Bipolar Resectoscope Research Articles

Predictors of Infused Distending Fluid Volume in Hysteroscopic Myomectomy.

Background and Objectives: The use of a bipolar resectoscope has become popular due to the lower risk of hyponatremia. However, gynecologists might overlook the risk of water intoxication. Water intoxication is associated with the infusion of distending fluid. We were interested in the prediction of the infused distending fluid volume in the era of bipolar hysteroscopy. Thus, the aim of this study was to identify the predictors of the infused distending fluid volume for hysteroscopic myomectomy. Materials and Methods: All consecutive women who underwent monopolar (n = 45) or bipolar (n = 137) hysteroscopic myomectomy were reviewed. Results: Myoma diameter (cm, coefficient = 680 mL, 95% confidence interval (CI) = 334-1025 mL, p <0.001) and bipolar hysteroscopy (coefficient = 1629 mL, 95% CI = 507-2752 mL, p = 0.005) were independent predictors of infused distending fluid volume. A myoma diameter ≥4.0 cm was the optimal cutoff value to predict the presence of >5000 mL of infused distending fluid. One woman in the bipolar group developed life-threatening water intoxication. Conclusions: Myoma diameter is associated with an increase in infused distending fluid volume, especially for myomas ≥4 cm. Meticulous monitoring of the infused distension fluid volume is still crucial to avoid fluid overload during bipolar hysteroscopic myomectomy.

Combined hysteroscopic Bigatti shaver (IBS) and resectoscope removal of a heterotopic cesarean scar pregnancy in the first trimester

To report a case of heterotopic cesarean scar pregnancy reduction using a combined hysteroscopic integrated Bigatti shaver (IBS) and resectoscope with the preservation of a normal gestational sac in the uterine cavity under simultaneous transabdominal ultrasound guidance. Video article. University-affiliated hospital. A 30-year-old woman, G5P2A2L2, with two previous cesarean deliveries and a history of fertility problems, was admitted with a heterotopic cesarean scar pregnancy at 7+2 gestational weeks. Ultrasound examination showed a dichorionic diamniotic pregnancy. The first gestational sac (1.7 × 1.7 × 0.6 cm) was located in the previous hysterotomy scars, with a thin layer of myometriummeasuring 0.2 cm in thickness and a rich blood supply. The second chorionic sac (2.8 × 2.4 × 1.8 cm) was observed at the uterine fundus. Normal cardiac activity and yolk sacs were observed in both gestational sacs. The couple strongly desired to preserve the intrauterine pregnancy. After Institutional Review Board approval was obtained, a hysteroscopic IBS combined with a bipolar resectoscope was used to remove the heterotopic cesarean scar pregnancy while preserving the intrauterine gestational sac under simultaneous transabdominal ultrasound guidance. The heterotopic cesarean scar pregnancy was completely resected using hysteroscopy, and the gestational sac in the uterine cavity was successfully preserved. Trophoblastic tissue was confirmed using histopathological examination. The patient had an unremarkable postoperative recovery. Subsequent serial ultrasonography confirmed a single ongoing pregnancy with normal growth parameters and a normal placental site. The inability of an IBS to perform coagulation can be offset by its combination with the bipolar resectoscope. Hysteroscopic IBS combined with resectoscope to remove a heterotopic cesarean scar pregnancy offers a short operation time and minimum blood loss. It could be an optimized approach for the management of heterotopic cesarean scar pregnancy in the first trimester when an intrauterine pregnancy needs to be preserved.

