Bipolar electrosurgical loop excision procedure for cervical intraepithelial neoplasia.

OBJECTIVES: We sought to determine the safety and efficacy of a bipolar electrosurgical loop excision instrument in the diagnosis and treatment of cervical intraepithelial neoplasia (CIN). MATERIALS AND METHODS: Twenty-eight patients underwent treatment for CIN using a 20 x 10-mm bipolar electrosurgical loop device (Valley Forge Scientific, Oaks, PA). A Malis (Valley Forge Scientific) electrosurgical generator unit (60 watts cutting) was used to remove the cervical lesion and transformation zone under colposcopic guidance. Specimens were evaluated for histopathological diagnosis, tissue depth, fragmentation of specimens, mean maximal thermal artifact, and mean maximal endocervical and ectocervical thermal artifact. RESULTS: Final pathology from bipolar electrosurgical loop excision revealed CIN3 (8), CIN2 (4), CIN1 (11), human papillomavirus changes (3), and normal findings (2). Mean operating time was less than 15 minutes, and mean estimated blood loss was less than 10 ml. Average number of tissue pieces was 1.6 (range, 1-4). No complications occurred. Mean maximal thermal artifact was 0.318 mm. Mean endocervical mucosal and ectocervical mucosal thermal artifacts were 0.177 mm and 0.176 mm, respectively. Mean tissue depth of the excised specimen was 0.40 cm. Histopathological diagnosis was possible on all specimens. In five specimens (17.9%), evaluation of the cauterized endocervical margin for CIN was not possible, owing to thermal artifact. No correlation was observed between tissue depth and thermal artifact. CONCLUSION: Bipolar electrosurgical loop excision for the treatment of CIN is a safe and effective alternative to the traditional unipolar electrosurgical loop excision. Thermal artifact did not interfere with histopathological diagnosis, and the presence of artifact at cauterized margins was similar to that reported for historically unipolar specimens. A randomized control trial comparing therapeutic effectiveness of bipolar electrosurgical loop excision and unipolar electrosurgical loop excision is planned.

The importance of management information systems in a managed care environment.

Keys to successful information systems for home care providers are planning and control. With managed care's emphasis on data, agencies need to have information systems that can handle the demands managed care puts on agencies today--planning before hurrying to install a system will ensure control as the managed care contracts add up.