title: Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study.
abstract: OBJECTIVE
  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 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 microablative fractional CO2 laser can produce a remodeling of vaginal connective tissue without causing damage to surrounding tissue.
authors.affiliation: 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.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvatore
authors.forename: Umberto
authors.initials: U
authors.lastname: Leone Roberti Maggiore
authors.forename: Stavros
authors.initials: S
authors.lastname: Athanasiou
authors.forename: Massimo
authors.initials: M
authors.lastname: Origoni
authors.forename: Massimo
authors.initials: M
authors.lastname: Candiani
authors.forename: Alberto
authors.initials: A
authors.lastname: Calligaro
authors.forename: Nicola
authors.initials: N
authors.lastname: Zerbinati
mesh_terms: D000368:Aged; D059268:Atrophic Vaginitis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery; D017698:Postmenopause; D011446:Prospective Studies; D014621:Vagina / Q000473:pathology / Q000601:surgery; D014848:Vulvovaginitis / Q000473:pathology / Q000601:surgery*