Hysteroscopic Endomyometrial Resection Research Articles

Hysteroscopic surgery does not adversely affect the long-term prognosis of women with endometrial adenocarcinoma

Study objective To determine the effect of hysteroscopic surgery on the long-term clinical outcome of women diagnosed with endometrial cancer. Design Prospective cohort study (Canadian Task Force classification II-3). Setting University-affiliated teaching hospital. Patients From January 1990 through December 2005, the principal author (GAV) performed primary hysteroscopic surgery in 3401 women with abnormal uterine bleeding. Among these women, there were 16 occult and 3 known endometrial cancers. Interventions All women underwent hysteroscopic evaluation and partial (n = 8) or complete (n = 11) rollerball electrocoagulation and/or endomyometrial resection. After diagnosis of endometrial malignancy, women were counseled regarding their disease and management, in accordance with established clinical practice guidelines. Follow-up ranged from 1 to 14 years and was conducted by office visits and telephone interviews. Measurements and main results Among the 3401 women, there were 19 women with endometrial adenocarcinoma, 3 of whom were known to harbor cancer before hysteroscopic surgery. One woman refused hysterectomy and remains alive and well 5 years after total hysteroscopic endomyometrial resection. Two women wished to maintain fertility; 1 consented to hysterectomy after incomplete resection of her lesion. The other was treated with progestins. Her cancer reverted to complex hyperplasia, and she requested hysterectomy 4 years later. No residual cancer was found. After 5 years of follow-up, 1 patient died from carcinoma of the gallbladder (2 years), and 2 died at 4 years; 1 at the age of 87 years of natural causes and the other at the age of 86 years from acute renal failure unrelated to her cancer. Fourteen women remain alive and well at 5 to 14 years of follow-up. Two additional women remain alive and well at 1 and 4 years of follow-up. Conclusion Resectoscopic surgery did not adversely affect the 5-year survival and the long-term prognosis in 14 women with endometrial cancer.

Endometrioid adenocarcinoma treated by hysteroscopic endomyometrial resection

A 53-year-old multiparous woman, with no identifiable risk factor for endometrial cancer, presented with menorrhagia. She had been treated with oral contraceptives for 3 years. Office endometrial biopsy indicated well-differentiated villoglandular adenocarcinoma of the endometrium. The patient refused hysterectomy and would consent only to hysteroscopic resection. She remains alive and well, with no clinical evidence of recurrence 5 years after resection. We propose that skillful resectoscopic surgery, under specific circumstance, may be an appropriate alternative treatment to hysterectomy for some early uterine malignancies.

Hysteroscopic endomyometrial resection may be an effective therapy in patients with atypical endometrial hyperplasia

Hysteroscopic endomyometrial resection may be an effective therapy in patients with atypical endometrial hyperplasia

Reoperative Hysteroscopic Surgery in the Management of Patients Who Fail Endometrial Ablation and Resection

Study Objective To determine the safety and efficacy of reoperative hysteroscopic surgery for women who fail endometrial ablation and resection. Design Retrospective chart review and follow-up (Canadian Task Force classification II–2). Setting Private office practice. Patients Twenty-six women who had undergone endometrial ablation or resection and experienced failure characterized by intolerable pain, bleeding, or asymptomatic hematometra. Intervention Sonographically guided hysteroscopic endomyometrial resection. Measurements and Main Results Mean length of time from initial treatment for abnormal uterine bleeding and reoperative hysteroscopic surgery was 41.2 ± 47.9 months. Five (19.2%) women required simple dilatation and 21 (80.8%) required endocervical resection to achieve access to the uterine cavity. There were no operative complications. Mean operating time was 20.3 ± 9.5 minutes. Mean specimen weight was 6.7 ± 4.9 g. Adenomyosis was present in 15 (57.7%) specimens. Women were followed for a mean of 23.2 ± 22.7 months. Twenty-three (88.5%) achieved satisfactory results and avoided hysterectomy. Three women (11.5%) eventually required hysterectomy because of recurrent pain or bleeding. Conclusion Reoperative hysteroscopy is useful in managing women after failed endometrial ablation and resection. It produces excellent results in achieving amenorrhea and relief of cyclic pelvic pain, thereby avoiding hysterectomy in most patients.

Hysteroscopic endomyometrial resection: Where have we been? Where are we going?

