Hysteroscopic Procedures Research Articles

Predictive Factors of Tolerance in Office Hysteroscopy - a 3-Year Analysis from a Tertiary Center.

Pain is the primary limitation to performing hysteroscopy. We aimed to evaluate the predictive factors of low tolerance to office hysteroscopic procedures. Retrospective cohort study of the patients who underwent office hysteroscopy from January 2018 to December 2020 at a tertiary care center. Pain tolerance to office-based hysteroscopy was subjectively assessed by the operator as terrible, poor, moderate, good, or excellent. Categorical variables were compared with the use of the Chi-squared test; an independent-samples t-test was conducted to compare continuous variables. Logistic regression was performed to determine the main factors associated with low procedure tolerance. A total of 1,418 office hysteroscopies were performed. The mean age of the patients was 53 ± 13.8 years; 50.8% of women were menopausal, 17.8% were nulliparous, and 68.7% had a previous vaginal delivery. A total of 42.6% of women were submitted to an operative hysteroscopy. Tolerance was categorized as terrible or poor in 14.9% of hysteroscopies and moderate, good, or excellent in 85.1%. A terrible or poor tolerance was more frequently reported in menopausal women (18.1% vs. 11.7% in premenopausal women, p = 0.001) and women with no previous vaginal delivery (18.8% vs. 12.9% in women with at least one vaginal birth, p = 0.007). Low tolerance led more often to scheduling a second hysteroscopic procedure under anesthesia (56.4% vs. 17.5% in reasonable-to-excellent tolerance, p < 0.0005). Office hysteroscopy was a well-tolerated procedure in our experience, but menopause and lack of previous vaginal delivery were associated with low tolerance. These patients are more likely to benefit from pain relief measures during office hysteroscopy.

Comparison of Efficacy of Vaginal Misoprostol versus a Synthetic Osmotic Dilator (Dilapan-S) for Cervical Preparation before Operative Hysteroscopy: A Randomized Controlled Study.

To compare the need for mechanical cervical dilatation following vaginal misoprostol or synthetic osmotic dilator (Dilapan-S) usage for cervical preparation before operative hysteroscopy. Fifty-five premenopausal women scheduled for operative hysteroscopic procedures with a 26 Fr resectoscope were included in this randomized, controlled clinical trial. After randomization, either 400 μg of vaginal misoprostol or intracervical synthetic osmotic dilator (Dilapan-S) was inserted 12 h before operative hysteroscopy. The need for additional mechanical cervical dilatation before insertion of the resectoscope was compared between the two groups. Initial cervical diameter before mechanical dilatation, intraoperative complications (cervical tears, creation of a false passage), and ease of dilatation were also compared between the two groups. In the misoprostol group, 92% of women required additional mechanical cervical dilatation, whereas only 36% of women in the Dilapan-S group required additional dilatation (P < 0.05). The median initial cervical diameter achieved with Dilapan was 9 mm (Q1: 7 mm; Q3: 10 mm), and with misoprostol, it was 6 mm (Q1: 4.5 mm; Q3: 8 mm) (P < 0.05). There was no significant difference in other outcome parameters between the two groups. Synthetic osmotic dilator (Dilapan-S) is more efficacious than vaginal misoprostol at ripening the cervix before operative hysteroscopy.

İmplantasyon Başarısızlığı Olan Hastalarda Donmuş Embriyo Transferi Öncesi Histeroskopik Cerrahinin Etkisi

