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Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue

an ex vivo study

Salvatore, Stefano MD1; Leone Roberti Maggiore, Umberto MD1; Athanasiou, Stavros MD2; Origoni, Massimo MD1; Candiani, Massimo MD1; Calligaro, Alberto MD3; Zerbinati, Nicola MD4

doi: 10.1097/GME.0000000000000401
Original Articles

Objective 2 laser">Microablative fractional CO2 laser has been proven to determine tissue remodeling with neoformation of collagen and elastic fibers on atrophic skin. The aim of our study is to evaluate the effects of 2 laser">microablative fractional CO2 laser on postmenopausal women with vulvovaginal atrophy using an ex vivo model.

Methods This is a prospective ex vivo cohort trial. Consecutive postmenopausal women with vulvovaginal atrophy managed with pelvic organ prolapse surgical operation were enrolled. After fascial plication, the redundant vaginal edge on one side was treated with CO2 laser (SmartXide2; DEKA Laser, Florence, Italy). Five different CO2 laser setup protocols were tested. The contralateral part of the vaginal wall was always used as control. Excessive vagina was trimmed and sent for histological evaluation to compare treated and nontreated tissues. Microscopic and ultrastructural aspects of the collagenic and elastic components of the matrix were studied, and a specific image analysis with computerized morphometry was performed. We also considered the fine cytological aspects of connective tissue proper cells, particularly fibroblasts.

Results During the study period, five women were enrolled, and 10 vaginal specimens were finally retrieved. Four different settings of CO2 laser were compared. Protocols were tested twice each to confirm histological findings. Treatment protocols were compared according to histological findings, particularly in maximal depth and connective changes achieved. All procedures were uneventful for participants.

Conclusions This study shows that 2 laser">microablative fractional CO2 laser can produce a remodeling of vaginal connective tissue without causing damage to surrounding tissue.

From the 1Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy; 2Urogynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece; 3Department of Experimental Medicine, Histology, and Embryology, University of Pavia, Pavia, Italy; and 4Department of Dermatology, University of Insubria, Varese, Italy.

Received August 27, 2014; revised and accepted October 28, 2014.

Funding/support: None.

Financial disclosure/conflicts of interest: S.S., A.C., and N.Z. have had financial relations (expert testimonies and lectures) with DEKA Laser. The other authors report no potential conflicts of interest.

Address correspondence to: Umberto Leone Roberti Maggiore, MD, Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Via Olgettina 58-60, Milan 20132, Italy. E-mail:

© 2015 by The North American Menopause Society.