Hysteroscopic Morcellation Research Articles

Extent of Myometrial Resection With Various Surgical Methods for Endometrial Polypectomy Procedures

OBJECTIVE: To assess whether the frequency and extent of myometrial resection differs among surgical methods commonly used for endometrial polypectomy. METHODS: We conducted a retrospective cohort study of pathology samples from polypectomy procedures performed on patients 18–50 years of age. Samples were reevaluated by a blinded pathologist to assess the following primary outcome measures: presence and percentage of myometrium on the pathology sample, prevalence of isolated myometrium, and depth of myometrial resection. Data were evaluated using Fisher exact test and Kruskal-Wallis test, followed by multiple comparisons analysis. To maintain a familywise error rate of 5% across all four primary analyses, the Bonferroni correction method was applied. RESULTS: Of 458 pathology samples, 21.8% were obtained using hysteroscopic morcellators, 11.1% were obtained with hysteroscopic scissors, and 67.0% were obtained with hysteroscopy with dilation and curettage (D&C). Hysteroscopic morcellation demonstrated a higher prevalence of myometrium (58.0% vs 9.8% and 15.3%, for hysteroscopic scissors and hysteroscopy with D&C, respectively; P<.001), a larger percentage of pathology samples with more than 25% myometrium (26.0% vs 4.0% and 0.6%, respectively; P<.001), and a higher prevalence of isolated myometrium compared with hysteroscopy with D&C (11.0% vs 0.7%; P<.001). CONCLUSION: The presence and proportion of myometrium in polypectomy samples obtained using hysteroscopic morcellators was significantly higher compared with hysteroscopic scissors and hysteroscopy with D&C.

Optimization of intrauterine interventions in spontaneous abortion

Introduction. Retained products of conception (RPOC) are detected in 15 % of women after spontaneous or medical abortion. RPOC blind removal from the uterine cavity remains the "gold standard" of surgical treatment, which, however, may be associated with a high risk of certain complications that pose a serious threat to female reproductive function and quality of life. An alternative method for eliminating RPOC proposed by operative hysteroscopy demonstrating the visual control advantages.Aim: to evaluate clinical effectiveness and safety of RPOC removal in incomplete spontaneous abortion using hysteroscopic morcellation.Materials and Methods. The prospective comparative study included 135 women with incomplete spontaneous abortion aged 18 to 40 years, divided into 3 groups: group 1 – 42 patients after RPOC electromechanical vacuum aspiration (EVA); group 2 – 44 patients after RPOC manual vacuum aspiration (MVA); group 3 – 49 patients after RPOC hysteroscopic morcellation (HM). In all patients, the level of total endotoxin was measured, metroaspirate cytokine profile was analyzed, the indicator of endometrial microcirculation was assessed before surgical treatment and on day 1 afterwards, and genital ultrasound examination was performed on day 3–5 post-surgery.Results. In the post-surgical vs. pre-treatment period, the EVA and MVA groups revealed significantly increased levels of total endotoxin and interleukin (IL) IL-1β (p < 0.05). In contrast, these parameters in the HM group changed insignificantly (p > 0.05). In all groups, IL-8 and tumor necrosis factor alpha (TNF-α) levels after surgery were significantly elevated (p = 0.001). In the EVA and MVA groups, levels of anti-inflammatory cytokines IL-4 and IL-10 were markedly decreased (p = 0.001), which did not change in the HM group (p > 0.05). A significantly accelerated microcirculation rate was noted in the EVA and MVA groups while comparing it at pre-surgery level (p = 0.001), but not in the HM group (p = 0.415). Incomplete RPOC removal was reported for 4.5 % MVA patients, all EVA and HM patients had total RPOC elimination. Intraoperative bleeding, uterine perforation were not reported in any examined patient.Conclusion. The early-stage treatment results showed that RPOC removal by the HM is an effective and safe approach. Limited inflammatory response and stable endometrial microcirculation upon using the HM evidence about a minimal impact on the endometrium that lowers probability of postoperative adhesion.