Aim: The aim of this study was to evaluate the benefit of hysteroscopy (HS) before single frozen-thawed embryo transfer (sFET) on patients with previous implantation failure. Material and Methods: A total of 1352 infertile women with a previous implantation failure who underwent their first sFET treatment between January 2015 and December 2017 were included in this study. The patients were classified into two main groups in which HS was omitted (Group 1), and who underwent HS (Group 2). Furthermore, Group 2 was classified into two subgroups as patients without any intrauterine pathology (Group 2a), and those with intrauterine pathology (Group 2b). sFET was performed on all patients within 50 days of hysteroscopy. The major outcome measure was the clinical pregnancy rate. Results: The mean number of mature oocytes and fertilization rates were similar between groups. The clinical pregnancy rate was found to be 33.3% (n=70) in Group 1. Comparatively this rate was statistically significantly higher in patients in Group 2. The clinical pregnancy rate was 44.2% (n=378) in Group 2a, and 44.4% (n=127) in Group 2b (p=0.014). There was a significant difference between Group 1 and Group 2a (OR: 1.58, 95% CI: 1.15-2.17, p=0.004), and also Group 2b (OR: 1.59, 95% CI: 1.10-2.31, p=0.013). However, no significant difference was observed between Group 2a and Group 2b (p=0.896). Conclusion: Our findings demonstrate that HS surgery increases the probability of pregnancy rate at least by 1.58 times in patients having previous implantation failure when the hysteroscopic procedure is followed by sFET.

Does Hysteroscopic Dissection of Partial Uterine Septum Represent a Risk Factor for Placental Abnormalities in Subsequent Pregnancy Compared with Controls Undergoing Other Hysteroscopic Surgery? Results from a Large Case–Control Analysis

Hysteroscopic septum dissection (HSD) is thought to improve fertility and pregnancy outcomes. However, the available literature suggests that uterine surgery can cause placental abnormalities in subsequent pregnancies. A case-control study was performed at the University Medical Center of Ljubljana, Department of Human Reproduction, from 1 January 2016 to 31 December 2018. The primary outcome was the association between HSD and the occurrence of placental abnormalities. We included women who underwent HSD due to infertility. Age-matched women who underwent hysteroscopic surgery for other issues were considered as controls. In addition, we divided the groups according to conception method. Only singleton pregnancies and first delivery were considered. A total of 1286 women (746 who underwent HSD and 540 controls) were included in the analysis. HSD had no influence on placental abnormalities since the ratio was comparable regardless of the method of conception (113/746 vs. 69/540; p = 0.515). Infertile women who conceived naturally after HSD had a normal placentation rate comparable to women who did not undergo HSD (380/427 vs. 280/312; p = 0.2104). The rate of placental abnormalities in women who achieved pregnancy with IVF/ICSI procedures following HSD was comparable to that of women who did not undergo HSD (52/319 vs. 33/228; p = 0.5478). Placenta previa occurred significantly more often in infertile women without HSD after IVF/ICSI compared to natural conception (2/312 vs. 7/228; p = 0.0401). HSD was not associated with higher rate of placental abnormalities in the first singleton pregnancy compared with other hysteroscopic procedures. A higher rate of placenta previa in pregnancies following IVF/ICSI procedures, which was shown by our research, is corroborated by previous research findings.

Evaluation of Stress Hormone Levels, Preoperative Anxiety, and Information Needs before and after Hysteroscopy under Local Anesthesia in Relation to Transvaginal Procedures under General, Short-Term Anesthesia

Background: Hysteroscopy is currently the gold-standard procedure in the evaluation of the uterine cavity and treatment of intrauterine lesions as it is minimally invasive and has high diagnostic efficiency. According to previous observations, many patients are afraid of minimally invasive procedures performed under general anesthesia. They are also afraid of procedures that, according to them, may be associated with pain. To address this issue, in this study, the levels of stress and anxiety, and biochemical parameters indicating the hormonal response in terms of the stress response in hysteroscopic procedures under local anesthesia were compared with those of traditional surgical procedures and uterine cavity curettage procedures under general, short-term anesthesia. Methods: This study included 184 participants: 153 women undergoing diagnostic or operative mini-hysteroscopy procedures with the use of a hysteroscope of a reduced diameter under local, paracervical anesthesia without the participation of an anesthesiologist, and 31 women undergoing hysteroscopy or uterine cavity curettage under general, intravenous, short-term anesthesia with the participation of an anesthesiologist. To determine cortisol and prolactin levels using electrochemiluminescence, blood was collected from the patients on the day of admission to the hospital, i.e., the day of surgery, in the morning, while fasting. An original survey questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Visual Analogue Scale (VAS) were used as research tools. The questionnaires were completed by the patients themselves 60 min before the surgery. Results: APAIS: no significant differences in anxiety and information demand scores were observed between the study groups. Anxiety before surgery was significantly higher than that before anesthesia in both groups. Similarly, information demand for surgery was significantly higher than that for anesthesia in both groups. VAS: no significant differences in anxiety and stress scores were observed between the groups. No significant differences in prolactin and cortisol levels were observed between the groups. Conclusions: It can be concluded that it is necessary to apply the interventions that reduce the anxiety of the patients and inform patients about the planned course of the procedure, since higher levels of anxiety before the procedure result in a significant increase in procedure duration, which in turn can increase the pain experienced by the patients.

