Hysteroscopic Morcellation Research Articles

Hysteroscopic Morcellation Versus Loop Resection for Removal of Placental Remnants: A Randomized Trial

Study ObjectiveTo compare hysteroscopic morcellation with loop resection for the removal of placental remnants in terms of procedure time, adverse events, tissue availability, histology results, short-term effectiveness, and postoperative adhesions. DesignA randomized controlled trial (Canadian Task Force classification I). SettingA teaching and university hospital. PatientsWomen with placental remnants. InterventionsHysteroscopic morcellation with the TRUCLEAR 8.0 Tissue Removal System (Smith & Nephew, Inc, Andover, MA) or loop resection with a rigid 8.5-mm bipolar resectoscope (Karl Storz GmbH, Tuttlingen, Germany). Measurements and Main ResultsForty-six and 40 women were included in the hysteroscopic morcellation and resection groups, respectively. The median operating time was significantly shorter for hysteroscopic morcellation compared with loop resection (6.2 minutes [interquartile range, 4.0–11.2 minutes] vs 10.0 minutes [5.8–16.4 minutes], p = .023). Both operating time and total procedure time, corrected for the diameter of the placental remnants, were significantly reduced for hysteroscopic morcellation compared with loop resection, by 40% (95% confidence interval, 15%–58%; p = .005) and 22% (95% CI, 5%–37%; p = .014), respectively. No adverse events occurred during hysteroscopic removal. Perforation at dilation in 8 cases of the hysteroscopic morcellation group resulted in 2 procedure discontinuations and 1 incomplete procedure. Incomplete removal was found in 1 uncomplicated hysteroscopic morcellation procedure and 2 resection procedures. Pathology results confirmed the presence of placental remnants in 27 of 40 (67.5%) and 26 of 37 (70%) patients in the hysteroscopic morcellation and resection groups, respectively. Second-look hysteroscopy showed de novo intrauterine adhesions in 1 of 35 patients (3%) in the hysteroscopic morcellation group and 1 of 30 (3%) patients in the resection group. ConclusionHysteroscopic morcellation is a faster alternative than loop resection. Both techniques are safe and show high rates of complete removal and tissue availability and low rates of de novo intrauterine adhesions.

Hysteroscopic morcellator to overcome cervical stenosis

To report a step-by-step technique to using a hysteroscopic morcellator to safely gain access into the intrauterine cavity in two patients with severe cervical stenosis and concomitant intrauterine pathology. Video article introducing the hysteroscopic morcellator for overcoming severe cervical stenosis. Academic-based practice. A 36-year-old G0 female with primary infertility and uterine polyps and a 34-year-old G0 female with uterine polyps and a difficult trial transfer before undergoing an IVF cycle. In both patients, preoperative saline-infused sonography revealed submucosal filling defects and severe cervical stenosis. A hysteroscopic technique using the Hologic Myosure to overcome severe cervical stenosis with or without the use of intraoperative ultrasound. Despite using preoperative Cytotec, cervical stenosis was identified. Under direct visualization, a 4-mm Myosure XL blade was placed through a 7.25-mm Myosure XL hysteroscopy. The cutter blade, powered by an electromechanical drive system, enables simultaneous rotation and reciprocation. The blade allows one to shave and remove tissue and is applied to cervical stenosis, allowing safe access into the intrauterine cavity. The intrauterine hysteroscopic Myosure morcellator allowed for safe and direct entry into the uterine cavity. We have since applied this technique to all patients where cervical stenosis is identified and have minimized potential uterine perforation and false tracks in our patients. Our technique is an alternative method for overcoming severe cervical stenosis and minimizing potential intraoperative complications.

Office Hysteroscopic Treatment of Uterine Fibroids

Advances in endoscopic and therapeutic hysteroscopic technology have made the removal of submucosal fibroids possible in the outpatient setting. Removal of submucosal fibroids can be particularly challenging in the outpatients due to intramural components of some submucosal fibroids and the hard consistency of fibroids which makes specimen retrieval rather difficult through the endocervical canal. Fibroids which are <2 cm and completely intracavitary are easier to remove in the outpatients. Specimen retrieval can be addressed either by slicing the fibroid using bipolar electrodes, by using a hysteroscopic morcellator or leaving the fibroid in the uterine cavity after enucleation to be expelled with uterine contractions. Patient acceptability appears to be high in a small number of retrospective case series published in the literature. Further reports and data from prospective trials would be beneficial in improving our understanding of this procedure which appears to be performed by a relatively small number of centres.