Anesthesia-free In-office Hysteroscopic Morcellation for Endometrial Polyps: A Prospective Study.

The objective of the study was to evaluate the feasibility and quality of anesthesia-free in-office hysteroscopic morcellation for the treatment of endometrial polyps. A prospective, single-center, open-label, single-arm clinical trial was conducted to evaluate the efficacy of hysteroscopic morcellation for endometrial polyps or retained products of conception. All surgical procedures were performed using the TruClear™ 5C system in the office setting without anesthesia. The primary endpoint was the success rate of surgery, defined as the completion of the operation. The secondary endpoints were operating time, fluid deficit, adverse events, pain evaluated by Visual Analog Scale (VAS) scores, and recurrence rate. Ninety-five patients underwent hysteroscopic morcellation without anesthesia and received the treatment. The success rate of surgery was 100% (95/95), and the mean operating time was 7.3 min. Adverse events occurred in only 2.1% (2/95), with vasovagal reflex. The mean VAS scores during the procedure ranged from 2.4 to 3.1, and the recurrence rate after 6 months was 2.1% (1/47), with a pregnancy rate of 33% (11/33). When comparing nulliparous and parous patients, the success rate and the operating time were equivalent, and the mean VAS scores during the procedure were both within tolerable levels but significantly higher in nulliparous patients (3.3-4.5 vs. 1.6-1.9, P < 0.001). This study demonstrated that anesthesia-free in-office hysteroscopic morcellation for endometrial polyps can be safely performed with feasible quality and only tolerable pain. This less-invasive procedure is expected to become more widespread in future.

Hysteroscopic Morcellation of Retained Products of Conception After Conservative Management of Placenta Accreta

Hysteroscopic Morcellation of Retained Products of Conception After Conservative Management of Placenta Accreta

Prostaglandin Injection for Myoma Expulsion (PRIME): Case Series of a Novel Approach to Hysteroscopic Resection of FIGO Type 2 Myomas

Study ObjectiveTo evaluate the use of dilute carboprost tromethamine injection at the endometrium/myoma junction during hysteroscopy to facilitate myoma expulsion and removal in a single procedure. DesignCase series. SettingSingle high-volume academic medical center. PatientsSeven patients aged 32 to 51 years old with FIGO type 2 uterine myomas and symptoms of abnormal uterine bleeding or infertility undergoing hysteroscopic resection with a morcellation device from November 2022 to July 2023. InterventionDilute injection of carboprost tromethamine (10 µg/mL) at time of hysteroscopic myomectomy. Measurements and Main ResultsThe main outcome measure was ability to complete the hysteroscopic myomectomy in a single procedure using a hysteroscopic morcellator. Secondary outcomes included total operative time, fluid deficit, and postoperative pharmacologic side effects and/or surgical complications. Among our 7 patients, all had successful single procedure complete resections of myomas ranging from 0.9 to 4.6 cm in maximal diameter. Average operative time was 30 minutes, and average fluid deficit was approximately 839 mL. The carboprost dosages used ranged from 30 to 180 µg. One patient experienced prolonged postoperative nausea and vomiting that resolved with antiemetics. One patient experienced postoperative endometritis that improved with antibiotics. ConclusionIn this pilot study, injection of dilute carboprost intraoperatively facilitated one-step hysteroscopic myomectomy of FIGO 2 myomas, via enhanced extrusion of the intramural portion of the fibroid into the uterine cavity, with both short operative times and acceptable fluid deficits.

