Energy systems for operative hysteroscopy.

The use of energy to perform intrauterine surgery can be broken down into three fundamental elements: delivery, transmission, and tissue strike. Thermal delivery devices, including monopolar or bipolar electrodes and quartz fibers, transmit energy either directly or indirectly to tissue. Transmission is unaffected, facilitated, or deterred by the distention medium that fills the intrauterine cavity. The final targeted-tissue effects represent the complex summation of energy type and concentration; treatment time; tissue constituents and hydration; and the convective currents created by tissue vascularity and circulating distention medium. Efficiency, safety, and efficacy are inextricably linked to the thoughtful orchestration of all of these elements. The responsibilities to know how and why are only stepping stones to attaining the best surgical result. We are reminded that surgery transcends technique only when experience and judgment are coupled with fundamental knowledge. Only then can science become art in the hands of the hysteroscopic surgeon.