Universal Operating Hysteroscope Set Instructions Manual

Important general instructions for use Ensure that this product is used only as intended and described in this instruction manual, by adequately trained and qualified personnel, and that maintenance and repair is only carried out by authorized specialized technicians. Use this product only with the combinations and with the accessories and spare parts listed in this instruction manual. Use other combinations, accessories and replacement parts only if they are expressly intended for this use and if the performance and safety requirements are met. Reprocess the products before every application and before returning them for repair as required by the instruction manual in order to protect the patient, user or third parties. Subject to technical changes! Due to continuous development of our products, illustrations and technical data may deviate slightly from the data in this manual. CAUTION -- USA only: Federal law restricts this device to sale by or on the order of a physician.

Safety instructions and levels of danger Symbol

Level of danger WARNING! Failure to observe can result in death or serious injury. CAUTION! Failure to observe can result in slight injury or damage to the product. IMPORTANT! Failure to observe can result in damage to the product or surrounding. NOTE! Tips for optimum use and other useful information.

GERMANY RICHARD WOLF GmbH D--75438 Knittlingen Pforzheimerstr. 32 Tel.: (..49)--(0)7043--35--0 Fax:(..49)--(0)7043--35300 MANUFACTURER

USA RICHARD WOLF Medical Instruments Corp. 353 Corporate Woods Parkway Vernon Hills, Illinois 60061 Tel.: 847--913 1113 Fax: 847--913 1488

UK RICHARD WOLF UK Ltd. Waterside Way Wimbledon SW 17 0HB Tel.: 020--8944 7447 Fax: 020--8944 1311

E--mail: [email protected] Internet: www.richard--wolf.com

E--mail: sales&[email protected] Internet: www.richardwolfusa.com

E--mail: [email protected] Internet: www.richardwolf.uk.com

BELGIUM N.V. Endoscopie RICHARD WOLF Belgium S.A. Industriezone Drongen Landegemstraat 6 B--9031 Gent --Drongen Tel.: +32 9.280.81.00 Fax: +32 9.282.92.16

FRANCE RICHARD WOLF France S.A.R.L. Rue Daniel Berger Z.A.C. La Neuvillette F--51100 Reims Tel.: +33 3.26.87.02.89 Fax: +33 3.26.87.60.33

AUSTRIA RICHARD WOLF Austria Ges.m.b.H. Wilhelminenstraße 93 a A--1160 Wien Tel.: +43 1-- 405 51 51 Fax: +43 1-- 405 51 51--45

E--mail: [email protected]

E--mail: [email protected]

E--mail: [email protected] Internet: www.richard--wolf.at

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Contents 1

Intended use...

1

2

Indications and field of use...

1

3

Contraindications...

1

4

Combinations...

1

5 5.1

Illustration... Legend and identification...

2 2

6 6.1 6.1.1 6.1.2 6.2 6.3 6.4 6.5 6.5.1 6.5.2 6.5.3 6.5.4 6.5.5

Use... 3 Preparation... 3 Inserting the hysteroscope telescope into the external sheath... 3 Inserting the internal sheath into the hysteroscope telescope... 4 Intermittent flow... 6 Continuous flow... 7 Dilation using C02... 8 Additional instructions for use... 9 Light... 9 Electric current... 9 HF applications... 9 Laser applications... 10 Irrigation fluid... 10

7 7.1 7.2

Checks... 10 Visual check... 10 Functional check... 11

8 8.1 8.1.1 8.1.2 8.2 8.3 8.4 8.5 8.5.1 8.5.2 8.6 8.6.1

Reprocessing and maintenance... Disassembly before cleaning... Internal sheath... Hysteroscop telescope... Manual reprocessing... Machine reprocessing... Checks... Assembly before sterilization... Hysteroscope telescope... Internal sheath... Sterilization... Steam sterilization...

9 9.1 9.2

Technical data and order data... 15 Sheaths for continuous irrigation... 15 Sheaths for intermittent irrigation... 15

10

Spare parts and accessories... 16

11 11.1

Operating, storage, transport and shipping conditions... 16 Disposal of product, packaging material and accessories... 16

12

Literature... 17

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12 12 12 12 13 13 13 13 13 13 14 14

I

1

Intended use The Universal Operating Hysteroscope Set is used for visualizing and dilating the cervical channel, the cavum uteris and the tubal ostia (using fluid or CO2 gas). The scope is applied via the natural passage.