Role of vocal distraction analgesia on pain management in the office hysteroscopy procedure: a randomized controlled studya

Role of vocal distraction analgesia on pain management in the office hysteroscopy procedure: a randomized controlled studya

Characteristics of Submucous Myomas and the Risk of Anemia.

Background and Objectives: Uterine fibroids still represent the most common indication for hysterectomy for benign pathologies. In the United States, more than 479,000 hysterectomies are performed annually, 46.6% for myomas and 47.7% in women aged from 18 to 44 years. By applying appropriateness criteria to this procedure, it has been estimated that overuse ranges from 16 to 70%. One of the main reasons that induce patients and gynecologists to consider hysterectomy is represented by severe anemia. Materials and Methods: This is a retrospective cohort study of 202 patients with uterine fibroids diagnosed by transvaginal ultrasound who underwent a hysteroscopic procedure. Myoma grade, size, location, and number were assessed by transvaginal scan and office hysteroscopy and correlated to the pre-treatment hemoglobin level. Results: Univariate analysis showed that anemia does not have a statistically significant association with myoma number and with age considered as a numerical predictor. In the patients with myoma type 0, there is a possibility of 81% having anemia regardless of menorrhagia. On the contrary, in patients with myoma type 1 or type 2, the possibility of having anemia varies according to the presence or absence of menorrhagia. If there is menorrhagia, the risk of moderate anemia is only present for myomas &gt;60 mm. Conclusions: The results of this study may contribute to defining objective criteria for the management of submucous myomas and anemia. Our data suggest that submucosal myomas type 0 &gt;10 mm should always be treated, putting patients at risk for anemia. Myomas type 2 and 3 should be treated for the risk of anemia in the presence of menorrhagia episodes or if &gt; of 60 mm. Adequate management of anemia and myomas could reduce the rate of unnecessary hysterectomies.

Hysteroscopicmetroplasty as a treatment option for women with congenital dysmorphic uterus suffering from impaired reproductive performance

Congenital uterine anomalies have been proven to be associated with impaired reproductive performance. The 2013 ESHRE-ESGE classification of female genital tract malformations defines T shaped and infantalis uterus as dysmorphic uterus. Our aim was to examine whether the reproductive performance of patients with primary congenital dysmorphic uterus can be improved using hysteroscopic metroplasty. A retrospective cohort study of 35 patients suffering from 1 year of failed attempts to conceive, recurrent early pregnancy losses, or repeated implantation failures of in vitro fertilization cycles who were diagnosed with a dysmorphic uterus in both a diagnostic hysteroscopy procedure and three-dimensional transvaginal ultrasound (3D-TVS). All patients had undergone an operative hysteroscopic procedure for uterine anomaly repair and their reproductive performance is described before and after the procedure, so that the women acted as their own control. Within 3 years of the procedure, a total of 25 patients (71.4%) reported that they had achieved a pregnancy. A total of 15% of patients only conceived for the first time after the procedure, 15 patients (42.9%) conceived within 6 months and 18 (51.4%) within 1 year. A total of 12 of the 25 pregnant patients (48%) gave birth to a live newborn. We conclude that in non-DES exposed patients with impaired reproductive performance and congenital dysmorphic uterus, hysteroscopic metroplasty for uterine repair could serve as a treatment option for recurrent implantation failure, and may lead to improved reproductive performance and obstetric outcome.

