Ex vivo myolysis with dual wavelengths diode laser system: macroscopic and histopathological examination

Abstract

Ex vivo myolysis with dual wavelengths diode laser system: macroscopic and histopathological examination Maurizio Nicola D’Alterio1, *, Francesco Scicchitano1 , Daniela Fanni2 , Gavino Faa2 , Antonio Simone Laganà3 , Marco Noventa4 , Felice Sorrentino5 , Luigi Nappi5 , Stefano Angioni1 1Department of Surgical Sciences, Division of Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, Italy 2Department of Medical Sciences and Public Health, Unit of Anatomic Pathology, University of Cagliari, 09124 Cagliari, Italy 3Department of Obstetrics and Gynecology, “Filippo del Ponte” Hospital, University of Insubria, 21100 Varese, Italy 4Department of Women and Children's Health, Clinic of Gynecology and Obstetrics, University of Padua, 35121 Padua, Italy 5Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, 71121 Foggia, Italy *Correspondence: mauridalte84@gmail.com (Maurizio Nicola D’Alterio) DOI:10.31083/j.ceog4804138 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 7 March 2021 Revised: 28 March 2021 Accepted: 9 April 2021 Published: 15 August 2021 Background: Uterine fibroids are the most common benign gynaecological tumours in women. When symptomatic, heavy menstrual bleeding is the principal manifestation of uterine fibroids. Nowadays, several conservative procedures have been utilized to discourage hysterectomy or myomectomy and great interest has been focused on laser energy technology associated with mini-invasive approaches. Diode lasers demonstrated many advantages in laparoscopic and hysteroscopic surgery. Methods: To evaluate the Dual Wavelength Diode Laser System (DWLS) ablation techniques for treating fibroids, we devised an experimental system for characterizing the myolysis fibre ablation performance with a particular fibre designed to create a thermal ablation in the centre of the myoma. All the myomas were used for the experiment after a total hysterectomy and their excision from the fresh uteri. The experiment setup was composed of two beaker containers filled with isotonic saline water, temperature monitoring myoma surface and water bath, a diode laser fibre and a diode laser energy deposition system. Results: Good macroscopic results have been found for fibroids of about 60 cm3 ablated with a setting of 10 W of 980 nm + 10 W of 1470 nm and for samples of about 15 cm3 ablated with a setting of 5 W of 980 nm + 5 W of 1470 nm, where the volume of the ablated fibroids were 46.6% and 41.6%, respectively. Conclusion: This is the first ex vivo study with a new DWLS, which made it possible to understand which one of its settings could be recommended for the safest and best macroscopic results in myolysis. Keywords Uterine fibroids; Myolysis; Diode laser; DWLS; Hysteroscopy; Ex vivo