Primary Resectoscopic Treatment of First-Trimester Miscarriage

ObjectivesTo determine the feasibility and safety of resectoscopic treatment for uterine evacuation of first-trimester miscarriage. MethodsA single-centre prospective study performed between April 2021 and October 2021 at a university-affiliated tertiary medical centre. Patients diagnosed with early miscarriage of up to 12 weeks from the last menstrual period were eligible for participation. Recruited patients underwent hysteroscopic uterine evacuation under general anaesthesia by a Versapoint 2 bipolar resectoscope 24Fr (Johnson and Johnson, Germany). ResultsA total of 15 patients were recruited for the study. The procedural characteristics as well as intra- and postoperative adverse events were recorded. The mean duration of the procedure was 14.3 ± 3.7 minutes. The achievement of complete evacuation was recorded in all cases, and no adverse events occurred during any procedure. Post-procedure follow-up 6 weeks after treatment was conducted by office hysteroscopy in 10 women and by ultrasonography in 4 women. One woman had conceived prior to her scheduled follow-up visit. In total, 2 (13.3%) cases of retained products of conception were diagnosed during office hysteroscopy and they were removed by the “see-and-treat” technique without anaesthesia. The diagnosis was confirmed pathologically. No intrauterine adhesions were detected and none of the women required a second hysteroscopy under anaesthesia due to retained products of conception. ConclusionsHysteroscopic evacuation of first-trimester miscarriage by a standard resectoscope is a safe and feasible technique.

Operative hysteroscopy versus ultrasound-guided electric vacuum aspiration for removal of retained products of conception: A prospective cohort study

ObjectivesTo compare intrauterine adhesion (IUA) formation after hysteroscopic removal (HR) of retained products of conception (RPOC) with IUA formation after ultrasound-guided electric vacuum aspiration (EVA) and externally validate the outcomes of an RCT. Study designThis prospective cohort study was conducted from April 2015 until June 2022 in 2 Dutch teaching hospitals and one Belgian university hospital. Women opting for EVA underwent the procedure as soon as possible. In the HR group, the therapeutic hysteroscopy was performed at least eight weeks after the end of pregnancy. Postoperatively, an office second-look hysteroscopy was offered to all patients. Women were included if they had been diagnosed with RPOC ranging from 1 to 4 cm on ultrasound and did not want to participate in the RCT. EVA was performed using a Karman cannula. Operative hysteroscopy consisted either of hysteroscopic morcellation with the TruClear™ System or the Intrauterine BIGATTI Shaver or cold loop resection with a bipolar resectoscope. ResultsOf 178 included women, 124 were treated with HR and 28 with EVA. Outcomes of HR and EVA did not differ significantly in terms of complications (5.6 % vs 3.6 %; p = 1.00). Second-look hysteroscopy showed IUAs in 14 of 91 women (15.4 %) after HR and in 1 of 16 (6.3 %) after EVA (p = .461). Completeness of removal was significantly higher (90.1 %) after HR than after EVA (68.8 %) (p = .035). Additional operative hysteroscopy was required in 14.3 % of the HR group versus 37.5 % in the EVA group (p = .036). ConclusionIn our cohort study, no significant differences in IUAs or complications were found. RPOC removal with HR was more often complete than removal with EVA, and additional therapeutic hysteroscopy was less frequently required after HR. These findings need to be correlated with those of RCTs. Clinical trial registrationThe study was registered in de Dutch Trial Register (NTR4923). Date of registration 23-11-2014. Date of first enrollment 01-01-2015. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923

Hysteroscopic removal of a heterotopic cervical pregnancy to preserve a patient’s intrauterine sac

To introduce a case of removing the heterotopic cervical pregnancy while preserving the normal gestational sac in the uterine cavity by hysteroscopic surgery under ultrasound guidance. Video description of the case and surgical procedure. Hospital affiliated to university. A 35-year-old woman, G7P1A5L1, was admitted with a heterotopic cervical pregnancy 21 days after IVF-ET (the corrected gestational age was 5+2 weeks). The serum β-hCG level was 24,530.00 mIU/ml at the corrected gestational age of 5+3 weeks. The ultrasound examination on the day of admission showed that there was a gestational sac in the cervical canal (1.5×0.8×0.5 cm, yolk sac visible) and another sac in the intrauterine cavity (1.2×1.2×1.1 cm, yolk sac visible). The pregnant woman and her partner strongly urged the removal of the cervical gestational sac and continuing the intrauterine pregnancy to term. After the Institutional Review Board (IRB) approval was obtained, hysteroscopic surgery with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the heterotopic cervical pregnancy while preserving the intrauterine gestational sac. The heterotopic cervical pregnancy was completely resected by hysteroscopy, and the normal gestational sac in the uterine cavity was successfully preserved. Ultrasound-guided hysteroscopic surgery allowed us to successfully preserve the intrauterine pregnancy while removing the cervical pregnancy completely. During the operation, the dilation pressure and the flow rate of the dilation fluid was kept as low as possible to avoid excessive intrauterine pressure and excessive dilation fluid entering the intrauterine cavity, which could have had adverse effects on the intrauterine pregnancy sac. No surgical-related or anesthesia-related complications occurred. The pathological results confirmed placental villi and decidual tissue. The One-month follow-up ultrasonography showed a live single intrauterine pregnancy with cardiac activity. Hysteroscopic removal of a heterotopic cervical pregnancy under ultrasound guidance can be safely performed while successfully preserving an ongoing intrauterine pregnancy.