Reproductive and obstetrical outcomes after treatment of retained products of conception: hysteroscopic removal vs ultrasound-guided electric vacuum aspiration, a prospective follow-up study

BackgroundTraditionally, curettage is the most widely performed surgical intervention used to remove retained products of conception. However, hysteroscopic removal is increasingly performed as an alternative due to the potentially lower risk of intrauterine adhesions and higher rates of complete removal. Until recently, studies comparing curettage with hysteroscopic removal regarding reproductive and obstetric outcomes were limited, and data conflicting. ObjectiveTo study reproductive and obstetric outcomes in women wishing to conceive after removal of retained products of conception by hysteroscopy or ultrasound-guided electric vacuum aspiration. Study designProspective long-term follow-up study, conducted in three teaching hospitals and one university hospital. Patients were included from April 2015 until June 2022 for follow-up; either in a randomized controlled, non-blinded trial on the risk of intrauterine adhesions after removal of retained products of conception, or in a cohort alongside the randomized trial. Women with an ultrasonographic image suggestive for retained products of conception ranging from 1 to 4 cm were eligible. Surgical procedures in the randomized controlled trial consisted of hysteroscopic morcellation or ultrasound-guided electric vacuum aspiration, while in the cohort hysteroscopic treatment consisted of hysteroscopic morcellation or cold loop resection compared with ultrasound-guided electric vacuum aspiration. ResultsA total of 261 out of 305 patients (85.6%) were available for follow-up resulting in a cohort of 171 women after hysteroscopic removal and 90 women after removal of retained products of conception by ultrasound guided vacuum aspiration. Respectively, 92/171 (53.8%) women in the hysteroscopic removal group and 56/90 (62.2%) in the electric vacuum aspiration group wished to conceive (p=.192). Subsequent pregnancy rates were 88/91 (96.7%) after hysteroscopic removal and 52/56 (92.9%) after electric vacuum aspiration (p=.428). The live birth rate was 61/80 (76.3%) and 37/48 (77.1%) after hysteroscopic removal and electric vacuum aspiration, respectively (p=.914), with 8/88 (9.1%) pregnancies in the hysteroscopic removal group and 4/52 (7.7%) pregnancies in the electric vacuum aspiration group still ongoing at follow-up (p=1.00). The median time to conception was 8.2 weeks (interquartile range 5.0–17.2) in the hysteroscopic removal group and 6.9 weeks (interquartile range 5.0–12.1) in the electric vacuum aspiration group (p=.262). The overall placental complication rate was 13/80 (16.3%) in the hysteroscopic removal group and 11/48 (22.9%) in the electric vacuum aspiration group (p=.350). ConclusionHysteroscopic removal and ultrasound-guided electric vacuum aspiration of retained products of conception seem to have no significantly different effect on subsequent live birth rate, pregnancy rate, time to conception and pregnancy complications. Reproductive and obstetric outcomes after removal of retained products of conception are reassuring, albeit with a high risk of placental complications.

Evaluation of whether there is residual polyp tissue after hysteroscopic morcellation at Cam and Sakura City Hospital: a retrospective cohort study

BackgroundIn polypectomy with mechanical hysteroscopic morcellators, the tissue removal procedure continues until no polyp tissue remains. The decision that the polypoid tissues were removed completely is made based on visual evaluation. In a situation where the polyp tissue was visually completely removed and no doubt that the polyp has been completely removed, short spindle-like tissue fragments on the polyp floor continue in most patients. There are no studies in the literature on whether visual evaluation provides adequate information at the cellular level in many patients in whom polypoid tissues have been determined to be completely removed. The aim of the present study was to analyze the pathological results of the curettage procedure, which was applied following the completion of polyp removal with operative hysteroscopy, and to evaluate whether there was residual polyp tissue in the short spindle-like tissue fragments that the mechanical hysteroscopic morcellator could not remove. The secondary aims of this study were to compare conventional loop resection hysteroscopy with hysteroscopic morcellation for the removal of endometrial polyps in terms of hemoglobin/hematocrit changes, polypectomy time and the amount of medium deficit.MethodsA total of 70 patients with a single pedunculate polypoid image of 1.5-2 cm, which was primarily visualized by office hysteroscopy, were included in the study. Patients who had undergone hysteroscopic polypectomy were divided into two groups according to the surgical device used: the morcellator group (n = 35, Group M) and the resectoscope group (n = 35, Group R). The histopathological results of hysteroscopic specimens and curettage materials of patients who had undergone curettage at the end of operative hysteroscopy were evaluated. In addition, the postoperative 24th hour Hb/HCT decrease amounts in percentage, the polypectomy time which was measured from the start of morcellation, and deficit differences were compared between groups.ResultsIn total, 7 patients in the morcellator group had residual polyp tissue detected in the full curettage material. The blood loss was lower in the morcellator group than in the resectoscope group (M, R; (-0.07 ± 0.08), (-0,11 ± 0.06), (p < 0.05), respectively). The deficit value of the morcellator group were higher (M, R; (500 ml), (300 ml), (p < 0.05), respectively). The polypectomy time was shorter in the morcellator group (M, R; mean (2.30 min), (4.6 min), (p < 0.05)).ConclusionsEven if the lesion is completely visibly removed during hysteroscopic morcellation, extra caution should be taken regarding the possibility of residual tissue. There is a need for new studies investigating the presence of residual polyp tissue.

