Transcervical Resection Of The Endometrium Research Articles

Incidence and risks of excessive distension absorption in hysteroscopic surgery using 5% mannitol solution: a retrospective descriptive study

ObjectiveTo clarify the incidence of excessive distension absorption in hysteroscopic surgery using 5% mannitol solution, evaluate the associated risks, and help to establish a safe fluid deficit threshold for such complication.DesignRetrospective descriptive study.SettingAcademic medical center.PatientsTen thousand six hundred ninety-three patients underwent inpatient hysteroscopic surgery with 5% mannitol perfusion using a monopolar electrosurgical instrument from Jan. 2015 to Sep. 2020.Intervention(s)None. This study has been approved by the Ethics Committee of Sun Yat-sen Memorial Hospital.Measurements and main resultsA fluid deficit of more than 1000 mL was defined as the diagnostic criteria for excessive distension absorption. The overall incidence of excessive distension absorption in this study was 0.46% (49/10693). The incidence was 2.57% (16/623) for transcervical resection of fibroid (TCRF), 2.36% (9/381) for retained products of conception (RPOC) removal, 1.20% (6/501) for hysteroscopic uterine septum resection (HSR), 0.48% (4/828) for transcervical resection of the endometrium (TCRE), and 0.53% (14/2621) for transcervical resections of adhesion (TCRA). Excessive distension absorption could occur within seven minutes in HSR. Among the patients diagnosed with excessive distension absorption, 30.77% (12/39) exhibited signs or symptoms related to circulation overload with a fluid deficit under 2500 mL, and 10.26% (4/39) developed pulmonary edema.ConclusionExcessive distension absorption could happen in all kinds hysteroscopic surgical treatment including RPOC removal and TCRA which were rarely reported. The overall incidence of excessive distension absorption could be low. But it would be five times higher in certain procedures such as TCRF, RPOC removal and TCRA. Resection using a needle electrode in HSR and TCRA may contribute to the short time development of excessive distension absorption. 30.77% of the patients could not tolerate the fluid deficit of less than 2500 mL which was set as a threshold for isotonic distending media and presented with circulation overload related signs or symptoms.

Time to Hysterectomy After Transcervical Resection of the Endometrium Based on Age: A Retrospective Cohort Review

To determine the rate of hysterectomy over time after transcervical resection of the endometrium (TCRE) based on age. Retrospective audit. A single gynecology clinic in regional Victoria, Australia. A total of 1078 patients who had undergone TCRE for abnormal uterine bleeding. The likelihood of hysterectomy was compared across age groups using the chi-square test. Time to hysterectomy was summarized as a median with the 25th and 75th percentiles and compared across age groups using the Kaplan-Meier plot (log-rank test) and Cox proportional hazards regression. The overall rate of hysterectomy was 24.2% (261 of 1078, 95% confidence interval [CI] 21.7-26.9). When age was categorized into <40 years, 40 to 44 years, 45 to 49 years, and >50 years, the rate of hysterectomy after TCRE was 32.3% (70 of 217), 29.5% (93 of 315), 19.6% (73 of 372), and 14.4% (25 of 174), respectively (p <.001). The likelihood of hysterectomy at any time point after TCRE among those aged 45 to 49 years and older than 50 years was 43% and 59% lower, respectively, than patients under 40 years (hazard ratio, 0.57; 95% CI, 0.41-0.80, and hazard ratio, 0.41; 95% CI, 0.26-0.65, respectively). The median time to hysterectomy was 1.68 years (25th to 75th percentiles, 0.77-3.76). This study demonstrated that patients who underwent a TCRE before the age of 45 years had a higher chance of having a hysterectomy than patients older than 45 years. This information will enable clinicians to inform patients of their chance of undergoing a hysterectomy at any time after TCRE.

The Reproducibility of Treatment of Perimenopausal Abnormal Uterine Bleeding Due to Ovulatory Dysfunction with Hysteroscopic Endometrial Resection versus Mirena

Objective: To compare the efficacy of local levonorgestrel intrauterine releasing system and transcervical resection of the endometrium (TCER) in the management of perimenopausal dysfunctional uterine bleeding. Patients and Methods: This study was done at Ain Shams and Al-Azhar University Maternity Hospitals during a period started from January 2019 to January 2021. Patients were followed up at the outpatient gynaecology clinics at regular schedules (3, 6 and 12 months) for one year duration. Perimenopausal patients with DUB were assigned randomly to either the levonorgestrel intrauterine system (n = 35) or endometrial resection (n = 45). Blood loss assessment charts were used to measure menstrual blood loss. Results: Total bleeding score/month decreased from a baseline median of 47.26 to 33.5 (P&lt;0.01) for the levonorgestrel intrauterine system and from 47.13 to 33.9 (P&lt;0.01) for transcervical resection of the endometrium. There was no statically difference in bleeding score before and during treatment between the two groups of women. Conclusion: Both treatments levonorgestrel intrauterine system and transcervical resection of the endometrium efficiently reduced menstrual bleeding. levonorgestrel intrauterine system should be considered the first-line treatment for idiopathic menorrhagia because it is easy to insert, has a sustained effect, provides contraception, may reduce the need for surgery, and is cost-effective and well tolerated.

