Endometrial vaporization of the cervical stump employing an office hysteroscope and bipolar technology Giovanni Pontrelli, MD, Stefano Landi, MD, Charalampos Siristatidis, MD, Attilio Di Spiezio Sardo, MD, Oronzo Ceci, MD, and Stefano Bettocchi, PhD From the Department of Obstetrics, Gynaecology and Neonatology–II Unit of Obstetrics and Gynaecology, University of Bari, Bari, Italy (Drs. Pontrelli, Ceci, and Bettocchi); the Department of Obstetrics and Gynaecology, Ospedale Sacro Cuore Don Calabria, Negrar (Verona), Italy (Dr. Landi); the Department of Obstetrics and Gynaecology, University of Naples “Federico II”, Naples, Italy (Dr. Di Spiezio Sardo), and the 3rd Department of Obstetrics and Gynaecology, “Attikon” Hospital, University of Athens, Athens, Greece (Dr. Siristatidis). Abstract. We report the successful treatment of a 40-year-old woman with ongoing cyclical vaginal bleeding lasting 10 days after laparoscopic subtotal hysterectomy. Hysteroscopic vaporization of the endometrial stripe in the cervical stump was performed in an office setting, using a 5-mm Bettocchi double-channel operative hysteroscope armed with a bipolar electrode. © 2007 AAGL. All rights reserved. KEYWORDS: Office hysteroscopy; Subtotal hysterectomy; Cervical stump; Bleeding Subtotal hysterectomy continues to represent a justifiable alternative to total hysterectomy for benign gynecologic conditions, being associated with a reduced rate of compli- cations (i.e., damage to surrounding pelvic organs, vaginal prolapse, hematomas, blood loss, wound infections), a shorter operative time, and more rapid recovery. 1,2 How- ever, the theoretical advantage of subtotal versus total hysterectomy in terms of better preservation of sexual satisfaction in young patients, because of less disturbance of the cervical and upper vaginal innervation, 3 was not confirmed by recent more robust evidence. 4 The main clinical arguments against subtotal hysterectomy are the risk for development of cancer in the cervical stump and the possibility of abnormal bleeding related to the pres- ence of even small islands of residual endometrial tissue in the cervical stump. 2 Nevertheless, the risk for development of a neoplasia in the cervical stump should no longer be considered a reason for preferring total to subtotal hysterectomy because the likelihood is low (less than 1%), 5 and cervical screening has already been shown to be effective in the follow-up of these patients. 6 On the other hand, the incidence of cyclical or continuous bleeding after subtotal hysterectomy ranges be- tween 1% and 31.4% in different series 1,7 and negatively affects the quality of life of those women who could expect to stop menstruating after such major surgery, as well as potentially complicating the use of hormone replacement therapy. 2 To minimize this complication, during surgery diathermy is usually applied to the top of the endocervical canal with the aim of destroying any cycling endometrium. 8 This modality, however, has not been proven to prevent future bleeding episodes. 7 Thakar et al 1 proposed that for- mal reverse conization, including the cervical epithelium together with the transformation zone, as well as any resid- ual endometrium, could minimize this complication during a laparotomic subtotal hysterectomy. The authors have no commercial, proprietary, or financial interest in the products or companies described in this article. Corresponding author: G. Pontrelli, Department of Obstetrics, Gynae- cology and Neonatology-II Unit of Obstetrics and Gynaecology, University of Bari, Bari, Italy. E-mail: giovepontre@alice.it Submitted April 27, 2007. Accepted for publication June 1, 2007. 1553-4650/$ -see front matter © 2007 AAGL. All rights reserved. doi:10.1016/j.jmig.2007.06.006 Journal of Minimally Invasive Gynecology (2007) 14, 767–769