Vasovagal Syncope during Office Hysteroscopy-A Frequently Overlooked Unpleasant Complication.

Due to technological advancements in miniaturization of instruments and improved optics, the number of office hysteroscopic procedures has increased over time. Office hysteroscopy is preferred due to avoidance of general anesthesia and decreased overall cost. Vasovagal syncope has been implied as the most common complication. Vasovagal syncope is associated with inappropriate reflex vasodilation and bradycardia in the setting of an acute malfunction between the autonomic nervous system and the cardiovascular system; however, there is no mortality associated with vasovagal syncope. A management strategy for acute vasovagal reflex during office hysteroscopy is proposed in order to manage this common complication.

Method of Hysteroscopic Procedure for Polyps Impacts Myometrium Identification in Pathology Specimens

Hysteroscopic polypectomy is a commonly performed procedure for patients undergoing fertility treatment. Various methods and instruments are available to perform this procedure and selection often depends on surgeon preference. Newer devices that utilize suction and mechanical energy may disrupt the basalis layer.

TIPS and Tricks for the Difficult Hysteroscopy

<h3>Study Objective</h3> The objective of this video is to provide gynecologists with the tools to successfully perform difficult hysteroscopic procedures. <h3>Design</h3> Narrated video. <h3>Setting</h3> There are many conditions including abnormal uterine bleeding which require sampling and/or visualization of the endocervical canal and intrauterine cavity. Hysteroscopy with direct visualization of the cavity is the gold standard for evaluation. <h3>Patients or Participants</h3> Patients undergoing hysteroscopy. <h3>Interventions</h3> This video describes 1) risk factors for a difficult hysteroscopy 2) how to optimize for success with preoperative planning and hysteroscopic set up and 3) tips and tricks to successfully navigate and complete a difficult hysteroscopy. <h3>Measurements and Main Results</h3> This video can serve as a resource for gynecologists to successfully perform difficult hysteroscopies. <h3>Conclusion</h3> Hysteroscopy is one of the most frequently performed gynecologic procedures and many are surgically challenging. It is important for gynecologists to optimize their skills in performing difficult hysteroscopies to provide the best care for our patients.

7426 Hysteroscopic Resection of an Endocervical Cesarean Scar Fibroid

<h3>Study Objective</h3> To present a case of a hysteroscopic resection of an endocervical fibroid from within a Cesarean scar defect (CSD), also known as an isthmocele. <h3>Design</h3> Video case presentation. <h3>Setting</h3> Operative hysteroscopic procedure performed at an urban, academic surgical center. <h3>Patients or Participants</h3> 37-year-old G4P3013 with a history of 3 prior Cesareans, a hysteroscopic and abdominal myomectomy. For 3 months following a spontaneous abortion, she experienced abnormal uterine bleeding. Saline infusion sonogram and MRI revealed a 2.9 cm anterior endocervical fibroid. Options for management were reviewed. Following a short course of progestins that resulted in persistent intermenstrual spotting, and considering desire for future pregnancy, hysteroscopic resection was subsequently decided. <h3>Interventions</h3> Hysteroscopic myomectomy of CSD myoma. <h3>Measurements and Main Results</h3> Successful hysteroscopic resection and techniques to limit intraoperative and postoperative bleeding are described. Postoperatively, the patient had heavy bleeding in PACU with a quantitative blood loss of 700 mL. <h3>Conclusion</h3> Preoperative, intraoperative, and postoperative considerations for this case are reviewed. Preoperative considerations include adequate counseling, imaging such as MRI, thorough discussion of the risks and understanding of the patient's desires in the event of possible hysterectomy. Intraoperatively, primary prevention of bleeding can be attempted with the use of vasoconstrictive agents for both parametrial and intra-myoma instillation to reduce blood flow to the uterus and fibroid. Minimizing the use of electrosurgery may be preferable given the high risk of perforation. Postoperatively, uterotonics are often ineffective at controlling CSD bleeding given the minimal residual myometrium, but antifibrinolytics such as tranexamic acid may be more helpful. If not placed in the operating room under hysteroscopic or ultrasound guidance, an intrauterine balloon can also be inserted postoperatively for tamponade.