Comparison of Bipolar Ball Endometrial Ablation and Transcervical Resection of the Endometrium in the Treatment of Heavy Menstrual Bleeding: A Randomized Clinical Trial.

Objectives:To compare the operative time, effectiveness, and patient satisfaction between ball endometrial ablation and transcervical resection of the endometrium (TCRE) using a bipolar resectoscope.Materials and Methods:Forty-four women with heavy menstrual bleeding who were unresponsive to at least 3 months' medical management were included in this randomized, controlled clinical trial. After randomization, patients underwent either TCRE or ball endometrial ablation using a bipolar resectoscope. The operative time, fluid deficit, and postoperative pain were recorded. The patients were evaluated postoperatively at 3, 6, and 12 months after surgery. Patient satisfaction, amenorrhea rate, reintervention rate, and pictorial blood-loss-assessment chart (PBAC) score were compared between the two groups.Results:The mean operative time in ball endometrial ablation group was 11.17 ± 2.24 min and in TCRE group was 22.33 ± 5.26 min (P < 0.001). There was no significant difference in the postoperative PBAC score, amenorrhea rates, patient satisfaction, and need for reintervention between the two groups.Conclusion:Operative time with ball endometrial ablation is significantly less when compared to TCRE when using a bipolar resectoscope.

Combined transcervical endometrial resection and levonorgestrel device treatment compared to transcervical endometrial resection for abnormal uterine bleed.

Transcervical resection of the endometrium (TCRE) is a first-line surgical treatment of abnormal uterine bleeding. However, many women experience unsuccessful results, causing hysterectomy in up 17% of cases. The aim of this study was to describe the odds of hysterectomy in women with abnormal uterine bleeding, treated with TCRE and levonorgestrel intrauterine contraceptive device (TCRE+LNG-IUCD) or TCRE alone. The secondary aim was to analyze the rate of amenorrhea. Designed as a retrospective cohort study, and conducted at Odense University Hospital, Denmark, the study included women with abnormal uterine bleeding, who underwent TCRE from January 2013 to December 2015. The decision of treatment with respect to LNG-IUCD was at the woman's discretion. Data were collected from medical records and a self-reported retrospective bleeding-pattern questionnaire. A multivariate regression model was used, enabling adjustment for potential and identified confounders. Out of 432 women, 276 (62%) consented to inclusion and of these, 16 (4%) were excluded. In total 88 (34%) received combined treatment and 172 (66%) received TCRE alone. Ten women (11%) treated with TCRE+LNG-IUCD underwent hysterectomy, compared with 27 (16%) treated with TCRE alone (OR=0.69, 95% CI 0.28-1.56; P=.34). Multivariate analysis disclosed a significant effect of TCRE+LNG-IUCD (OR=0.35, 95% CI 0.13-0.97; P=.04) on hysterectomy. The presence of fibromas was shown to increase the odds of treatment failure, resulting in hysterectomy (OR 2.69, 95% CI 1.15-6.31; P=.02). Furthermore, the incidence of amenorrhea was 59% in the TCRE+LNG-IUCD group and 36% in the TCRE alone group (OR=2.56, 95% CI 1.46-4.49; P<.01). The study showed significantly lower odds of hysterectomy in the TCRE+LNG-IUCD group when adjusted for confounders. Combination treatment improves the bleeding patterns significantly compared with monotherapy with TCRE.

2887 Hysterectomy after Failed Endometrial Resection and Endometrial Ablation Techniques. Can We Work Out When It is Going to Fail?

