Dynamics of Uterine Blood Flow Parameters in Minimally Invasive Surgeries of the Intrauterine Pathology with the Use of Various Energy Types

Study Objective: To analyze the nature of changes in the parameters of uterine blood flow in minimally invasive surgical treatment of intrauterine pathology with the use of the diode laser energy operated in pulsed mode or bipolar energy.
Study Design: Retrospective comparative study.
Materials and Methods. A retrospective analysis of the reports of the Doppler ultrasound examination of the uterine blood flow in 102 patients who underwent surgery in the period from 2016 till 2020 was conducted to study the dynamics of uterine blood flow parameters in minimally invasive surgeries of intrauterine pathology utilizing various types of energy. Treatment of intrauterine pathology with the use of surgical diode laser in pulsed mode was performed in 60 women (1^st group), 42 women were treated with bipolar energy (2^nd group). Resistance index (RI) and pulsatility index (PI) in the right and left uterine arteries, arterial perfusion index (API), possibility to register the blood flow in sub-endometrial and endometrial blood vessels were evaluated while studying the uterine blood flow.
Study Results. After the surgeries performed with the use of diode laser, the IR and PI remained unchanged statistically significantly more frequently than after the surgical treatment with the use of bipolar energy: 75 and 53.34% vs 30.95 and 33.33%. API statistically significantly more frequently increased in the 1^st group (53.33%) and decreased in the 2^nd group (66.67%). The blood flow in basal and coiled arteries of the uterus in post-surgery period is registered statistically significantly more often if diode laser was used as compared to the surgeries performed with bipolar energy (43.33 and 41.67% vs 21.43 and 19.05%, respectively).
Conclusion. The use of bipolar energy in the treatment of intrauterine pathology leads to more severe uterine blood flow disturbances than surgeries with the use of diode laser. That is why it is reasonable to use the energy of a diode laser in pulsed mode in case of minimally invasive surgical treatment of intrauterine pathology.

1. Dumanovskaya M.R., Chernukha G.E., Tabeeva G.I., Asaturova A.V. Endometrial hyperplasia: search for optimal solutions and strategies. Obstetrics and Gynecology. 2021; 4: 23–31. (in Russian) DOI: 10.18565/aig.2021.4.23-31

2. Chernukha G.E., Asaturova A.V., Ivanov I.A., Dumanovskaya M.R. Endometrial lesion''s pattern in different age groups. Obstetrics and Gynecology. 2018; 8: 129–35. (in Russian) DOI: 10.18565/aig.2018.8.129-134

3. Doherty M.T., Sanni O.B., Coleman H.G., Cardwell C. et al. Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: a systematic review and meta-analysis. PLoS One. 2020; 15(4): e0232231. DOI: 10.1371/journal.pone.0232231

4. Capmas P., Pourcelot A.-G., Giral E., Fedida D. et al. Office hysteroscopy: a report of 2402 cases. J. Gynecol. Obstet. Biol. Reprod. (Paris). 2016; 45(5): 445–50. DOI: 10.1016/j.jgyn.2016.02.007

5. Davydov A.I., Novruzova N.Kh., Strizhakov A.N. Endometrial hyperplasia: the analysis of the 2014 WHO classification and protocol RCOG & BSGE in the perspective of own results. Gynecology, Obstetrics and Perinatology. 2018; 17(4): 11–24. (in Russian) DOI: 10.20953/1726-1678-2018-4-11-24

6. Kazachkov E.L., Voropaeva E.E., Kazachkova E.A., Rogozina A.A. Clinical and morphological characteristics of endometrial polyps of different morphological types. Ural Medical Journal. 2019; 173(5): 81–6. (in Russian)

7. Tanos V., Berry К.Е., Seikkula J., Abi Raad E. et al. The management of polyps in female reproductive organs. Int. J. Surg. 2017; 43: 7–16. DOI: 10.1016/j.ijsu.2017.05.012

8. Kuznetsova I.V., Evsyukova L.V. Uterine fibroids and fertility. Gynecology. 2016; 18(3): 23–9. (in Russian) DOI: 10.26442/2079-5696_18.3.23-29

9. Fernandes S.M., Maçães A.M., Marques A.L., Leite H.V. Reproductive outcomes after hysteroscopic septoplasty: a retrospective study. Rev. Bras. Ginecol. Obstet. 2015; 37(3): 110–14. DOI: 10.1590/SO-720320150005258

10. Chernukha G.E., Ivanov I.A., Efendieva Z.N., Dumanovskaya M.R. et al. Etiological structure and diagnosis of abnormal uterine bleeding. Gynecology. 2018; 20(2): 14–17. (in Russian) DOI: 10.26442/2079-5696_2018.2.14-18

11. Schenker J.G., Margalioth E.J. Intrauterine adhesions: an updated appraisal. Fertil. Steril. 1982; 37(5): 593–610. DOI: 10.1016/s0015-0282(16)46268-0

12. Sarkisov S.E., Khitrykh O.V., Kukovenko E.M. Long-term results and the optimization of treatment policy for endometrial polyps in postmenopause. Obstetrics and Gynecology. 2009; 5: 44–8. (in Russian)

13. Kurtser M.A., Breusenko V.G., Kappusheva L.M., Golukhov G.N. et al. Endometrial polyps in the postmenopause. The role of electromechanical morcellation in treatment of endometrial polyps. Gynecology, Obstetrics and Perinatology. 2020; 19(1): 12–19. (in Russian) DOI: 10.20953/1726-1678-2020-1-12-19

14. Maksimova T.A., Cherkasova A.L., Dzhibladze T.A., Zuev V.M. et al. Minimally invasive interventions in diagnosis and treatment of intrauterine pathology in women with infertility. Gynecology, Obstetrics and Perinatology. 2018; 17(1): 27–32. (in Russian) DOI: 10.20953/1726-1678-2018-1-27-32

15. Savelyeva G.M., Breusenko V.G., Kappusheva L.M. Hysteroscopy: atlas and manual. M.: GOETAR-Media; 2018. 243 p. (in Russian)

16. Ozerskaya I.A. Echography in gynecology. 2nd edition, reprint and additional. Moscow: Publishing house Vidar-M; 2013. 564 p. (in Russian)

17. Ozerskaya I.A., Semiletova A.A., Kazaryan G.G. Ultrasound diagnosis of endometritis: hemodynamic features of the uterus. Medical Visualization. 2018; 22(6): 82–96. (in Russian) DOI: 10.24835/1607-0763-2018-6-82-96

18. Ishenko A.I., Unanyan A.L., Kogan E.A., Demura T.A. et al. Clinical and anamnestic, immunological, echographie, and hysteroscopic features of chronic endometritis associated with impaired reproductive function. Annals of the Russian Academy of Medical Sciences. 2018; 73(1): 5–15. (in Russian) DOI: 10.15690/vramn927

19. Babaeva D.O. Some specific features of tumor blood flow in combination of benign uterine and ovarian neoplasms. Journal of Volgograd State Medical University. 2010; 3(35): 105–8. (in Russian)

20. Pace S., Cerekja A., Dillon K.C., Pace G. et al. Improvement in uterine artery doppler indices via hysteroscopic metroplasty. J. Prenat. Med. 2013; 7(2): 25–8.

21. Fu H.C., Huang K.H., Tseng C.W., Liang H.M. et al. Comparison of clinical outcomes and spectral Doppler indices of uterine and ovarian stromal arteries in women undergoing myomectomy with or without hypogastric arterial ligation. Ultrasound Obstet. Gynecol. 2006; 28(6): 831–6. DOI: 10.1002/uog.3839