A Prospective Analysis of Hysteroscopic Morcellation in the Management of Intrauterine Pathologies

ObjectiveTo determine the effectiveness of the MyoSure intrauterine mechanical morcellator device for removal of intrauterine pathology. DesignProspective cohort study (Canadian Task Force classification II-2). InterventionThis study was performed at the Royal Hospital for Women and Prince of Wales Private Hospital, Sydney, Australia. All women undergoing hysteroscopic removal of intrauterine pathology using the MyoSure device between January 2013 and June 2015 were included. ResultsA total of 255 MyoSure procedures were performed, with 61% performed by trainees. Resection of leiomyomas occurred in 40% or cases, polyps in 39%, combination pathology in 9%, pregnancy products in 6%, and preinvasive or invasive disease in 5% of cases. Complete resection of pathology was achieved in 92% of polyps, 66% of leiomyomas, and 87% of pregnancy tissue. Leiomyomas were more likely to be completely resected when surgery was performed by an attending physician or senior resident, however there was no statistically significant difference in clinical outcomes. When leiomyomas were stratified according to size, 87% of leiomyomas ≤40 mm were completely resected with only 48% of leiomyomas >40 mm completely resected with the index surgery. No intraoperative complications occurred. Postoperative outcomes included symptom resolution in 76%, further surgery (repeat hysteroscopy or hysterectomy) in 10%, pregnancy in 2%, and medical/conservative management in 12% of patients. ConclusionThe MyoSure device is very effective when used to resect endometrial polyps. Leiomyomas >40 mm are unlikely to be completely resected at a single operation when using the MyoSure device. Similar clinical outcomes were obtained when procedures were performed by trainees compared to senior clinicians.

Placental Remnant Removal With the Hysteroscopic Morcellator

Study Objective To investigate the the effectiveness of removal of placental remnants with the hysteroscopic morcellator (Myosure, Hologic). Design Prospective trial multicenter. Setting Two Teaching Hospitals. Patients Patients with a placental remnant or miscarriage remnant were treated with a hysteroscopic morcellator to remove the remnant. Intervention Patients who complained of persisting bloodloss after delivery or miscarriage underwent a transvaginal ultrasound. If there was a suspicion of a placentalremnant, confirmation was achieved by hysteroscopy. If a remnants was present, patient could decide to be treated immediately in the office, or to get an appointment to be treated in the OR. Prospective data were registered in a CRF. Measurements and Main Results The prospective CRF consisted patientdata. Number of days after delivery or miscarriage, the size of the remnant measured on the day of surgery by TVU, the location of the remnant seen by hysteroscopy, time needed to remove the remnant, vision during removal and blood loss as well as fluidloss. Moreover the patient filled in a VAS score if she was treated in the office. Overall 39 patients were treated. 9 patients in the OR and 22 patient in the office with a placental remnant after delivery and 8 after a miscarriage. All patients but one could be treated adequately in one visit. One patient had fluid loss of more than 1000cc. One patient bloodloss 500 cc. The VAS had a mean of 2.3 on a scale of 0 till 10 for the patient wthout anesthesia. Conclusion Morcellation of placental remnant seems feasible with the Myosure morcellator (Hologic). As an office procedure it was scored in 95% as acceptable by the patients.

Removal of Retained Products of Conception Using a Hysteroscopic Morcellator: A Safer Alternative

Removal of Retained Products of Conception Using a Hysteroscopic Morcellator: A Safer Alternative

Myosure Hysteroscopic Morcellation for the Management of Submucous Fibroids in an Out-Patient Hysteroscopy Setting

Myosure Hysteroscopic Morcellation for the Management of Submucous Fibroids in an Out-Patient Hysteroscopy Setting

Hysteroscopic Removal of Placental Remnants: A Randomized Trial Comparing Hysteroscopic Morcellation With Cold Loop Resectoscopy

Hysteroscopic Removal of Placental Remnants: A Randomized Trial Comparing Hysteroscopic Morcellation With Cold Loop Resectoscopy