USE OF HYSTEROSCOPIC MORCELLATION WITH A MYOSURE® DEVICE FOR REMOVAL OF UTERINE FOREIGN MATERIAL IN AN ORANGUTAN (PONGO SP.).

A 36-yr-old female intact hybrid orangutan (Pongo sp.) presented with evidence of chronic bacterial cystitis with no response to treatment with multiple systemic antibiotics. Abnormalities were identified within the reproductive tract on CT scan, and hysteroscopy was pursued based on the recommendation of an obstetrician-gynecologist. Hysteroscopic examination revealed a large amount of intrauterine foreign material consistent with wood wool from the orangutan's bedding. A hysteroscopic morcellator (MyoSure®) was used to remove the foreign material. Histologic examination of endometrial biopsies showed severe suppurative to pyogranulomatous endometritis with intralesional foreign (wood) fibers and bacteria. The orangutan was treated with antibiotics, but evidence of bacterial cystitis persisted. After 15 wk, additional wood wool was identified within the uterus by hysteroscopic examination and was removed similarly. Five months later, there was no recurrence of foreign material on hysteroscopy or CT. This report describes the first documentation of intrauterine foreign material in a nonhuman primate. Hysteroscopic morcellation is a useful technique for noninvasive removal of intrauterine foreign material in great apes.

Patient acceptability and satisfaction for hysteroscopic morcellation

Patient acceptability and satisfaction for hysteroscopic morcellation

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 morcellation – a novel method of scar ectopic pregnancy management: case report and review of literature

Hysteroscopic morcellation – a novel method of scar ectopic pregnancy management: case report and review of literature

Hysteroscopic morcellation vs. curettage for removal of retained products of conception: a multicenter randomized controlled trial

To study the comparison between hysteroscopic morcellation (HM) of retained products of conception (RPOC) with ultrasound (US)-guided electric vacuum aspiration in terms of intrauterine adhesion (IUA) formation, efficacy, and complications. A randomized controlled, nonblinded trial. Three teaching hospitals and one university hospital from April 2015 to June 2022. A total of 133 women with RPOC on US, ranging from 1-4 cm, were randomized to receive either HM or electric vacuum aspiration. Hysteroscopic morcellation was performed with the TruClear System (Medtronic, Minneapolis, MN, USA). Electric vacuum aspiration was performed using an 8- or 10-mm flexible plastic Karman cannula under US guidance. Women allocated to vacuum aspiration underwent the procedure as soon as possible. In the HM group, an office diagnostic hysteroscopy was planned a minimum of 6 weeks after the end of pregnancy, followed by retained product of conception removal at least 8 weeks after the end of the pregnancy. Postoperatively, an office second-look hysteroscopy was scheduled to assess the primary outcome of IUAs. Postoperative IUAs were seen in 14.3% (9/63) of patients in the HM group and 20.6% (13/64) of patients in the vacuum aspiration group (-6% [-19.1% to 7.1%]). Significantly more RPOC were removed completely by HM compared with vacuum aspiration (95.2% vs. 82.5% (-14% [-24.9% to -3.1%]), and additional operative hysteroscopy was less frequently necessary in the HM group (12.5%) compared with the vacuum aspiration group (31.3%) (-20.1% [-34.3% to -6%]). The median operating time was shorter for vacuum aspiration compared with HM (5.80 minutes vs. 7.15 minutes). No differences were observed between HM and vacuum aspiration for the occurrence of intraoperative or postoperative complications (5.5% vs. 5.0% and 2.7% vs. 1.3%, respectively). In our randomized controlled trial, no significant differences were found in the occurrence of IUAs and complications. However, the RPOC were more often completely removed by HM than vacuum aspiration, and the HM group required fewer additional hysteroscopic treatments. NTR4923 (https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923). Date of registration: November 23, 2014, date of initial participant enrollment: January 1, 2015.