2

Indications and field of use For examination, diagnostics and therapy in conjunction with endoscopic accessories in gynecology. The use is indicated in the following cases: Abnormal bleeding. Fertility problems. Pain in the lower abdomen. Myomas, polyps These products may only be applied by adequately qualified and trained medical personnel. NOTE! We recommend reading relevant literature regarding the planned use (see also section 13 “Literature”).

3

Contraindications Acute inflammation of the lower abdomen Infection of the vagina Pregnancy Contraindications directly related to the product are presently unknown. On the basis of the patient’s general condition the physician/surgeon in charge must decide whether the planned use is possible or not. For further information please see the latest medical literature.

4

Combinations CAUTION ! Caution if products are incorrectly combined ! Possible injury of the patient, user or others as well as possible damage to the product. Different products should only be used in combination if their intended use and relevant technical data (working length, diameter, etc.) are the same. Follow the instruction manuals of the products used in conjunction with this product. Light source and flexible light cable Cameras and objective lenses Hystero Pumps or Hystero--CO2 Pneus (Automatic Insufflators) Endoscopic accessories, see section 10 “Spare parts and accessories”. The cold--light connector (1.5) can be unscrewed and replaced by suitable adapters to connect light cables of other manufacturers. For order data please refer to the latest catalog pages.

1.5 25

Abb. 1

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5

Illustration

1.1

#

1.6

1.7

1.5 1.2

1.3

1.4

25

1.8 1.9 1.11

8753.XXX

1 3.7

# 2.6 2.2 2.5

2.1

Continuous Flow

3.3

1.10

3.4 3.5 3.6

2.3

2

3 #

2.4

#

3.1 3.7

Intermittent 2.1

3.1

2.6 2.2 2.5 2.3

2

3.2

3.2

3.3

3.4 3.5 3.6

3 #

5.1

Legend and identification Item

Item

Designation

1

Operating Hysteroscope telescope

2

External sheath

1.1

Objective lens

2.1

Sheath tube

1.2

Light exit

2.2

Locking collar tab, color--coded

1.3

Sheath tube

2.3

Locking mechanism

1.4

Size of fiber bundle diameter

2.4

Drain stopcock

1.5

Cold--light connector Color coding ring, orange Identification: Direction of view 12

2.5

Fr. size

2.6 3

Fr. size of working channel./ mm Internal sheath

1.7

Eyepiece cup

3.1

Sheath tube

1.8

Twist--lock mechanism

3.2

O--ring

1.6

Designation

1.9

Irrigation stopcock

3.3

Color--coded bracket

1.10

Direction of view

3.4

Membrane valve

1.11

O--ring

3.5

Seal

3.6

Sealing cap

3.7

Fr. size of sheath / mm

#

Product number

Identification in conformity with Medical Devices Directive 93/42/EEC only valid if the product and/or packaging is marked with this symbol. Products of category IIa and above, as well as sterile products or products with measuring function of category I, are additionally marked with the code number of the notified body (0124).

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6

Use CAUTION ! The products have only limited strength ! Exerting excessive force will cause damage, impair the function and therefore endanger the patient. Immediately before and after each use, check the products for damage, loose parts and completeness. Ensure that no missing instrument parts remain in the patient. Do not use products which are damaged, incomplete or have loose parts.

6.1

Preparation Check assembly (section 9.5). Keep measuring system ready. Perform a visual check (sections 8 and 8.1). Install the sealing cap (3.6), fig. 1.

3.6 Fig. 1 Perform a functional check (section 7.2)

6.1.1

Inserting the hysteroscope telescope into the external sheath Locking (fig. 2a): Insert the hysteroscope telescope (1) into the external sheath (2) in such a way that groove (c) and pin (d) are aligned, then push together until the locking mechanism (2.3) locks automatically. NOTE! If the locking mechanism (2.3) does not lock automatically, push the tab (2.2) as far as it will go and repeat the procedure.

2.2

c

2.2

d

Fig. 2a 25

Fig. 2b 2.3 Fig. 2

2

1

Unlocking (Fig. 2b): Push tab (2.2) and remove external sheath (2).

3

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6.1.2

Inserting the internal sheath into the hysteroscope telescope. Locking (Fig.3): Insert the internal sheath (3) into the hysteroscope telescope in such a way that the grooves (a) and the tongues (b) are aligned. Push together until the locking mechanism (1.8) locks automatically.

a

b

1

25

Fig. 3

3

Unlocking (Fig. 4): Push the bracket (3.3) of the internal sheath (3) as indicated by the arrow then remove the internal sheath (3).