7606 Prospective Study Investigating Change in Carboxyhemoglobin Blood Level during Operative Hysteroscopy

<h3>Study Objective</h3> Evaluate whether the use of radiofrequency energy during operative hysteroscopy leads to increases in patient blood levels of carboxyhemoglobin and to investigate procedural variables associated with these elevations. <h3>Design</h3> A cross-sectional study of 40 patients undergoing a hysteroscopic procedure using bipolar radiofrequency energy. <h3>Setting</h3> Ambulatory surgery center <h3>Patients or Participants</h3> Procedures for uterine leiomyoma, septa, products of conception, or a combination of these pathologies were included. Blood carboxyhemoglobin (COHb) levels were measured prior to and after surgery. Abnormal post-op carboxyhemoglobin level was defined as an increase of plasma carboxyhemoglobin ≥ 3.0%. All patients with abnormal post-operative levels were contacted and screened for carbon monoxide toxicity symptoms. No additional follow-up was conducted. <h3>Interventions</h3> Operative hysteroscopy was performed per standard protocol and the COHb blood levels were measured as described above. No additional interventions occurred. <h3>Measurements and Main Results</h3> 17.5% of patients met the criteria for abnormal post-op COHb levels. None of these patients reported symptoms of carbon monoxide toxicity. One patient with an elevated post-op COHb level had intra-operative hemodynamic changes. Summary statistics included frequency for categorical variables and averages for continuous variables. An abnormal postop COHb level was associated with a higher fluid deficit (p-value 0.024) and greater fibroid volume (p-value 0.04). <h3>Conclusion</h3> This study demonstrates that systemic absorption of carbon monoxide is a reproducible phenomenon in hysteroscopic resections using bipolar diathermy. Greater absorption is associated with a higher fluid deficit and greater fibroid volume. Although none of the patients with an abnormal increase screened positive for symptoms in the post-op setting and only one experienced hemodynamic changes intra-operatively, our study looked at a healthy and young patient population. More research is needed on the safety of this COHb exposure in patients with medical comorbidities. Special consideration should be given to the possibility of carbon monoxide absorption and the uncertain long-term effects when planning extensive resections.