Comparing Hysteroscopic Morcellation with Bipolar Resectoscope for Treating leiomyoma

Comparing Hysteroscopic Morcellation with Bipolar Resectoscope for Treating leiomyoma

Successful Hysteroscopic Management of Cesarean Scar Defect Pregnancy

A 30-year-old multipara of 2 with history of 1 cesarean delivery, presented to the emergency department (ED) with one day of pelvic pain and vaginal bleeding. A positive β-human chorionic gonadotropin (β-hCG) blood test (215 mUI/mL) had been obtained 20 days prior. Upon admission, she was hemodynamically stable, and the physical exam showed no cervical changes or active bleeding. Transvaginal Ultrasound (TVUS) performed in the ED revealed a gestational sac (GS) implanted in the uterine isthmus, with a 6.7 mm embryo without cardiac activity. She was admitted for further evaluation. Formal TVUS (Figure 1) revealed an apparent cesarean scar defect (CSD) containing a 6 mm embryo without cardiac activity. Trophoblast tissue extended towards the defect, and the myometrial residual thickness (MRT) measured 1.4 mm. Adnexa appeared normal. Serial β-hCG levels were obtained, resulting on 2,177 on admission, 1,972 on the second, and 1,924 mUI/mL on the fourth day. Based on these findings, diagnosis of CSD pregnancy was made. Hysteroscopic management (Figure 2) was decided and successfully performed under regional anesthesia and continuous ultrasound guidance. Complete resection of the GS occupying the CSD was achieved using a bipolar resectoscope. Post-procedure, the patient received a prophylactic dose of Methotrexate (100 mg IM), an etonogestrel implant was inserted, and was discharged without incidents the day following surgery. The pathology report confirmed the diagnosis. On follow-up 12 days after surgery, patient was asymptomatic, β-hCG levels resulted 7.4 mIU/mL, and on a 6-month follow-up visit, was discharged to primary healthcare. Reasonable evidence supports hysteroscopic management of CSD pregnancy, with the benefit of direct visualization (1, 2, 3). Other techniques, like use of a double balloon catheter have been described (4). Hysteroscopy was chosen despite of the MRT (5), with staged laparoscopic repair due to an unclear fertility desire.

Incidence of Intrauterine Adhesions After Hysteroscopic Myomectomy in Patients Seeking Fertility

To study the incidence of intrauterine adhesions (IUAs) after hysteroscopic myomectomy. Previous studies report a range of incidence for IUAs after hysteroscopic myomectomy. A retrospective review study. An academic community hospital in the Boston metropolitan area. Patients undergoing hysteroscopic myomectomy at our institution from January 2019 to February 2022. Patients were excluded if they did not have plans for future fertility or had a new diagnosis of cancer. All patients underwent hysteroscopic myomectomy using bipolar resectoscope without postoperative medical or barrier treatment. All procedures were performed by 1 of 4 fellowship-trained high-volume gynecologic surgeons with resident and fellow assistance. Incidence of postoperative IUAs was assessed and treated using second-look office hysteroscopy. A total of 44 patients without preoperative IUAs underwent hysteroscopic myomectomy during our study period, and 4 patients (9.1%) developed new IUAs. Among 9 patients who were found to have preoperative IUAs and underwent concurrent hysteroscopic myomectomy and lysis of adhesions, we found a recurrence of IUAs in 5 patients (55.6%). We found the number, size, and deepest type of myoma removed were not correlated to an increased risk of new IUA formation. In addition, removing myomas on opposing walls during the same operation did not increase the incidence of new IUAs. Formation of IUAs after hysteroscopic myomectomy is a well-documented consequence. Our reported incidence of 9.1% of new IUAs that are not affected by the number, size, deepest type of myoma resected, and resection of myomas on opposing uterine walls contributes to the current literature. In addition, our finding of 55.6% of recurrent IUAs in patients undergoing both hysteroscopic myomectomy and lysis of adhesions highlights a high-risk population requiring additional study.