25

3.3

3

Fig. 4

Connect the irrigation tube (A) and drain tube (B). (Fig. 5)

C

25

B Fig. 5

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A

4

Connect the flexible light cable (C), fig. 5. NOTE! To obtain optimum light transmission, the diameters of the fiber core of the endoscope and of the light cable must be the same. If the light cable diameter is too large, the coupling point with the endoscope may become excessively hot. If the light cable diameter is too small, the light output is reduced. The model / type number of the flexible light cable (cable) 8061.xx3 / 8062.xx3 serves to select the corresponding fiber core diameter that suites the endoscope: The code number for the fiber core diameter (1.4) on the cold--light connector (1.5) must correspond with the two digits to the right of the decimal point of the product number. (Fig. 6)

1.5

25

25

1.4 Fig. 6 CAUTION ! Intense heat due to high light energy ! In the case of unfavorable combinations, using the highly temperatureresistant flexible light cable 8063.353 can cause a temperature increase at the coupling point between the flexible light cable and the endosope. The user may get burns and the endocope can become damaged. Reduce the light output, if necessary use flexible light cable with product no. 8061.xx3 / 8062.xx3.

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6.2

Intermittent flow If fluid (such as isotonic saline or Purisole ) is used as a dilation medium, hysteroscopy is carried out under continuous irrigation with the help of the irrigator or hystero pump. In CO2 hysteroscopy, CO2 gas is applied as a dilation medium with the help of a suitable ”Hystero--CO2--Pneu” automatic insufflator. If necessary the cervical channel is dilated to the diameter of the hysteroscope sheath using hegar dilators. The dilation medium is supplied through irrgation stopcock (1.9) on the hysteroscope telescope (1). Figure 7 Connection diagram for intermittent flow

1

25

1.9

Fig. 7

Fig. 7a: Drain 25

2

1.9

close

NOTE! To drain the dilation medium, close irrigation stopcock (1.9), unlock the connection between the external sheath (2) and the hysteroscope telescope (1), then pull the hysteroscope telescope (1) slightly out of the external sheath (2), as shown in fig. 7a.

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6

6.3

Continuous flow The dilation medium is supplied through the hysteroscope telescope (1). The medium is drained via the external sheath (2). Figure 8, Connection diagram for continuous flow

1 2 25

Fig. 8 NOTE! Open the irrigation stopcock when inserting the hysteroscope. The liquid discharged distally as a jet will dilate the passage and facilitate insertion of the hysteroscope. The irrigation tube must be free of air bubbles. The drain stopcock serves to control pressure. OPEN: High flow → low pressure CLOSE: No flow → high pressure. Pressure regulation by varying the irrigation height (i.e. fluid level 1.40 m -- 1.65 m above operating level) or by adjusting the Hystero Pump. WARNING ! If a liquid is used as dilation medium there is the risk of a fluid overload syndrom. Carefully monitor the fluid balance. Stop the operation if the fluid difference reaches 1 liter!

7

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6.4

Dilation using C02 NOTE! Open the irrigation stopcock (1.9) when inserting the hysteroscope. The CO2 gas discharged distally will dilate the passage and facilitate insertion of the hysteroscope. The pressure is controlled via the ”Hystero CO2 Pneu” automatic insufflator. Figure 9, Connection diagram for CO2 flow

25

1.9

Fig. 9 WARNING ! Danger if air is in the irrigation system! Danger of embolism ! Before use, purge the irrgation system at a flow of 100 ml/min for a minute

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6.5

Additional instructions for use

6.5.1

Light IMPORTANT ! Use only products with type BF applied parts in conjunction with this endoscope. WARNING ! Accumulation of heat due to high light energy! Danger of inadvertent tissue damage due to insufficient distance between the light exit area and the tissue. Do not touch the light exit area and avoid direct contact with the tissue. WARNING ! Fire hazard! Do not place the endoscope onto heat- sensitive, flammable surfaces, such as dark drapes, as the extreme heat generated in the light exit area will lead to inadmissibly high temperatures or even ignition. Lay down the endoscope at a safe place. If you do not use the endoscope for some time, switch off the light source.

6.5.2

Electric current WARNING ! Danger of electric shock due to leakage currents! Patient leakage currents can add up if the endoscope is combined with powered endoscopic accessories. Make sure that such combinations do not exceed the permissible patient leakage currents.