8847 Office Operative Hysteroscopy Using the LiNA Operascope Lasso and Biopsy Forceps

Study Objective To evaluate the LiNA OperaScope Lasso and Biopsy Forceps for office hysteroscopy with polypectomy and targeted endometrial biopsy. Design Retrospective clinical study. Setting Private Gynecology Practice. Patients or Participants 148 patients who underwent office hysteroscopy, including 31 patients with polypectomy and 27 patients with targeted endometrial biopsy. Interventions Office hysteroscopy was performed with the LiNA OperaScope, a single use hysteroscope with an operative channel. Polypectomies were performed with the LiNA OperaScope Lasso (16 mm), a 5 Fr mechanical instrument with a basket at the distal end. Targeted biopsies were obtained with the LiNA OperaScope Biopsy Forceps (5 Fr). Measurements and Main Results In 2021, 148 hysteroscopies were performed in an office setting under local anaesthesia with paracervical block. The mean age of the patients was 53 years. 53% of the patients were menopausal. The main indications for hysteroscopy included abnormal uterine bleeding, postmenopausal bleeding, abnormal findings during diagnostic imaging as well as endometrial polyps. In 31 patient's polypectomies were performed with the LiNA OperaScope Lasso. In 29/31 patients the polypectomies were successfully completed (average polyp size 1,1 cm, ranging from 0,5 – 2 cm). In one patient the endometrial polyp was only partially removed due to large polyp size (2,5 cm). One patient did not tolerate the hysteroscopy procedure. In all successful polypectomy cases sufficient tissue samples for pathology assessment were obtained. 27 patients underwent endometrial biopsies with the LiNA OperaScope Biopsy Forceps. In 26/27 cases the procedure was completed successfully and sufficient tissue samples for pathology assessment were obtained. None of the patients who underwent endometrial biopsies with the LiNA OperaScope Biopsy Forceps experienced any interruption due to pain or loss of tolerability during the procedure. Conclusion The LiNA OperaScope Lasso and Biopsy Forceps are suitable instruments for hysteroscopic polypectomies and targeted endometrial biopsies in the office setting. To evaluate the LiNA OperaScope Lasso and Biopsy Forceps for office hysteroscopy with polypectomy and targeted endometrial biopsy. Retrospective clinical study. Private Gynecology Practice. 148 patients who underwent office hysteroscopy, including 31 patients with polypectomy and 27 patients with targeted endometrial biopsy. Office hysteroscopy was performed with the LiNA OperaScope, a single use hysteroscope with an operative channel. Polypectomies were performed with the LiNA OperaScope Lasso (16 mm), a 5 Fr mechanical instrument with a basket at the distal end. Targeted biopsies were obtained with the LiNA OperaScope Biopsy Forceps (5 Fr). In 2021, 148 hysteroscopies were performed in an office setting under local anaesthesia with paracervical block. The mean age of the patients was 53 years. 53% of the patients were menopausal. The main indications for hysteroscopy included abnormal uterine bleeding, postmenopausal bleeding, abnormal findings during diagnostic imaging as well as endometrial polyps. In 31 patient's polypectomies were performed with the LiNA OperaScope Lasso. In 29/31 patients the polypectomies were successfully completed (average polyp size 1,1 cm, ranging from 0,5 – 2 cm). In one patient the endometrial polyp was only partially removed due to large polyp size (2,5 cm). One patient did not tolerate the hysteroscopy procedure. In all successful polypectomy cases sufficient tissue samples for pathology assessment were obtained. 27 patients underwent endometrial biopsies with the LiNA OperaScope Biopsy Forceps. In 26/27 cases the procedure was completed successfully and sufficient tissue samples for pathology assessment were obtained. None of the patients who underwent endometrial biopsies with the LiNA OperaScope Biopsy Forceps experienced any interruption due to pain or loss of tolerability during the procedure. The LiNA OperaScope Lasso and Biopsy Forceps are suitable instruments for hysteroscopic polypectomies and targeted endometrial biopsies in the office setting.

7536 Can Body Mass Index be a Predictor of Pain during Office Hysteroscopy? Findings from a Single-Center Study

<h3>Study Objective</h3> Improved technology and miniaturization of the hysteroscopes has allowed for the implementation of office hysteroscopies. One of the most common factors resulting in failure to complete the procedure during office hysteroscopy is pain. Given a society with increasing rates of obesity, there is no available evidence as to whether there is an impact of obesity in a patient's pain tolerance, therefore we seek to determine the relationship between BMI and pain level during office hysteroscopy. <h3>Design</h3> Retrospective chart review of 115 office diagnostic hysteroscopies performed without anesthesia using vaginoscopy technique. <h3>Setting</h3> University-based clinic. <h3>Patients or Participants</h3> Patients older than 18 years old presenting for in-office hysteroscopy. <h3>Interventions</h3> In-office hysteroscopy without anesthesia performed using vaginoscopy technique with rigid 5 mm diagnostic hysteroscope with 30-degree optic lens. <h3>Measurements and Main Results</h3> VAS pain scale from 0-10 was used immediate after the procedure to quantify pain. <h3>Conclusion</h3> There is no association between BMI and pain during office hysteroscopy procedures, therefore BMI is not a predictor of pain. Further studies may consider using a larger sample. In a society with increasing rates of obesity, it is important to address potential barriers to care for our evolving population.