Study Objective Heavy Menstrual Bleeding is the most common reason for gynaecological consultation in the United Kingdom. We aimed to identify factors that may contribute to failed ablation/resection of endometrium, to improve future patient selection and counselling. Design Retrospective audit was performed for women who underwent hysterectomy, January 2012 - December 2018, following a Thermablate, NovaSure, or transcervical resection of endometrium (TCRE). Setting Northern Health and Social Care Trust, Northern Ireland. Patients or Participants 85 patients were identified by clinical coding department. Interventions N/A. Measurements and Main Results Mean age at hysterectomy was 43 years, Average body mass index (BMI) was 31.73 kg/m2. 87% underwent a pre-operative pelvic ultrasound scan, of these 32% had fibroids detected. 72% underwent endometrial ablation using Thermablate, 17% NovaSure, 2% Thermablate followed by NovaSure, 2% had Thermablate twice, performed nine months apart, and 7% patients had transcervical resection of the endometrium. 47% had a trial of Mirena IUS prior to ablation. Mean ablation to hysterectomy interval was 23 months. The main indication for hysterectomy was heavy menstrual bleeding (75%), followed by pelvic pain (13%), then both heavy menstrual bleeding and pelvic pain (11%). Mean specimen weight at hysterectomy was 183g. Abnormal pathology was confirmed in 70% of hysterectomy specimens (Fibroids 54%, adenomyosis 14% and combined pathology including fibroids, adenomyosis, simple hyperplasia and endometriosis in 32%. Dysmenorrhoea, parity, previous normal vaginal deliveries/caesarean section, BMI and type of ablation did not reach clinical significance in terms of predictive parameters. Conclusion When ablation/ resection fails our results demonstrated that the pre-operative demographics above were a poor predictor. Associated identified pathologies particularly fibroids and adenomyosis suggests that pre-operative diagnosis of these would be valuable in optimizing patient selection and counselling.

For women with heavy menstrual bleeding, does randomized controlled trial evidence support the transcervical resection of the endometrium (TCRE) and ablation instead of hysterectomy?

For women with heavy menstrual bleeding, does randomized controlled trial evidence support the transcervical resection of the endometrium (TCRE) and ablation instead of hysterectomy?

Operative hysteroscopy platform at a university teaching hospital: a retrospective study

ObjectiveThis study was performed to investigate the prevalence, indications, effectiveness, outcomes, and complications of operative hysteroscopy in gynecological patients with an emphasis on the need for further training and equipping facilities as performed by consultant gynecologists.MethodsThis was a retrospective descriptive study of operative hysteroscopic procedures from 19 September 2016 to 31 December 2018.ResultsIn total, 1919 hysteroscopic procedures were performed [1829 (95.3%) diagnostic and 90 (4.7%) operative hysteroscopies]. The patients’ mean age was 42.4 years (range, 20–69 years). The most common operative procedure was hysteroscopic fibroid polypectomy in 31 patients (34.4%), followed by transcervical resection of the endometrium in 23 (25.6%) and endometrial polypectomy in 16 (17.8%). The most common indication was menorrhagia in 57 patients (63.33%), followed by recurrent miscarriages in 9 (10.00%) and primary infertility in 5 (5.56%). Sixty-six patients (73.33%) were treated under general anesthesia and 24 (26.67%) under spinal anesthesia. Fifteen fibroids (48.4%) were 3 to 4 cm in size and 11 (35.5%) were >4 cm. Eight polyps (50%) were 3 to 4 cm. The mean uterine size and endometrial thickness were 8.9 ± 2.16 weeks and 11.1 ± 3.01 mm, respectively. The mean preoperative hemoglobin level was 10.9 g/dL and the mean estimated blood loss was 65.9 ± 48.7 mL (range, 10–200 mL). Thirty-eight patients (60.3%) with heavy bleeding improved with no need for further medical or surgical intervention. Eleven patients (44%) with reproductive issues conceived or regained their normal menstrual pattern. Two patients (2.2%) had excessive fluid absorption and one (1.1%) had uterine perforation.ConclusionsOperative hysteroscopy was an effective and safe option in certain uterine pathologies. Specific training in operative hysteroscopy should be promoted to make this type of surgery an integral part of gynecological services in the developing world.

How do ablation techniques compare with transcervical resection of the endometrium at one year and later in women with heavy menstrual bleeding?

How do ablation techniques compare with transcervical resection of the endometrium at one year and later in women with heavy menstrual bleeding?

How do ablation techniques compare with transcervical resection of the endometrium at one year and later in women with heavy menstrual bleeding?

How do ablation techniques compare with transcervical resection of the endometrium at one year and later in women with heavy menstrual bleeding?

Inter-rater agreement in the diagnosis of adenomyosis by 2- and 3-dimensional transvaginal ultrasonography.