6.5.3

HF applications Follow the “Notes and instructions on HF applications“, order no.: GA--S 002 as well as the HF device manufacturer’s instructions. WARNING ! Danger of injury if the HF instrument is not in the surgeon’s field of view, i.e. not visible through the scope! Inadvertent tissue damage as well as damage to the distal end of the endoscope and to instrument parts is possible. Activate HF instruments only if the live HF part is fully visible through the scope and in contact with the target tissue.

WARNING ! HF arcing!

10mm

Fig. 10

9

Danger of injury from HF applications not fulfilling the intended use or insufficient distance between live HF instruments and other conductive (endoscope) parts. When activated, live HF parts of HF instruments must be kept at a safe distance of at least 10 mm from the distal end of the endoscope (Fig. 10).

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6.5.4

Laser applications When using lasers, follow the laser device manufacturer’s notes and instructions as well as the general regulations on the use of lasers. Wear the required personal protection gear. CAUTION ! Do not work without any view throught the scope! Inadvertent damage to the tissue as well as damage to the distal end of the endoscope and of instrument parts is possible! Activate the laser only after the tip of the laser fiber has become visible through the scope and is directed at the tissue to be treated. CAUTION ! Accumulation of heat due to highly concentrated laser beam! The heat generated by the laser beam reduces the strength of instrument parts. Do not aim the laser beam at instrument parts, in particular not at plastic parts. Maintain a sufficient safety distance. CAUTION ! Danger of eye injuries! Do not work without filter attachment! Use a suitable filter attachment on the endoscope eyepiece!

6.5.5

Irrigation fluid CAUTION ! Check electrical conductivity of irrigation fluid! The user must choose a low- conductivity irrigation fluid to suit the application. Do not use NaCl solution (saline) in HF applications.

7

Checks CAUTION ! If products are damaged or incomplete. Possible injury of patient, user or third person. Run through the checks before and after each use. Do not use products which are damaged or incomplete or have loose parts. Return damaged products together with loose parts for repair. Do not attempt to do any repairs yourself.

7.1

Visual check

Fig. 11

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Check instruments and accessories for damage, sharp edges, loose or missing parts and rough surfaces. Replace damaged and hard or brittle sealing caps (3.6) and membrane valves (3.4) as well as O--rings (3.2)/(1.11), (Fig. 11). Check that the lateral holes on the external sheath (2.1) are not plugged. Any lettering, labeling or identification necessary for the safe intended use must be legible. Missing or illegible lettering, labeling or identification which may lead to wrong handling and reprocessing must be restored.

10

7.2

Functional check Check the irrigation and drain stopcocks for easy operation. Rinse out the irrigation and drain stopcocks using an irrgator. The dilation medium must be discharged distally in a jet. If gas is used: Make sure no pressure is building up. Check the individual components for easy assembly. Check the locking mechanisms of all components. Check compatibility between light connector, flexible light cable and light source. Checking image quality and light output: Any deposits on the glass surfaces can cause the field of view to become stained or blurred which may considerably impair light transmission. Clean the glass surfaces with a swab soaked with alcohol (wooden swab carrier, not metal or plastic), wipe difficult--to--remove deposits with instrument cleaner* (Fig. 12).

*For the above, please also refer to the “Notes and instructions on the reprocessing of Richard Wolf products, accessories and devices”, order number: GA--J 020.

25

Fig. 12

Hold the distal end of the endoscope towards a light source. Broken fibers appear as black dots in the cold--light connector (1.5). If more than 30% of the fibers are broken, the light output is no longer sufficient. (Fig. 13).

1.5 25

Fig. 13

11

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8

Reprocessing and maintenance IMPORTANT ! Follow the current ”Notes and instructions on the reprocessing of R.Wolf products, accessories and devices”, order no.: GA--J 020. Do not use disinfectants containing peracetic acid without corrosion protection agents, phenols or chlorine components for the reprocessing of R. Wolf products. Do not exceed the maximum exposure time specified by the manufacturer of the disinfectants used.

8.1

Disassembly before cleaning

8.1.1

Internal sheath Figure 14: Remove sealing cap (3.6). Unscrew seal holder (3.5). Remove membrane valve (3.4) from seal holder and discard. NOTE! We recommend replacing the membrane valve (3.4) after each use. Remove O--rings (3.2) with a suitable O--ring tool (such as 15 106.230 of Richard Wolf). For easier disassembly remove the proximal O--ring before the distal O--ring.