Comparison Between Scissors and Resectoscope in Resection of Uterine Septum

Background: Septate uterus is a common congenital uterine malformation. It is due to abnormal resorption of the Mullerian canal in embryonic life. Poor reproductive outcomes (e.g., abortion and preterm births) are associated with septate uterus.&#x0D; Aim of the work: The present study aimed to compare scissors and resectoscope regarding the efficacy and safety in resection of uterine septum.&#x0D; Patients and Methods: This study was conducted in the outpatient clinic of Al-Azhar University Hospital (New Damietta) from December 2017 to October 2020. Women were assigned into one of the two groups. The first included fifteen women, who underwent septoplasty by scissor and the Group II included fifteen women who were submitted to septoplasty by bipolar resectoscope.&#x0D; Results: Group (I) had a higher pain score in group I than group II with a significant difference. Mild pain was reported in 10 cases (66.7%) in group I and 4 (26.7%) in group II. However, moderate pain was reported for 5 cases (33.3%) and 11 cases (73.3%) in groups I and II, respectively, with a statistically significant difference. However, both groups were comparable regarding patient characteristics, operative data, postoperative complications and postoperative results of hysteroscopy, three months after the resection of the uterine septum.&#x0D; Conclusion: Scissor is preferred over the bipolar resectoscope especially in thin septum. It is associated with comparable outcome to the bipolar resectoscope. However, bipolar resectoscope was associated with significantly higher pain scores than scissors.

The influence of different methods of hysteroscopic metroplasty using a bipolar resectoscope on the restoration of reproductive function in women with a septate uterus

Uterine septum is the most common congenital anomaly of the uterus, accounting for 35% of all diagnosed malformations. Data on the effectiveness of restoring reproductive function in women with a septate uterus after hysteroscopic metroplasty are contradictory, there are no data on the comparison of reproductive results after removal and dissection of the septum using a bipolar hysteroresectoscope. The purpose of the study was to assess the effectiveness of reproductive function recovery after dissection and removal of the uterine septum using a bipolar hysteroresectoscope. Material and methods. 78 patients of group B with uterine septum, reproductive failure, bipolar hysteroscopic metroplasty were under observation. Among the examined patients, 39 suffered from miscarriage and 39 suffered from infertility. 37 women of the BI group underwent hysteroscopic bipolar dissection of the uterine septum; 41 women of the BII group underwent hysteroscopic bipolar resection of the septum. Results and their discussion. Within 2 years after metroplasty, pregnancy occurred in 86.49% of women in the BI group and in 100% of women in the BII group (p&gt;0.05); the specific weight of miscarriages was 9.38% and 0.00%, respectively (p&gt;0.05); childbirth - 58.88% and 70.97% (p&gt;0.05); premature births – 17.65% and 6.45% (p&gt;0.05); term deliveries - 38.24% and 64.52% (p&lt;0.04, SD 0.34 [0.12-0.93]). In women with initial infertility, pregnancy occurred in 61.54% of women in the BI group (n=13) within 2 years after the operation, in 69.23% in the BII group (n=13) (p&gt;0.05); the specific weight of miscarriages was 25.00% and 22.22%, respectively (p&gt;0.05); childbirth - 75.00% and 77.78% (p&gt;0.05); premature births – 12.50% and 11.00% (p&gt;0.05); term deliveries - 62.50% and 66.67% (p&gt;0.05). Analysis of recovery of reproductive function 2 years after surgery in women with initial miscarriage showed that 90.48% of women in the BI group became pregnant, 94.44% in the BII group (p&gt;0.05); the specific weight of miscarriages was 31.58% and 11.76%, respectively (p&gt;0.05); childbirth - 68.42% and 88.24% (p&gt;0.05); premature births – 26.32% and 5.88% (p&gt;0.05); term deliveries - 42.11% and 82.35% (p&lt;0.02, SD 0.16 [0.03-0.73]). Conclusions. The use of the technique of removal of the uterine septum during bipolar hysteroresectoscopy compared to the technique of its dissection in women with a septate uterus and reproductive failure leads to a probable increase in the termination of pregnancy by term delivery both in the general group and in the group of patients with initial miscarriage.

