It was presented in Nagpur hysteroscopy carnival in a debate on Bipolar energy sources in hysteroscopy vis a vis Monopolar energy.

1. Bipolar in
hysteroscopy
Dr Rajesh Gajbhiye.

5. Monopolar is traditionaly used.
Technological advance have made new generation equipments to use
Bipolar electrodes .
Uses Saline or Ringers making the procedure not only safer but gets
it to the office as well to further reduce the cost.

6. See and treat
• Option to treat benign pathology in the same sitting
• Saves time
• Avoids return visits
• Reduces the anxiety of pt between the diagnosis and treatment
• Bipolar can be used with smaller diameter hysteroscope,No dilatation
is required.

7. Electrical circuit
Monopolar
The entire patient is involed in the circuit
Greater chances of current diversion to undesirable locations.
Bipolar circuit
Current flows between two electrodes the circuit is closed by
placing tissue between two electrodes
less chance of diversion.

8. Types of electrode
• Spring, twizzle and ball electrode.
• Spring tip for hemostatic vaporization large areas.
• Ball tip for precise vaporization
• Twizzle tip for hemostatic resection and morcellation of tissue.
• Cutting loop similar to traditional resectoscopy

9. • It allows vaporisation of tissue
• Cuts and dessicates the tissue
• Instantaneous tissue vaporization eliminates resection chips thus
permitting continuous visualisation of tissue effect.
• Cutting power and coagulation is better due to plasma effect.
• Vision during resection is not disturbed.
• A vaporizing electrode may prevent significant blood loss during
myoma resection by sealing blood vessels as the tissue is vaporized.13

10. Uses
• Removal of submucous fibroids
• Transection of intrauterine septa
• Removal of polyps
• Endometrial Ablation
• Transection of intrauterine adhesions

11. Complications of Monopolar resectoscope
• Active electrode injury-perforation of uterus, bowel,bladder
• Other vascualr structure
• Current Diversion;-burns to cervix,vagina, or vulva
• Damage of electrode insulation
• Loss of contact with between external sheath and cervix –burns
• Direct coupling of current-if tissue is stuck
• Genital tract injuries have occurred as a result of current diversion.
Vilos and colleagues.

12. Distension media
• For monopolar-use electrolyte free distension media like
sorbitol,glycine or mannitol
• Bipolar resectoscopic are generally designed that even in the
electrolyte rich media like normal slaine the circuit is completed.
• Biggest advantage.The risk of hyponatremia is obviated Hyponatremia
– cerebral edema caused by Glycine –death
• In Bipolar-normal saline used has ion concentrations similar to human
plasma which reduces electrolyte changes and hyponatremia
• Fluid deficits must still be monitored so they do not exceed 2,000 mL

13. • A randomized trial comparing monopolar electrodes using glycine
1.5% with two different types of bipolar electrodes (TCRis,
Versapoint) using saline, in hysteroscopic surgery.(Berg A, Sandvik
L, Langebrekke A, Istre O).
• Bipolar electrodes appear to have a safer profile compared with
monopolar electrodes because of the unchanged serum sodium.
Irrigant consumption was significantly higher in the two bipolar
groups, without any side effects during or after the procedure

14. • Case-Control Study of Complications Associated With Bipolar and
Monopolar Hysteroscopic Operations
• Raz Bahar, MD, Michal Shimonovitz, BMedSc, Avi Benshushan, Asher Shushan,
(The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 376-380)
• The bipolar hysteroscopic system has eliminated the need to use
hypotonic solutions as irrigation medium, with its life-threatening
complications. When limiting normal saline solution to 2 L, no serious
complications associated with irrigation medium are expected.
Therefore, we believe that when available, the bipolar system should
be preferred

15. Comparision of Monopolar and Bipolar
resection of myoma (Romer T)
• Preferred Indications
• Myoma Grade 2 and large myoma(>4cm)
• Advantage
• Avoidance of TUR syndrome.
• Less complications
• raerly second surgery
• Results 60% after first surgery with monopolar,95% with bipolar.

16. conclusions
• Bipolar has biggest advantage that it can be done with NS or RL
without the fear of life treatening complication like cerebral edema.
• The main evolution with Bipolar is shifting from inpatient procedures
to the office leading to saving of medical costs and making see and
treat facility.
• Excellent hemostasis in vapour cut mode
• Total vaporisation of myoma avoids the process of removing the chips
from field of vision.

17. Thankyou