3.6 3.2

3.5

3.4 Fig. 14 8.1.2

Hysteroscop telescope Figure 15: Remove the O--ring (1.11). Unscrew the cold--light connector (1.5).

1.5

1.11

25

Fig. 15

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12

8.2

Manual reprocessing Wet preparation at the point of use Brush the internal channels of the instruments with the supplied brushes (see section 11 “Spare parts and accessories”). Manual cleaning / disinfection

8.3

Machine reprocessing NOTE! To avoid damage during reprocessing we recommend using a suitable reprocessing basket (see section 11 “Spare parts and accessories”). Dry preparation at the point of use Disassembly before cleaning: section 9.1 Machine cleaning / disinfection

8.4

Checks Perform a visual check (see section 8.1)

8.5

Assembly before sterilization NOTE! Screw on the threaded connections only loosely before sterilization to allow a sufficient flow of sterilization medium Tighten all screw connections before use.

8.5.1

Hysteroscope telescope Figure 16: Install the cold--light connector (1.5). Install the O--Ring (1.11).

1.5

1.11

25

Fig. 16 8.5.2

Internal sheath Figure 17: Install O--rings (3.2). For easy assembly install the distal O--ring before the proximal O--ring. Place a membrane valve (3.4) into the seal holder (3.5). Screw on the seal holder (3.5) together with the membrane valve (3.4).

3.4

3.5

3.2 Fig. 17

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8.6

Sterilization

8.6.1

Steam sterilization Steam sterilization at 134°C (272°F) using the fractional prevacuum method.

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14

9

Technical data and order data Illustration

Product no.

Designation, Technical data

25

8753.411

9.1

TELESCOPE 12 W 3.6MM H 2MM WL 227MM

Sheaths for continuous irrigation Illustration

Product no. Color code

214

4.8 mm

n/a

INNER SHEATH FOR HYSTEROSCOPE 8753.004

n/a

2.2 mm x 3.42 mm

5 Fr.

OUTER SHEATH FOR HYSTEROSCOPE 15.5FR 8753.006

214

5.4 mm.

n/a

INNER SHEATH FOR HYSTEROSCOPE 8753.007

n/a

2.8 mm x 2.98 mm

7 Fr.

OUTER SHEATH FOR HYSTEROSCOPE 17.5FR 8753.008

214

5.8 mm

n/a

OUTER SHEATH FOR HYSTEROSCOPE 15FR 8753.003

Outer sheath

Internal sheath

Working Auxiliary instrulength External dia. Internal dia. ments (mm)

blue

5 Fr.

green

7 Fr.

white

INNER SHEATH FOR HYSTEROSCOPE 8753.009

3 mm n/a

3.5 mm x 4.04 mm

3 mm

n/a= not applicable

15

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9.2

Sheaths for intermittent irrigation Illustration

Product no.

Color code

OUTER SHEATH FOR HYSTEROSCOPE 15FR 8753.001

Working length (mm)

External dia.

Internal dia.

214

12 Fr.

n/a

n/a

1.5 mm

3 Fr.

yellow

3 Fr.

INNER SHEATH FOR HYSTEROSCOPE 8753.002

10

Auxiliary instruments

Spare parts and accessories Illustration

Product no.

Designation

suitable for Hysteroscope telescope 8753.411

6.09

CLEANING BRUSH Ø 9MM TL 405MM

External sheath 8753.008 Internal sheath 8753.009

6.03

CLEANING BRUSH Ø 5MM TL 240MM

External sheath 8753.001/.003/.006

6.041

CLEANING BRUSH Ø 3MM TL 365MM

Internal sheath 8753.004

15 364.326

O--ring, red (dia. 9 mm x 1 mm) (item 1.11)

Hysteroscope telescope 8753.411

15 364.325

O--ring, red (dia. 5 mm x 1.5 mm) (item 3.2)

15 176.100

Seal holder (item 3.5)

Internal sheath 8753.007

89.102

SEAL Ø 11MM

89.00

SEALING CAP CAP <2.4MM

15 106.230

O--ring holder

38044.311

REPROCESS BASKET

all internal sheaths

complete set

The products can be combined as required provided the relevant technical data and intended uses are observed. For the general overview please refer to the latest catalog sheets and brochures, or contact Richard Wolf or your Richard Wolf representative.