Hysteroscopic myomectomy with the IBS® Intrauterine Bigatti Shaver: A Retrospective Comparative Analysis of the impact of rotational speed and aspiration flow rate

Myoma removal remains a challenge hysteroscopically including for the "IBS®" Intrauterine Bigatti Shaver technique. To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology. This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size:<3 cm and 3-5 cm. Both Groups A and B were similar in terms of patient age, parity, symptoms, myoma type and size. Submucous myomas were classified according to the European Society for Gynaecological Endoscopy classification. All patients underwent a myomectomy with the IBS® under general anaesthesia. The conventional 22 Fr. Bipolar Resectoscope was used in cases requiring conversion to the resection technique. All surgeries were planned, performed and followed by the same surgeon in both institutions. Complete resection rates, total operation time, resection time and used fluid volume. Complete resection with the IBS® Shaver was seen in 93/107 (86.91%) in Group A versus 83/84 (98.8 %) in Group B (P=0.0021). Five patients (5.8%) in Subgroup A1 (<3 cm) and nine patients (42.9%) in Subgroup A2 (3cm~5cm) could not be finished with the IBS (P<0.001, RR=2.439), while in Group B only one case (8.3%) in Subgroup B2 (3cm~5cm) underwent a conversion to bipolar resectoscope (Group A: 14/107=13.08% vs. Group B: 1/84=1.19%, P=0.0024). For <3cm myomas (subgroup A1 versus B1) there was a statistically significant difference in terms of resection time (7.75±6.363 vs. 17.28±12.19, P<0.001), operation time (17.81 ± 8.18 vs. 28.19 ±17.614, P<0.001) and total amount of fluid used (3365.63 ± 2212.319 ml vs. 5800.00 ± 8422.878 ml, P<0.05) in favour of Subgroup B1. For larger myomas, a statistical difference was only observed for the total operative time (51.00±14.298 min vs. 30.50±12.122 min, P=0.003). For hysteroscopic myomectomy using the IBS®, 1,500rpm rotational speed and 500ml/min aspiration flow rate are recommended as these settings result in more complete resections compared to the conventional settings. In addition, these settings are associated with a reduction in total operating time. Reducing the rotational speed rate from 2500 rpm to 1500 rpm and increasing the aspiration flow rate from 250 ml/min to 500 ml/min improve complete resection rates and reduce operating times.

Лечение внутриматочной патологии с использованием технологий fast track хирургии

Study Objective: Evaluation of the clinical effectiveness of the use of fast track surgery technologies in the treatment of submucosal uterine fibroids and endometrial polyps Study Design: Retrospective comparative study. Materials and methods. A retrospective comparative analysis of the data of 46 women was performed to assess the clinical effectiveness of the use of fast track surgery approach to treat intrauterine pathology. The 1st group included 23 women treated with the use of fast track surgery method. The 2nd group consisted of 23 women who underwent surgery with bipolar resectoscope in the gynecological hospital setting without the use of fast track surgery approach. Study Results. The complex application of fast track surgery technology components made it possible to achieve 100% efficiency in the treatment of intrauterine pathology, decrease pain-syndrome intensity in the postoperative period in 69.57% of women, ensure early mobilization of the patients and reduce hospital stay from 2–8 inpatient days to 2–2.5 hours. Conclusion. Implementing the fast track surgery principles into the treatment of patients with intrauterine pathology makes it possible to reduce a patient’s hospital stay, allows minimizing the consequences of the surgical injury and facilitates fast recovery of a woman. Keywords: intrauterine pathology, fast track surgery, diode laser, resectoscopy.