Minimally Invasive Gynecologic Surgery for Benign Conditions

The objective of this review is to evaluate the progress made in laparoscopic and hysteroscopic gynecologic surgery and address challenges still faced by surgeons using minimally invasive techniques to improve the care of women with noncancerous gynecologic problems. Relevant literature was reviewed and evidence-based arguments put forward in the article for the progress that has been made and the deficiencies that still exist. In the last 2 decades, enormous progress has been made in providing minimally invasive surgical options for women with gynecologic diseases. The progress has been especially striking in the performance of hysterectomy, the most common major surgery performed on nonpregnant women. The recent controversy over power morcellation has revealed a poor understanding of the literature concerning leiomyosarcoma leading to confusion and consequently denial of minimally invasive surgical options for many women. Hysteroscopic surgery has been evolving rapidly with the development of hysteroscopic morcellator, global endometrial ablation systems, and hysteroscopic tubal sterilization. Although huge advances have been made in minimally invasive gynecologic surgery, high-quality evidence from well-designed clinical trials is lacking for many of the new technologies. Accurate estimates regarding the risk of occult leiomyosarcoma are also lacking. Additional research is urgently needed to address these deficiencies.

Future research and developments in hysteroscopy

Hysteroscopy has become an important tool to evaluate intrauterine pathology. In most cases, the pathology can be diagnosed and treated in the office or outpatient setting. The ability to use normal saline as a distending medium allows the procedure to be performed using bipolar energy. During hysteroscopic myomectomy, visualization can remain unobstructed with the use of a hysteroscopic morcellator. Its use is also associated with decreased operating time. The use of Essure(®) to block the proximal fallopian tube by a hysteroscopic approach is an approved procedure for tubal sterilization. However, it has been increasingly used to prevent hydrosalpinx fluid from entering the uterine cavity in women undergoing invitro fertilization. The hysteroscopic approach has also been used to treat a variety of conditions such as treatment of interstitial pregnancy, caesarean scar pregnancy and retained placenta. However, the number of cases is still relatively small, and no randomized trial has ever been conducted. One of the potentially important developments is the use of falloposcopy to obtain distal tubal cytology as a screening for ovarian cancer. The technique remains to be refined.

Hysteroscopic polypectomy in an office setting: specimen quality assessment for histopathological evaluation

ObjectivePolypectomy under hysteroscopic guidance is the treatment of choice for most endometrial polyps, but mechanical or electrical effects at the time of surgery may result in artifactual displacement of tissue with obvious resultant diagnostic problems. The purpose of this study was to record qualitative and quantitative histopathological artifacts and to assess differences between artifacts found in specimens obtained by different surgical polypectomy techniques. Study designDuring the period from November 2012 to March 2013, 90 retrospective consecutive polyp histopathological slides and their reports were identified for this study. Initially reported slides were reviewed blind by two histopathologists, who were not provided with any surgical details. The issued reports and those of the reviewing pathologists were then compared. ResultsOf the 90 reviewed polyp slides, there was complete agreement on the initial issued report in all cases. ConclusionsRemoval of endometrial polyps in an office setting using mechanical instruments, bipolar electrode or a hysteroscopic morcellator provides adequate tissue for histological diagnosis, and there is no difference between these three techniques for adequacy of histological examination, despite the effects of thermal injury or tissue fragmentation.

Morcellement hystéroscopique versus résection à l’anse bipolaire pour les polypes endométriaux

ObjectiveThe treatment of endometrial polyps is based on hysteroscopic resection. The aim of the current study was to compare the results associated with hysteroscopic morcellation and those observed with bipolar loop resection. Patients and methodsA single-center observational retrospective comparative study was performed, including 25 patients who underwent hysteroscopic resection of endometrial polyps from January 2012 to December 2013. The mean size of polyp was 9.2mm in the group compared to 12.5mm in the resection group loop (P=0.06). ResultsTwelve patients underwent resection of the polyp morcellation with MyoSure® and 13 with bipolar resection loop Versapoint® 24F. The mean operative time was 16minutes in morcellation group and 17minutes in the bipolar resection group (P=0.76). Complete removal was achieved in 100% of cases in morcellation group and in bipolar loop resection. Regarding intraoperative and postoperative complications, no complication was observed in the two groups. Discussion and ConclusionResults associated with hysteroscopic morcellation and bipolar loop resection seen to be comparable.