Office intrauterine morcellation for retained products of conception

Objective Proposing hysteroscopic morcellation (HM) as a surgical-therapeutic approach in the treatment of retained products of conception (RPOC) to prevent intrauterine adhesions (IUAs). Design Prospective analysis. Setting A teaching and university hospital. Patients Women with RPOC. Interventions Office -HM with ‘Truclear 5 C’. Material and methods Twenty-two consecutive patients presenting with trophoblastic residue retention after miscarriage and interruption of pregnancy or placenta remnants after cesarean section or delivery were enrolled. These women underwent office-HM with ‘Truclear 5 C’. Primary outcomes were median time and rate of hospitalization. The quality of the specimen was also analyzed. A hysteroscopic second look for IUAs was performed. Results Mean procedure time was six minutes (SD ± 5). Tissue samples had a mean collection size 2.5 cm3+0.9. 38% of the samples had spotting or abnormal vaginal discharge. Dilatation of the cervical canal was not performed in any case. Second-look hysteroscopy did not show any de novo IUAs in any of the enrolled patients. Conclusions In the hysteroscopic treatment of RPOC, HM is a valid choice in an office setting without the use of cervical dilatation. Removal of RPOC was uneventful in all cases, simple and carried out faster without any adverse outcomes.

Comparing Hysteroscopic Morcellation with Bipolar Resectoscope for Treating leiomyoma

Comparing Hysteroscopic Morcellation with Bipolar Resectoscope for Treating leiomyoma

7763 Hysteroscopic Morcellation (with Bigatti Shaver) Under Laparoscopic Guidance: A Novel Approach to Management of Caesarean Scar Pregnancy

<h3>Study Objective</h3> To present our experience in treating cases with caesarean scar pregnancy by hysteroscopic morcellation using Bigatti Shaver over a period of 1 year. <h3>Design</h3> Longitudinal prospective study for 1 year & follow up done till beta HCG level comes to normal. <h3>Setting</h3> Patients positioning in the OT table: Lithotomy position, 45-degree angle between OT table & patients elevated legs. 2 Endomat Select: one for irrigation & other for suction, RPM-2100, Irrigation: 200-250 ml/min, Pressure: 150mm of Hg <h3>Patients or Participants</h3> 10 women between age 22-35years presented to us in the OPD with caesarean scar pregnancy confirmed on their dating ultrasound. <h3>Interventions</h3> Pre operative investigations were done prior to surgery and under laparoscopy they were posted for surgical intervention - removal of scar pregnancy by Bigatti Shaver. <h3>Measurements and Main Results</h3> • No fertility desired by the patient further, so patient should be tubectomised • It should be done till 7 weeks of period of gestation • Myometrial thickness should be between 2 to 4 mm <h3>Results</h3> 1. None had any intra or post operative complications. 2. Average duration of procedure: less than half an hour & blood loss less than 100ml. 3. Serial Beta HCG from the day of discharge and weekly therefore done, which returned to non-pregnant levels by end of 4 weeks. <h3>Conclusion</h3> Hysteroscopic morcellation is a convenient and effective mode of management of caesarean scar pregnancy with excellent safety profile and patient satisfaction rates.