11

Operating, storage, transport and shipping conditions. Operating conditions

+10°C to +40°C , 30% to 75% rel. humidity, atmospheric pressure 700 hPa to 1060 hPa

Storage, transport and shipping conditions

-- 20°C to +60°C , 10% to 90% rel. humidity, atmospheric pressure 700 hPa to 1060 hPa

NOTE! To prevent damage during transport or shipment of the products we recommend using the original packaging material.

11.1

Disposal of product, packaging material and accessories. For the disposal observe the regulations and laws valid in your country. For further information please contact the manufacturer.

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12

Literature IMPORTANT! As we cannot provide a comprehensive bibliography we would ask users to keep themselves informed of all new developments in this field. Motashaw ND, Dave S: Diagnostic and therapeutic hysteroscopy in the management of abnormal uterine bleeding. J Reprod Med 35:616--620, 1993. Taylor PJ, Hamou JF. Hysteroscopy. J Reprod Med 28: 359--389, 1984. Shirk GJ, Gimpelson RJ: Control of intrauterine fluid pressure during operative hysteroscopy. J Am Assoc Gynecol Laparosc 1: 229--133, 1994. Magos AL, Baumann R, Lockwood GM, et al: Experience with the first 250 endometrial resections for menorr hagia. Lancet 337 (4): 1074--1078, 1991. Garry R, Erian J, Grochmal SA: A multi--centre collaborative study into the treatment of menorrhagia by Nd: YAG laser ablation of the endometrium. Br J Obstet Gynaecology 98: 357--362, 1991. Garry R: Endometrial laser ablation. In Endometrial Ablation. Edited by BV Lewis, AL Magos. New York, Churchill-- Livingstone, 1993, pp 67--81. Corson SL, Books PG: Resectoscopic myomectomy. Fertil Steril 55: 1041, 1991. Donnez J, Nisolle M, Gillerot S, et al : Hysteroscopic surgery with the Nd: YAG laser. Gynaecol Endose 2 (3) 121--129, 1993. Wamsteker K, de Blok S: Resection of intrauterine fibroids. In Endometrial Ablation. Edited by BV Lewis, AL Magos. New York, Churchill Livingstone, 1993, pp 161--170. Wamsteker K, de Blok S, Gallinat A, et al: Fibroids. In Endometrial Ablation. Edited by BV Lewis, AL Magos. New York, Churchill Livingstone, 1993, pp 171--181. Hucke J, Campo RL, Bruyne de F, et al: Die hysteroskopische Resektion submukoser Myome. Geburtshilfe Frauenheilkd 52: 214--218, 1992. Gallinat A, Lueken RP: Laser Technique versus Electrosurgery in the Hysteroscopic Treatment of Submucous Fibroids. In Hysteroscopy Update. Edited by JM Phillips, RB Hunt, FD Loffer. Santa Fe Springs, AAGL Publications Corporation, 1997, pp 65--66. Gallinat A, Lueken RP: Removal of Submucous Myomata with Intramural Parts. In Hysteroscopy Update. Edited by JM Phillips, RB Hunt, FD Loffer. Santa Fe Springs, AAGL Publications Corporation, 1997, p 85. Goldfarb HA: Comparison of CO2 and Continuous--Flow Technique for Office Hysteroscopy. In Hysteroscopy Update. Edited by JM Phillips, RB Hunt, FD Loffer. Santa Fe Springs, AAGL Publications Corporation, 1997, pp 25--27. Gallinat A: Carbon Dioxide Hysteroscopy: Principles and Physiology. In Hysteroscopy, Principles and Practice. Edited by AM Siegler, HJ Lindemann. Philadelphia, J.B. Lippincott, 1984, pp 45--47. DcCherney AH: Treatment of Irregular Menstrual Bleeding by Hysteroscopic Resection of Submucous Myomas and Polyps. In Hysteroscopy, Principles and Practice. Edited by AM Siegler, HJ Lindemann. Philadelphia, J.B. Lippincott, 1984, pp 138--139. Goldrath MH, Fuller TA, Segal S: Laser photovaporization of endometrium for the treatment of menorrhagia. Am J Obstet Gynecol 140: 14, 1981 Lueken RP, Gallinat A, Möller CP: The Aplication of the Nd: YAG Laser in CO2 Hysteroscopy. In Lasers in Gynecology. Edited by G Bastert and D Wallwiener. Berlin, Springer--Verlag, 1992, pp 203--210.

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