International Journal of Gynecology & ObstetricsVolume 70, Issue S2 p. B95-B95 Panel Hysteroscopic endometrial ablation Hysteroscopic endomyometrial resection: Where have we been? Where are we going? M. Wortman, M. WortmanSearch for more papers by this author M. Wortman, M. WortmanSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)85234-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS22000Pages B95-B95 RelatedInformation

Experience with Isotonic 2.2% Glycine as Distension Medium for Hysteroscopic Endomyometrial Resection

The feasibility of performing hysteroscopic endomyometrial resection using isotonic 2.2% glycine as distension medium was studied in 181 consecutive operations. A standard continuous flow loop-resectoscope was used. Distension was achieved by means of a gravity-fed system and glycine flowed out under its own pressure. The mean (±SEM) glycine deficit was 160 ± 20 ml and in only 7 patients was it >1 liter (maximum 1,800 ml). Only in patients with >1 liter glycine absorption was there a significant decrease in serum sodium level (mean 9 mmol/l), while serum osmolality remained normal. Apart from 1 case of transient nausea, these patients had no sequelae. We experienced isotonic 2.2% glycine as a useful and safe distending medium for operative hysteroscopy.

Relationship of endometrial thickness with the menstrual timing of leuprolide acetate administration for preoperative preparation for hysteroscopic surgery

To assess the relationship of menstrual timing of administration of gonadotropin-releasing hormone (GnRH) agonist on the effectiveness of endometrial thinning and unwanted uterine bleeding. Prospective observational study. Gynecology department of a community hospital. One hundred consecutive women in a private practice, without submucous myomas, scheduled for transcervical endomyometrial resection or ablation. A GnRH agonist was administered at an unspecified time of the menstrual cycle. Transcervical hysteroscopic endomyometrial resection or ablation was performed 1 month later. No significant statistical differences were seen in either the effectiveness of endometrial thinning or the occurrence or severity of unwanted uterine bleeding. A GnRH agonist as pretreatment for endomyometrial resection or ablation can be administered at any time during the menstrual cycle with similar efficacy. Timing of surgery can be at the mutual convenience of patient and physician.

An interaction between danazol and warfarin in women with menorrhagia treated for thinning the endometrium prior to resection

Six patients on long‐term anticoagulant therapy with warfarin, and suffering from menorrhagia, underwent hysteroscopic endomyometrial resection. They received 600 mg danazol daily preoperatively for 4 weeks to suppress the endometrium. The simultaneous use of danazol and warfarin potentiated the anticoagulation effect of warfarin, the mean reduction of warfarin dosage being 52%. Three patients out of six experienced bleeding complications because of increased anticoagulation, two of them postoperatively. One patient experienced excessive bleeding after having danazol continued postoperatively. Patients on warfarin therapy who are prescribed danazol must be monitored closely to avoid excessive anticoagulation and subsequent bleeding in hysteroscopic surgery. Concomitant use of these drugs postoperatively must be avoided.

Hysteroscopic endomyometrial resection for the treatment of menorrhagia — follow-up of 86 cases

Objective: The aim of the study was to determine the effectiveness of hysteroscopic endomyometrial resection in the treatment of menorrhagia. Study Design: Eighty-six women with menorrhagia underwent hysteroscopic endomyometrial resection between November 1990 and November 1993. The surgery was carried out under spinal anesthesia in 54 (64%) of the patients. A standard resectoscope was used and the uterine cavity distended with 2.2% glycine. The mean follow-up period was 22 months (range 4–39). Results: No major complications occurred and no fluid overload was reported. One episode of uterine perforation, one of pelvic infection, five episodes of postspinal headache and four of hematometra were recorded. Hysterectomy was performed in five cases. Follow-up information was available on 79 (92%) patients. Amenorrhea was achieved in 20 (25%) patients and hypomenorrhea in 44 (56%) patients. Only three (4%) patients showed no improvement in menstrual flow. Conclusions: Hysteroscopic endomyometrial resection is a safe and effective mode of treatment for menorrhagia in selected patients.

Hysteroscopic Endomyometrial Resection for the Treatment of Menorrhagia in Patients with Major Medical Diseases

The aim of this study was to determine the effectiveness and safety of hysteroscopic endomyometrial resection in the treatment of menorrhagia in patients unfit for major surgery or general anesthesia. Twenty-one patients with major medical diseases, including patients with severe heart or vascular diseases and patients suffering from mental retardation or cerebral palsy, were treated between November 1990 and October 1994. A standard resectoscope was used, and the uterine cavity was distended with 2.2% glycine. The procedure was carried out under spinal anesthesia in 11 (52%) of the patients. Seventeen (85%) of 20 patients with follow-up (mean 17 months) reported amenorrhea or hypomenorrhea. Resection was repeated in 3 patients, 2 of whom had hematometra. One uterine perforation in the cervix dilatation phase occurred. During the surgery, no fluid overload and only a single hemorrhage in excess of 600 mL were reported. In conclusion, hysteroscopic endomyometrial resection appears to be a safe and effective alternative for high-risk patients with menorrhagia. (J GYNECOL SURG 11:221, 1995)