74: Hysteroscopy for Selective Removal of Residual Trophoblastic Tissue

Abstract

To assess the role of selective removal of residual trophoblastic tissue by hysteroscopy compared to conventional, non-selective, blind vacuum suction and curettage. Prospective non-randomized study. University hospital. Forty-four consecutive patients with residual trophoblastic tissue after a suction curettage for abortion or miscarriage were enrolled. Preoperative assessment was based on a sonographic triage (transvaginal sonography with Color-Doppler imaging and/or sonohysterography). Selective removal of residual trophoblastic tissue was performed by hysteroscopy. Operative hysteroscopy was performed by using the Bettocchi continuous-flow 5-mm office hysteroscope with a 5-F operative channel for crocodile forceps, or the 27-F resectoscope (Storz), by the cold use of the electrical loop. Intrauterine pressure was set on 50 mmHg. Conventional, non-selective, blind removal was performed by using vacuum suction and curette. Eighteen patients underwent traditional curettage and 26 underwent hysteroscopy. Demographic data were similar in both groups with no differences in age, gravity, parity and previous abortion. Mean duration of hysteroscopy was 24±13min. Four patients (28%) who underwent conventional blind removal later required hysteroscopic removal due to persistent residual trophoblastic tissue. None of those who underwent directed, selective removal by hysteroscopy needed further surgery. No surgical complications occurred in both groups. Cold removal by using electric resectoscopic loops or hysteroscopic forceps, properly used at low intrauterine pressure, proved to be a safe and useful procedure for removal of retained residual trophoblastic tissue. This procedure reduces the high risk of persistent residual trophoblastic tissue by conventional blind suction, which may compromise further fertility.