Technical Challenges in Hysteroscopic Myomectomy with Prolapsing Cervical Fibroid

<h3>Study Objective</h3> To demonstrate various techniques to overcome challenges encountered during hysteroscopy myomectomy for multiple fibroids with concurrent prolapsing cervical fibroid. <h3>Design</h3> Stepwise demonstration using narrated video footage. <h3>Setting</h3> An academic tertiary care hospital. <h3>Patients or Participants</h3> A 44-year-old G4P2022 presented with heavy menstrual bleeding reporting heavier menses over the last few years. Pelvic exam demonstrated a 4 cm prolapsing cervical fibroid and a 12-week size multi-fibroid uterus. Pelvic MRI showed a multi-fibroid uterus with at least 30 myomas, including 5 submucosal fibroids measuring between 1-3 cm each. There was also a 3.7 cm pedunculated fibroid prolapsing through the cervix, into the vagina. Patient declined hysterectomy and opted for conservative surgical management. She underwent excision of prolapsing fibroid, hysteroscopic myomectomy, hysteroscopic endometrectomy, and levonorgestrel IUD placement. <h3>Interventions</h3> Below are strategies to remove multiple submucosal fibroids hysteroscopically when the cervix is dilated due to a prolapsing fibroid. 1. Two 0 PDS Endo-Loops are secured at the base of the prolapsing fibroid. The stalk is transected, and the fibroid is removed. 2. A purse string suture is placed around the cervix using 0 PDS and tagged with a hemostat at 12 o'clock. Once the hysteroscope is placed through the dilated cervix, the purse string suture is tightened, preventing leakage of hysteroscopic fluid. 3. Fibroids greater than 3 cm are enucleated at the base. Once the fibroid is free floating in the cavity, it can be grasped with a forcep and removed intact through the dilated cervix. Smaller submucosal fibroids are excised using hysteroscopic morcellator. <h3>Measurements and Main Results</h3> All submucosal fibroids were successfully removed with a minimal hysteroscopic fluid deficit. Patient tolerated the procedure well. <h3>Conclusion</h3> Multiple submucosal fibroids were safely and efficiently removed using the strategies above. A purse-string suture on the cervix prevents leakage of hysteroscopic fluid while maintaining uterine distension. Large fibroids were enucleated and removed intact through the dilated cervix.

EARLY PREGNANCY FAILURE: A NOVEL APPLICATION FOR HYSTEROSCOPIC MORCELLATION

Missed abortions occur in up to one third of pregnancies. Pregnancy and subsequent miscarriages are typically diagnosed early in the first trimester in the REI/ART population. Currently, standard management options include expectant management, medical management, and surgical management with dilation and curettage. There are several disadvantages to “blind” dilation and curettage, including risk of adhesion formation and post-procedural retained products of conception. This video demonstrates a newer approach for management of early pregnancy loss with targeted resection using a hysteroscopic morcellator. This video demonstrates the benefits of hysteroscopy and shares tips for successful completion of the procedure, as well as suggestions for optimal patient selection.

Comparison of Hysteroscopic Morcellation Versus Resectoscopy in Treatment of Patients with Endometrial Lesions: A Meta-Analysis