Hystero-embryoscopy: evaluation and evacuation of spontaneous missed abortions

To demonstrate the steps for hystero-embryoscopic evaluation of a 7-week spontaneous missed abortion and evacuation of the products of conception. Illustrate the surgical technique and highlight its advantages in improving the evaluation of spontaneous missed abortions. Video case presentation and demonstration of surgical technique. Tertiary referral center. The patient provided consent for the video and its publication. Following vaginoscopy, the cervix was approached without prior blind cervical dilation. Navigation from the endocervix to the endometrial cavity was performed using a 2.9-mm diameter hysteroscope. The endometrial cavity was thoroughly inspected revealing an intact gestational sac and submucosal fibroids. An operative grasper was introduced, the chorion and amnion were penetrated, and embryoscopy was performed. In-flow was reduced for external morphological inspection of the embryo, which was then grasped and retrieved. The procedure was continued by introducing of a 26-french bipolar resectoscope, after which the products of conception were excised without electricity and sent for histologic and genetic analyses. This procedure allowed for proper embryonic evaluation and hysteroscopic evacuation of products of conception was successfully performed. Cytogenic analysis of this case revealed a female embryo with trisomy 15. No maternal and fetal cell admixture was noted in the analysis, allowing a precise diagnosis. Hystero-embryoscopy is a valuable diagnostic and therapeutic procedure for cases of missed abortion. It may reveal embryonic morphological abnormalities, expand the diagnostic spectrum in the evaluation of pregnancy loss, and avoid potential complications from blind curettage.

8886 Endometrial Wound Healing Duration after Hysteroscopic Treatment of Type 2 and 3 Myomas

<h3>Study Objective</h3> To assess the mean resolution time of the fovea after hysteroscopic treatment of type 2 and type 3 myoma. <h3>Design</h3> Prospective observational study. <h3>Setting</h3> University of Naples Federico II, Naples, Italy. <h3>Patients or Participants</h3> <b>W</b>omen aged 30-50 years, with at least one type 2 or type 3 myoma, history of infertility or uterine bleeding who underwent hysteroscopic myomectomy. <h3>Interventions</h3> <b>A</b>ll patients underwent hysteroscopic myomectomy, using a 15 Fr or 26 Fr resectoscope, either outpatient or in the operating room. All surgical procedures were performed by one expert hysteroscopist. Cold loop myomectomy applied to bipolar resectoscope was used for the removal of the intramural component of the myomas. All women underwent repeated follow-up office hysteroscopies every week after the surgical procedure for the first month and then every two weeks for the following months <h3>Measurements and Main Results</h3> Thirty-one patients with type 2 or 3 myoma with infertility (26/31) or uterine bleeding (15/31) were enrolled. The resectoscopic myomectomy was successful in all cases, without any significant complications. Overall, the mean diameter of resected myomas was 23 mm. The fovea was almost completely restored between three to six weeks after surgery in case of myomas < 2 cm and on average within 56 days for myomas of any size. The resolution was faster in women < 40 years old. No correlation was observed between the resolution time of the fovea and the different localization of the myomas <h3>Conclusion</h3> These preliminary data showed short time to resolution of the fovea in case of type 2 and 3 myomas hysteroscopically treated. The respect of the myometrium and the reduced thermal injury obtained thanks to the cold loop technique applied to bipolar resectoscope, may have influenced the resolution time of the fovea

7984 Primary Hysteroscopic Treatment of First Trimester Miscarriage Using Resectoscope - a Pilot Study

<h3>Study Objective</h3> To determine the feasibility and safety of hysteroscopic resection using standard resectoscope for uterine evacuation of first-trimester miscarriage. <h3>Design</h3> A prospective feasibility study. <h3>Setting</h3> Academic, tertiary-care medical center. <h3>Patients or Participants</h3> Women diagnosed with early miscarriage up to 12 weeks from last menstrual period. <h3>Interventions</h3> Overall, in this pilot study, 15 women were recruited for hysteroscopic evacuation of the uterine cavity between April 2021 and October 2021. All procedures were performed under general anesthesia by Versapoint 2 Bipolar Resectoscope 24Fr (J&J, Germany). <h3>Measurements and Main Results</h3> Collected data, including demographic characteristics, pregnancy-sac size and location, length of procedure, as well as intra and postoperative adverse events, were recorded. The mean duration of the procedure was 14.3 ± 3.7 minutes. Complete evacuation was recorded in all cases, and no adverse events occurred during any procedure. Post- procedure follow-up was conducted by office hysteroscopy in 10 women and by ultrasonography in 5 women. In one case, retained products of conception were diagnosed in the office hysteroscopy and were removed using the "see-and-treat" technique without anesthesia. The diagnosis was confirmed pathologically. <h3>Conclusion</h3> Hysteroscopic evacuation using resectoscope for the treatment of early miscarriage is a safe and feasible technique. Randomized trials are needed to examine the efficacy of hysteroscopic treatment compared with traditional dilation and curettage.