Comparative characteristics of the effect of mono and bipolar energy during hysteroresectoscopy

The objective: to evaluate of postoperative complications, duration of surgical intervention and hospital stay of patients after hysteroscopic surgery using monopolar or bipolar electrodes.Materials and methods. Eighty gynecological patients who had hysteroscopic surgery were divided into two groups of 40 women each. Patients of the I (main) group had hysteroscopic procedures using a bipolar electrode, the persons in the II (comparison) group – a monopolar electrode. The registration of operative complications was carried out – bleeding, perforation, excess fluid and hyponatremia. The time of operation and stay in a gynecological hospital were also taken into account.Results. There were no statistically significant differences between the two groups regarding patient’s characteristics, ultrasound findings, serum sodium levels before and after surgery, uterine perforation, and intraoperative bleeding. Fluid overload was significantly higher in patients of the II group (p&lt;0.03). Postoperative hyponatremia was also significantly pronounced in the II group (p&lt;0.05). The average operation time was significantly shorter in women of the I group compared to the II group (p=0.01), and the hospital stay was significantly shorter for patients after hysteroscopic intervention using bipolar energy compared to the group in which monopolar energy was used (p=0.04). Conclusions. Hysteroresectoscopy with the use of bipolar electrodes is accompanied by a significant decrease in cases of hyponatremia, reduction of the duration of surgical intervention and the stay of gynecological patients in the hospital after surgery. Therefore, this method is safe and effective compared to the use of monopolar electrodes.

Major Perioperative Complications of Benign Gynecologic Procedures at a University-Affiliated Hospital

Background: With the increasing use of minimally invasive techniques for gynecologic procedures, women are at a low risk for peri-operative complications. The purpose of this study was to determine the incidence of and risk factors for major intra or postoperative complications among women undergoing benign gynecologic surgeries. Methods: We conducted a retrospective observational study of all women who underwent benign gynecologic surgery in 2016-2017 at a University-Affiliated community hospital. Pregnant women, malignancy cases, and hysteroscopic or minor vulvar procedures were excluded. Primary outcome was composite intraoperative and/or 30-day postoperative complications requiring medical or surgical management. Logistic regression identified significant patient, peri-operative and surgeon risk factors associated with complications. Results: Of 975 patients included, 53 patients experienced major intra or postoperative complications (5.4%). Mean age was 47.7 ± 13.8 years. Mean BMI was 27.1 ± 5.8 kg/m2. Prior abdominal surgery (laparotomy or laparoscopy) (adjusted odds ratio [OR]= 2.01, 95%CI 1.05-3.83) and emergency surgery (adjusted OR= 19.54, 95%CI 2.99-127.54) were significantly associated with major complications. Surgeon volume of 1-2 operative days per month (adjusted OR=0.30, 95%CI 0.10 - 0.87) and age 40-64 years (adjusted OR=0.24, 95%CI 0.11- 0.56) had a protective effect on the risk of major complications. Conclusions: Among patients in our sample, 5.4% experienced major complications from a benign gynecologic surgery. Complications from benign gynecologic surgery are rare, even in the absence of robotic equipment. Center-specific data and a discussion of the increased morbidity associated with with prior abdominal surgery and emergency surgery should be considered for pre-operative patient counselling.

Vaginal transisthmic myomectomy: a step by step video tutorial

To provide a video tutorial on vaginal transisthmic myomectomy in women with large submucosal fibroids. Stepwise demonstration of the technique, with a narrated video footage. Submucosal fibroids protrude into the uterine cavity and can cause numerous symptoms, including abnormal uterine bleeding, dysmenorrhea, subfertility, and obstetric complications. Over the last decades, hysteroscopic resection has become the preferred surgical approach for submucosal fibroids because it provides significant advantages regarding perioperative morbidity and postoperative recovery time when compared with laparotomy or laparoscopy with complete transection of the uterine wall. However, in large or multiple fibroids, longer surgery durations of hysteroscopic resection can lead to higher complication rates and incomplete resection. In some cases, hysteroscopic resection might even be impossible to perform. Furthermore, in many regions, special equipment for hysteroscopic myomectomy might not be available. Herein, we present a minimally invasive surgical alternative for approaching submucosal fibroids. A 26-year-old woman presenting with hypermenorrhea and dysmenorrhea (on a numeric rating scale from 0-10) caused by a recurrent International Federation of Gynaecology and Obstetrics (FIGO) type 0 fibroid measuring 5 cm in diameter. Vaginal transisthmic myomectomy performed with a longitudinal transection of the uterine cervix and isthmus, morcellation of the fibroid with a scalpel, and multilayer reconstruction. Vaginal transisthmic myomectomy is a fast and relatively simple, minimally invasive surgical technique suitable for large or multiple FIGO 0 and some FIGO 1 fibroids, necessitating the use of only basic surgical equipment. Vaginal transisthmic myomectomy provides an additional minimally invasive surgical approach for submucosal fibroids. This surgical option for selected patients may help prevent complications resulting from prolonged hysteroscopic surgery,repeated hysteroscopic procedures owing to incomplete resection, and the morbidity of transabdominal approaches for myomectomy.With this video, we aim to expedite the clinical learning curve of this technique, which should be investigated on a broader scale in the future.