Nouvelle technique en hystéroscopie : les morcellateurs hystéroscopiques

A new technology recently appeared for the treatment of endo-uterine pathologies: hysteroscopic morcellators. It seemed to us useful to review this new technology. The morcellator we mostly experiment is the Myosure®, in 14 patients, with a median age of 40.5years (28–58). The time of procedure went from 5 to 75min with a median time at 26min. The median of the total fluid deficit was 300mL (0–1500mL). A conversion in traditional resectoscopy happened in 4 cases (29%). This results are not so good as in literature. This is probably bound to one the learning curve but also the type of pathology. For the operative time, all the studies agree that hysteroscopic morcellation is faster than hysteroscopic resection. The quantity of fluid used is also lesser, as the deficit of fluid when the morcellator is used. The percentage of success to remove the pathology is high, close to 100% for the polyps and 92% for the submucous myomas. The indications are the polyps and the submucous myomas type 0 or 1. The morcellation of remnant trophoblastic tissues is also described and seems effective. Others indications, as the removal of uterine septum or cure of uterine synechias, are criticisable. In conclusion, hysteroscopic morcellators are probably a great progress for the cure of the endo-uterine pathologies. They cannot yet concurrence the hysterosopic resectoscopes for the treatment of big submucous myoma or those with a large intramyometrial involvement.

Twelve-Month Outcomes for Patients Undergoing Hysteroscopic Morcellation of Uterine Polyps and Myomas in an Office or Ambulatory Surgical Center

Study ObjectiveTo examine efficacy of hysteroscopic removal of polyps and myomas on health-related quality of life and symptom severity at 1-year postprocedure. DesignRandomized, prospective, comparative setting clinical trial (Canadian Task Force classification II-2). SettingNine outpatient obstetrics and gynecology practices and hospitals in the United States. PatientsWomen 18 to 55 years of age with polyps and/or type 0 or I myomas ≥1.5 and ≤3.0 cm. InterventionsTreatment of polyps and fibroids with the MyoSure device. Measurements and Main ResultsA total of 118 lesions (76 polyps, 42 myomas) were removed. Among the 118 pathologies removed, 53 were removed in an office setting (28 myomas, 25 polyps), and 55 were removed in an ambulatory surgical center (ASC) setting (14 myomas, 41 polyps). The mean percentage of pathology removed was 95.9 ± 6.8% for fibroids and 99.9 ± 0.7% for polyps. Symptom severity as measured by the Uterine Fibroid Symptom-Quality of Life (UFS-QOL) scale improved significantly (p < .01) between baseline (mean score of 67.5 ± 15.4) and 12 months postprocedure (mean score of 22.3 ± 22.6). The Health-Related Quality of Life (HRQOL) scale also improved significantly (p < .01) between baseline (mean score 38.7 ± 23.3) and 12 months postprocedure (mean score of 83.9 ± 24.4). Both the office and ASC groups demonstrated a statistically significant (p < .01) improvement in UFS-QOL and HRQOL. ConclusionFor women with intrauterine polyps and/or myomas who experienced abnormal uterine bleeding, hysteroscopic morcellation with the MyoSure device provided significant, durable health-related, quality-of-life improvements up to 12 months postprocedure. These findings were the same for patients treated in both an office-based setting and ASCs.

Removal of Endometrial Polyps: Hysteroscopic Morcellation vs. Bipolar Resectoscopy, a Randomized Trial

Removal of Endometrial Polyps: Hysteroscopic Morcellation vs. Bipolar Resectoscopy, a Randomized Trial

Moving Hysteroscopic Surgery Out of the Operating Room: An Analysis of Myomectomy and Polypectomy Procedures Performed Using Office Hysteroscopic Morcellation

To describe characteristics and outcomes of a series of office hysteroscopic morcellation procedures and to identify benefits and obstacles associated with office-based hysteroscopic morcellation.

A Comparison of Physician-Rated Performance Characteristics, Preference and Ease of Use for the MyoSure® Hysteroscopic Morcellator Providing a Suction on Demand Feature for Visualization of the Uterine Cavity

To evaluate whether the addition of an elective suction feature on the MyoSure® device influenced physician perception regarding ease-of-use or visualization compared with other marketed hysteroscopic morcellators.

Hysteroscopic Morcellation: Review of of the Manufacturer and User Facility Device Experience Database

Hysteroscopic Morcellation: Review of of the Manufacturer and User Facility Device Experience Database

Hysteroscopic Morcellation: Specimen Quality Assessment for Histopathological Evaluation after Endometrial Polypectomy

Polypectomy under hysteroscopic guidance is the treatment of choice for most endometrial polyps, mechanical or electrical effects at the time of surgery may result in artifactual displacement of tissue with obvious resultant diagnostic problem. The purpose of this study was carried out to record qualitative and quantitative histopathological artifacts and to assess differences between artifacts found in specimens obtained by different surgical polypectomy techniques.

MyoSure XL Hysteroscopic Morcellation for the Removal of a Hard Leiomyoma

MyoSure XL Hysteroscopic Morcellation for the Removal of a Hard Leiomyoma