Hysteroscopic management of a "hernia-like" uterine myoma within the uterine cavity

To introduce a case of a uterus "hernia-like" myoma within the uterine cavity that was successfully treated with hysteroscopy. Step-by-step explanation of the case and surgical procedure using a video and slides. The Medical Ethics Committee of Women and Children's Hospital of Chongqing Medical University approved the study and decided for this video to be exempt from formal approval, and informed consent was obtained from the patient. Hospital. A 37-year-old woman, gravida 1, para 1, with a history of secondary infertility for 2 years and heavy menstrual bleeding for 7 months, which eventually resulted in anemia, was diagnosed with a type 1 (International Federation of Gynecology and Obstetrics leiomyoma subclassification system) myoma approximately 4 cm in diameter using ultrasonography. Her hemoglobin level was 8.6 g/dL (11.5-15.0 g/dL), red blood cell count was 3.6 ×10-12/L (3.8-5.1 ×10-12/L), and hematocrit was 26.7% (35%-45%). Hysteroscopic myomectomy with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the hernia-like myoma. Blunt dissection combined with oxytocin (20 U I.V.) and uterine dilation pressure reduction was used to induce the hernial content (myoma) protrusion into the uterine cavity. The hernia-like myoma was completely resected by hysteroscopy, and all symptoms disappeared. The hernia-like myoma was successfully and completely resected by hysteroscopy. The operative time was 37 minutes. No surgical-related or anesthesia-related complications occurred. During the follow-up period, the patient had regular menstrual cycles without hypermenorrhea, and her anemia had improved. The 5-month follow-up ultrasound examination and hysteroscopy revealed that the uterine cavity had recovered well. The patient conceived 7 months after the procedure and delivered at term (39 weeks 1 day) via cesarean section. A hernia-like myoma covered with endometrium is a degenerative myoma that herniates into the myometrium and forms a hernia sac-like defect. Hysteroscopy is an effective and feasible method for treating hernia-like myoma.

The Safety and Efficacy of Vela Laser En-Bloc Endoscopic Resection versus Conventional Transurethral Resection of Bladder Tumor-A Single Center Experience.

(1) Background: The current gold standard treatment of bladder cancer is conventional transurethral resection of the bladder tumor (CTURBT) using monopolar or bipolar resectoscopes. Laser en-bloc resection of the bladder tumor (LERBT) could achieve a higher quality of the specimen, reduce perioperative complications, and decrease the recurrence rate. Here, we compare the efficacy and safety of en-bloc Vela laser resection versus the conventional monopolar/bipolar resection; (2) Methods: A total of 100 clinically cT1-2 patients with bladder cancer were retrospectively reviewed in this study. Among these patients, 50 patients received LERBT, and 50 patients received CTURBT. The baseline characteristics, operation variables, and clinical outcomes were collected. The primary performance was the presence of muscle layer in the specimen. Perioperative complications and recurrence-free survival (RFS) were also compared. Independent t-test, Chi-square test, Kaplan–Meier curves, and the Cox-regression model were used in the analysis; (3) Results: The median age of the patients in the laser and resectoscope groups was 69.2 and 68.0 years old, respectively. The statistical difference in the presence of the detrusor muscle was 92.0% in the laser group and 70.0% in the CTURBT group (p = 0.005). A lower incidence of bladder perforation (p = 0.041) and major surgical complications (p = 0.046) in the LEBRT group was observed. We found no differences in operation duration, catheterization time, and hospitalization time after adjustment. Additionally, there was no statistical difference in RFS after a median follow-up time of 25 months; (4) Conclusions: Endoscopic laser en-bloc resection of bladder tumor with Vela laser is an effective method with higher muscle inclusion rate and fewer complications.