Prospective Study Investigating Change in Carboxyhemoglobin Blood Level During Operative Hysteroscopy

To evaluate whether the use of radiofrequency energy during resectoscopy leads to increases in patient blood levels of carboxyhemoglobin (COHb) and investigate procedural variables associated with these elevations. A prospective cross-sectional study of 40 subjects undergoing a hysteroscopic procedure using bipolar radiofrequency energy. The study was conducted at an ambulatory surgery center. Procedures for uterine leiomyoma, septa, products of conception, or a combination of these pathologies were included. We measured blood COHb levels before and immediately after the surgery. Abnormal postoperative COHb level was defined as an increase of plasma COHb ≥3.0%. All patients with abnormal postoperative levels were contacted and screened for carbon monoxide toxicity symptoms. Summary statistics included frequency for categorical variables and averages for continuous variables. p values were reported without modification. A total of 17.5% of subjects met the criteria for abnormal postoperative COHb levels. None of these subjects reported symptoms of carbon monoxide toxicity. One subject with an elevated postoperative COHb level had intraoperative hemodynamic changes possibly related to COHb elevation. An abnormal postoperative COHb level was associated with a higher fluid deficit (p=.024) and greater myoma volume (p=.04). This study demonstrates that systemic absorption of carbon monoxide is a reproducible phenomenon in hysteroscopic resections using bipolar diathermy. Greater absorption is associated with a higher fluid deficit and greater myoma volume. Although none of the subjects with an abnormal increase screened positive for symptoms in the postoperative setting and only 1 experienced hemodynamic changes intraoperatively, our study looked at a healthy and young patient population. More research is needed on the safety of this COHb exposure in patients with medical comorbidities. Special consideration should be given to the possibility of carbon monoxide absorption and the uncertain long-term effects when planning extensive hysteroscopic resections.

Endometrial gene expression differences in women with coronavirus disease 2019

To study the potential effect of coronavirus disease (COVID-19) on the endometrial transcriptome of affected, symptomatic women for the detection of altered gene expression. Pilot study of the endometrial transcriptomes of women manifesting COVID-19 compared with those of women without COVID-19 undergoing hysteroscopic procedures for benign gynecologic disorders using RNA sequencing. Hospital and university laboratories. Women with (n = 14) and without a COVID-19 (n = 10) diagnosis based on a nasopharyngeal swab analysis using quantitative reverse-transcription polymerase chain reaction. The endometrium of the patients with COVID-19 had previously been tested for severe acute respiratory syndrome coronavirus 2 infection, revealing the absence of the virus in this tissue. Endometrial biopsy sample collection. Endometrial gene expression and functional analysis of symptomatic patients with COVID-19 vs. individuals without the infection. The systemic disease COVID-19 altered endometrial gene expression in 75% of the women, with the patients exhibiting a preponderance of 163 up-regulated (e.g., UTS2, IFI6, IFIH1, and BNIP3) and 72 down-regulated genes (e.g., CPZ, CDH3, and IRF4) (false discovery rate<0.05). A total of 161 dysregulated functions (36 up-regulated and 125 down-regulated) were typically enriched in the endometria of the patients with COVID-19, including up-regulation in pathways involved in the development of immune responses to viruses and cytokine inflammation, reflecting elicitation of a COVID-19 response pathway. Coronavirus disease 2019 affects endometrial gene expression despite the absence of severe acute respiratory syndrome coronavirus 2 RNA in endometrial tissues.