Redwine, D. B. (1993). Laparoscopic excision of endometriosis with 3-mm scissors: comparison of operating times between sharp excision and electro-excision. The Journal of the American Association of Gynecologic Laparoscopists, 1(1), 24-30. https://doi.org/10.1016/s1074-3804(05)80754-6
Redwine DB. Laparoscopic excision of endometriosis with 3-mm scissors: comparison of operating times between sharp excision and electro-excision. The Journal of the American Association of Gynecologic Laparoscopists. 1993;1(1):24-30. doi:10.1016/s1074-3804(05)80754-6
Redwine, D. B. "Laparoscopic excision of endometriosis with 3-mm scissors: comparison of operating times between sharp excision and electro-excision." The Journal of the American Association of Gynecologic Laparoscopists, vol. 1, no. 1, 1993, pp. 24-30.
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Electro-excision was 26% to 49% faster for endometriosis surgery
In a 1993 single-surgeon comparison of 135 women, electro-excision was associated with 26% to 49% shorter median operating times than sharp excision. Both groups were operated on with the same 3-mm scissors. Electro-excision sends electrical current through them. The current cuts tissue and coagulates bleeding vessels at the same time.
Key Findings
Median operating time was 26% to 49% shorter with electro-excision than with sharp excision across the four revised American Fertility Society stages (59 women versus 76 women).
The two groups did not differ significantly in disease stage (p > 0.5) or in the number of pelvic areas involved by endometriosis (p > 0.5).
Median operating time fell 33% for one through four pelvic areas involved, 50% for five or six areas, and 23% for seven or more areas.
Among the 76 women treated by sharp excision, early and later cases did not differ significantly in operating time (p > 0.5) or disease stage (p > 0.1).
No complication resulted with monopolar electro-excision, including among women excluded from the analysis.
Interpretation
The study compares consecutive cases from one surgeon at one center, looking back at records. The sharp-excision cases came first. The electro-excision cases followed. The author states that unidentified confounding variables may exist. The surgeon, the goal of surgery and the equipment stayed constant. Women with intestinal endometriosis or a presacral neurectomy were excluded. The main outcome was operating time. Operating room charges were not studied, and the paper reports no data on pain, recurrence or pregnancy.
RRM Context
RRM favors excision, which cuts out endometriosis tissue. Suppressive medications leave the disease in place. Both methods here cut out the tissue. The author cites a separate 1991 study of how often disease persisted or returned after sharp excision.
Our editorial summary of this paper, not the article's abstract.
Abstract
To determine if laparoscopic excision of endometriosis by electrosurgery is more rapid than by sharp dissection, a retrospective comparative study was made of operative times for the two procedures. Median operating times for laparoscopic electro-excision of endometriosis were 26% to 49% faster than excision by sharp dissection. A chi2 analysis of the frequency counts of surgical intervals, and disease stage revealed this difference to be statistically significant and not due to acquired experience or differences in extent of disease in the two groups. The reduction in operating time achieved with monopolar electro-excision seems primarily associated with a more rapid cutting action with simultaneous coagulation of bleeders.
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