The effect of bipolar and monopolar resectoscope use on optic nerve diameter in transurethral resection of the prostate

The effect of bipolar and monopolar resectoscope use on optic nerve diameter in transurethral resection of the prostate

Resection of a Longitudinal Vaginal Septum in an Obstructed Hemi-Vagina

<h3>Study Objective</h3> The objective of this video is to review the diagnosis and management of obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) and demonstrate a technique for resection of the longitudinal vaginal septum in a patient with OHVIRA. <h3>Design</h3> Not applicable. <h3>Setting</h3> Patient was placed in lithotomy position. <h3>Patients or Participants</h3> This is the case of a 22-year-old gravida 0 who presented with pelvic pain and vaginal discharge. Her physical exam was notable for a 5 cm fluctuant mass along the right vaginal wall. A pelvic ultrasound and MRI were consistent with Obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA). OHVIRA is a rare congenital abnormality of the Müllerian ducts, characterized by didelphys uterus, unilateral blind hemi-vagina, and ipsilateral renal agenesis. <h3>Interventions</h3> This video demonstrates a technique for resection of the longitudinal vaginal septum in a patient with OHVIRA. Optimal visualization of the septum was performed using vaginoscopy. A suction bulb was used to prevent outflow from the vagina, which allowed extension of the cavity with normal saline. Additionally, a sidekick needle was inserted through the septum into the obstructed vagina. This step was performed under ultrasound guidance to confirm proper needle placement, allowing distention of the blind hemi-vagina. The vaginal septum was then incised using the bipolar resectoscope. The resection of the septum was completed vaginally using the handheld Ligasure with subsequent visualization of both cervices. <h3>Measurements and Main Results</h3> Not applicable. <h3>Conclusion</h3> Surgical management and drainage of an obstructed hemi-vagina in a patient with OHVIRA is essential for symptom control. Prevention of re-accumulation of the fluid is achieved by complete resection of the septum. This can be facilitated by injecting a distending medium into the obstructed vagina. Trans-abdominal ultrasound can be helpful in confirming proper needle placement during this step, thus preventing vaginal wall damage during resection.

Mini-resectoscopy Endometrial Biopsy Accuracy Respect Dilatation and Curettage in Endometrial Cancer: A Retrospective Analysis

<h3>Study Objective</h3> Dilatation and curettage (D&C) biopsy is a "gold standard" to confirm the histology and grade of endometrial cancer but the concordance rate was only 70% between D&C and hysterectomy. <h3>Design</h3> We retrospectively reviewed 187 cases of endometrial cancer that were treated at our institution from January 2017 to June 2019. We analyzed all patients who underwent Trans Cervical mini-Resectoscopy (TCR) or D&C biopsy at our institution and received laparoscopic/laparotomic hysterectomy or staging as the treatment by our surgical team. <h3>Setting</h3> We categorized the patients into the TCR group or the D&C group. For each group, we compared the biopsy histological grade and histology with the final hysterectomy of all patients. <h3>Patients or Participants</h3> We analyzed 187 cases of endometrial cancer aged from 29 to 81 years. <h3>Interventions</h3> TCR was carried out, with lidocaine local cervical injection and awake sedation. Resectoscopy was performed with a 7mm bipolar resectoscope. D&C was carried out in general anesthesia and the cervix is dilated up to 10mm Hegar dilators. Two different pathologies analyzed the initial and hysterectomy specimens. <h3>Measurements and Main Results</h3> Endometrial biopsy was obtained by D&C in 103 (55%) cases and by TCR in 84 (45%) of cases. the median operative time was 17,5 for TCR and 17,41 for D&C without significant differences between the two methods (p<0,99). The second stage was preoperative detective only with the use of TCR biopsy 5 (100% of cases) respect none of D&C. Among 72 patients who underwent TCR biopsy, only 4 patients have been grading misdiagnosed in the final pathology, which gives a rate of 5,5% (K 0,918 IC 95% 0,958-0,878 p<0,001). In the D&C group of 87 patients, 17 (19,5%) patients have been grading misdiagnosed (K 0,699 IC 95% 0,764 - 0,634 p<0,001). <h3>Conclusion</h3> Our data, although retrospective, demonstrate that Trans cervical mini-resectoscopy provides a more accurate reflection of FIGO grade than D&C endometrial sampling.