with the PLASMA System

The PLASMA hystero-resection system allows for easy and safe treatment due to the low operating temperature and minimal thermal spread of the PLASMA. 37 38 39 40

With the PLASMA-OvalButton, endometrial polyps can be efficiently removed through vaporization. Alternatively, they can be removed through resection by using PLASMA loops.

PLASMA System Details

Endometrial Ablation

Reducing Abnormal Uterine Bleeding (AUB) with VERSAPOINT

The VERSAPOINT resection loops can be effectively utilized for reducing abnormal uterine bleeding by endometrial ablation.

  • The 2.5mm loop is for precise cutting.
  • The 4mm loop offers increased resection speed. 39

The 0°degree vaporizing electrode can be used to rapidly vaporize tissue including endometrial ablation.
The electrode should be applied using a stroking technique. 39

Endometrial Ablation Using the PLASMA System

The endometrial lining can be removed through the resection of the endometrium using PLASMA loops of different sizes.

Alternatively, a safe PLASMA vaporization of the endometrium and coagulation of the cornual areas can be performed with the PLASMA-OvalButton.

The endometrial lining can also be removed through PLASMA coagulation of the endometrium and cornual areas with the PLASMA-Roller. 37 38 39 40

PLASMA System Details

Hysteroscopic Metroplasty

Safe and Effective Metroplasty with VERSAPOINT Twizzle Electrode

Operative hysteroscopy with the VERSAPOINT Twizzle does not require cervical dilation, thus avoiding cervical incompetence, cervical lacerations and uterine perforation. VERSAPOINT is safe and effective in regard to reproductive outcome and is associated with shorter operating time and lower complication rates. 46 47

Treating Uterine Septa with the PLASMANeedle

Intrauterine adhesions and septa can be precisely removed using a PLASMA needle. There are angled and right-angled needle versions available.

Myomas

Uterine myomas are the most common benign gynecological tumors. A lot of women of reproductive age have uterine myomas, although they are symptomatic in only 20% to 40% of women over 35 years.

Although recent developments in the use of hormonal and nonhormonal drugs have improved the medical management of myomas, many symptomatic patients ultimately require surgical management or fail medical therapies. 49 50

Uterine Polyps

Endometrial polyps are overgrowths of endometrial glands that typically protrude into the uterine cavity. They are usually benign in nature and affect both reproductive age and postmenopausal women.

Endometrial polyps are relatively common and may be accompanied by heavy bleeding at menstruation or intermenstrual spotting. In symptomatic women endometrial polyps can be treated safely and efficiently with hysteroscopic excision. 51

Uterine Malformations

Common uterine anomalies are important owing to their impact on fertility. 52

Septate uterus is the most common congenital uterine malformation in women with infertility. It results from incomplete resorption of the midline septum between the two Mullerian ducts and can range from a slight midline septum to a complete septate uterus.

Hysteroscopic septum incision seems to improve natural conception rates in the year following surgery and is currently the gold standard for the treatment of uterine septa. 53

Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) is a broad term that describes irregularities in the menstrual cycle involving the frequency, regularity, duration and flow volume of bleeding outside of pregnancy.

Up to one-third of women will experience abnormal uterine bleeding in their life, with irregularities most commonly occurring at menarche and perimenopause. A normal menstrual cycle has a frequency of 24 to 38 days, lasts seven to nine days, with five to 80 milliliters of blood loss. Variations in any of these four parameters constitute abnormal uterine bleeding. 54

Sources

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  6. 6.„Psychosocial effects of hysterectomy: literature review“.​ N. Flory, F. Bissonnette und Y. Binik,
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  12. 12.„Psychosocial effects of hysterectomy: literature review“.​ N. Flory, F. Bissonnette und Y. Binik,
  13. 13.„Advantages of advanced laparoscopic systems“​ Z. R. M. J. G. J. B. N. Heemskerk J,
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  36. 36.Ambulatory management of heavy menstrual bleeding. Di Spiezio Sardo A, Spinelli M, Zizolfi B, Nappi C. Womens Health (Lond). 2016 Jan;12(1):35-43. doi: 10.2217/whe.15.80. Epub 2015 Dec 23. PMID: 26696502; PMCID: PMC5779561.​
  37. 37.A New Approach to Supracervical Hysterectomy during Laparoscopic Sacral Colpopexy for Pelvic Organ Prolapse:   Campagna, G., Morciano, A., Rossitto, C., Panico, G., Naldini, A., Ercoli, A., Cervigni, M., Scambia, G. A Randomized Clinical Trial. Neurourol. Urodynam. 36:798–802, 2017.

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