BackgroundHysteroscopic surgery has been widely used in clinical practice for more than 30 years due to its advantages of less trauma, less bleeding, and direct vision. The aim of this study was to compare hysteroscopic morcellation versus conventional resectoscopy for removal of endometrial lesions.Material/MethodsFor the database search, we used the keywords “morcellator,” “morcellators,” “morcellate,” “morcellation,” and “morcellated” combined with “hysteroscopy,” “uteroscope,” and “transcervical”. The last search was conducted on February 1, 2022. Randomized controlled trials (RCTs) were included in the meta-analysis.ResultsAccording to our retrieval scheme and the inclusion and exclusion criteria, we found 6 studies including 565 patients. For enumeration data, we calculated the effect size as relative risk (RR) and 95% confidence interval (95% CI), while for quantitative data we used the weighted mean difference (WMD) and 95% confidence interval (95% CI). There was no significant difference between success rate of hysteroscopic morcellation and conventional resectoscopy (relative risk and 95% confidence interval 1.05(0.97,1.13); P=0.232). Procedure time was also shorter with hysteroscopic morcellation, the procedure time of the hysteroscopic morcellation group was 3.43 min shorter compared with the conventional resectoscopy group, and the operating time in the hysteroscopic morcellation group was 2.81 min shorter. In terms of fluid deficit, there was no statistically significant difference in fluid loss between the 2 groups (P=0.209).ConclusionsHysteroscopic morcellation is associated with a shorter procedure time and operative time among patients with endometrial lesions compared with resectoscopy.

Hysteroscopic Morcellation in Endometrial Lesion Patients

Background: Hysteroscopy is a current diagnosis and treatment by the expertise surgeons. The hysteroscopic morcellation is not used in all hospitals compared to the electrosurgery resectoscope. Objective: The purpose of the present study was to characterize hysteroscopic diagnosis and treatment. The second purpose is to display the innovation in tissue collection called adaptive tissue collection (Budhosp-tissue collection). Materials and Methods: The present retrospective study was conducted on 63 patients who had hysteroscopy procedures between January 2019 and June 2021. The present research was an observational study and innovation of adaptive tissue collection (Budhosp-tissue collection). Results: The hysteroscopy had been used to treat 63 patients. The anesthetic included 61 patients that received intravenous anesthesia, one patient had general anesthesia, and one patient had spinal block. Fifty-five of 63 hysteroscopic patients (87%) had endometrial polyps, and six patients (9.5%) had submucous leiomyoma. Conclusion: Modern technologies are currently available for hysteroscopic morcellation. It has been recognized as a safe and effective resection. Notwithstanding, the innovation of adaptive tissue collection (Budhosp-tissue collection) appeared beneficial in rural hospital as it is less expensive and is the safest operation. Keywords: Abnormal uterine bleeding; Hysteroscopy; Hysteroscopic morcellator; Endometrial polyp

Evaluation of the Safety and Efficacy of Resection of Endometrial Polyps and Submucosal Fibroids in an Outpatient Setting in a Large District General Hospital in the UK.

Background:Conventionally, endometrial pathologies of varying complexity have been surgically treated as inpatients under a general or regional anesthetic.Aim:In this paper, we evaluate the safety and efficacy of hysteroscopic morcellation of endometrial pathology in the form of endometrial polyps (EPs) and submucosal fibroids in an outpatient setting for both simple and complex lesions using the Myosure™ device.Methods:Two hundred and forty-nine hysteroscopic resections were performed in an outpatient setting at the < BLINDED FOR REVIEW > from May 2014 to March 2021. The median age of the patients was 54 years. More than half of the patients presented with postmenopausal bleeding; 64% were diagnosed with EPs and 24% with submucous fibroids (SMFs). The size, topography, extension, penetration, and wall classification system scoring system were used to grade them as simple (≤4) or complex (≥5) pathologies.Results:90% of pathologies were simple (≤4), of which complete resection was carried out in 95% of patients; 10% of the pathologies were complex (≥5), of which 63% had complete resection. Two patients with complex pathologies returned for completion surgery as a two-step procedure. No procedure was abandoned due to the patient intolerance. The median intraprocedure pain score visual analog scale was 5/10 and immediate postprocedure pain score was 1/10. Notably, there was no intra- or post-procedure complications.Conclusion:Outpatient resection of endometrial pathology, both simple and complex, can be safely and effectively performed using hysteroscopic morcellator (Myosure™) and is accepted and well tolerated by patients.