To assess the inter-rater agreement of 2-dimensional (2D) and 3-dimensional (3D) transvaginal ultrasonography (TVUS) in the diagnosis of adenomyosis. This prospective study included premenopausal women (n = 96) with heavy menstrual bleeding, menstrual pain, or both who were scheduled for hysterectomy or transcervical resection of the endometrium. All women underwent real-time 2D TVUS and subsequently offline 3D TVUS, which was blinded to 2D TVUS, by a single expert rater and a single nonexpert rater for the diagnosis of adenomyosis based on standardized pattern recognition and junctional zone measurements. Three-dimensional TVUS was done on a computer with 3D volumes recorded during 2D TVUS by both raters. The expert rater reported the image quality of all 3D volumes (n = 192). Inter-rater agreement (Cohen's κ) was assessed for both techniques, and the improvement over time was assessed for 2D TVUS. Diagnosis of adenomyosis showed good (κ = 0.69) and poor (κ = 0.21) inter-rater agreement with 2D and 3D TVUS, respectively (P < .05). The agreement with 2D TVUS improved over time. The agreement with 3D TVUS was slightly better for expert-recorded 3D volumes (κ = 0.40), which also had better image quality (P < .05). The most reproducible 2D and 3D features were anechoic lacunae (κ = 0.52) and junctional zone irregularity (κ = 0.27), respectively. Standardized pattern recognition during real-time 2D TVUS may result in good agreement between expert and nonexpert raters for the diagnosis of adenomyosis. Offline 3D TVUS is less reproducible, and junctional zone measurements do not improve the inter-rater agreement. The low inter-rater agreement may be related to a lack of experience and low image quality of nonexpert-recorded 3D volumes.

1 - Final Results of a Randomized Controlled Trial of the Cardea™ GEA System Versus Transcervical Resection of the Endometrium (TCRE) Combined with Roller-Ball Ablation for the Treatment of Abnormal Uterine Bleeding

Study Objective: To evaluate the safety and effectiveness of the CardeaTM GEA System (a bipolar RF with 5.5 mm probe diameter) as compared to the control (TCRE - Trans Cervical Resection of the Endometrium) combined with roller-ball ablation for the treatment of abnormal uterine bleeding.

375 - Prophylactic Cervical Dilatation After Trans Cervical Resection of the Endometrium to Prevent Painful Hematometra

375 - Prophylactic Cervical Dilatation After Trans Cervical Resection of the Endometrium to Prevent Painful Hematometra

Trans-Cervical Resection of the Endometrium in Early Endometrial Cancer: Analternative Surgical Management Technique in the Setting of Morbid Obesity

Trans-Cervical Resection of the Endometrium in Early Endometrial Cancer: Analternative Surgical Management Technique in the Setting of Morbid Obesity

377. Transcervical resection of the endometrium in early endometrial cancer: An adaptive surgical technique as an alternative in the setting of morbid obesity

377. Transcervical resection of the endometrium in early endometrial cancer: An adaptive surgical technique as an alternative in the setting of morbid obesity

Preliminary Results of a Randomized Controlled Trial of the Cardea™ GEA System Versus Transcervical Resection of the Endometrium (TCRE) Combined with Roller-Ball Ablation for the Treatment of Abnormal Uterine Bleeding

Preliminary Results of a Randomized Controlled Trial of the Cardea™ GEA System Versus Transcervical Resection of the Endometrium (TCRE) Combined with Roller-Ball Ablation for the Treatment of Abnormal Uterine Bleeding

Impact of Myomas on the Results of Transcervical Resection of the Endometrium

Study ObjectiveTo investigate long-term hysterectomy rates after transcervical resection of the endometrium (TCRE) performed by experienced surgeons in the presence and absence of intracavitary myomas. DesignMulticenter case-control study (Canadian Task Force classification II-2). PatientsThe study group comprised 456 women with myomas who met the inclusion criteria, and of these, 82 (17.98%) later underwent hysterectomy. The control group comprised 1438 women without myomas, and of these, 284 (19.75%) later underwent hysterectomy. MethodsFrom 2001 to 2004, standardized results were extracted from Hyskobase on the basis of a total of 1894 women aged 23 to 59 years. The women were identified as having or not having myomas, and data from both groups were statistically analyzed. Detailed information on myoma size and intramural involvement (type 0, 1, and 2) was collected. Measurements and Main ResultsAfter TCRE, women with type 2 myomas, compared with those with type 0 myomas, were found to have a significantly higher risk of undergoing hysterectomy (p = .04), and women, including controls, with myomas >3.6 cm in greatest diameter were found to have a significantly higher risk of undergoing hysterectomy than were those with smaller myomas (p = .01). There was no statistically significant difference in risk of hysterectomy between type 0 and type 1 myomas or between type 1 and type 2 myomas. When hysterectomy rates between the myoma and control groups were compared, there was an increased risk of hysterectomy in the control group (p = .008). Multiple-step multivariate regression analysis of uterine and procedural characteristics of TCRE demonstrated that factors that were positive predictors of hysterectomy within 66 months after resection were younger age, inaccessible uterine corners, enlarged uterus, and pretreatment using gonadotropin-releasing hormone agonists. ConclusionWhen performing TCRE in women with intracavitary myomas, the chance of treatment success is worsened if they are of type 2 or their diameter is >3.5 cm. In addition, younger age increases the risk of hysterectomy and the need for pretreatment with gonadotropin-releasing hormone agonists, or if the uterus is enlarged or the uterine corners are difficult to access during the procedure.

Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding

Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding

Endometrial resection and ablation techniques for heavy menstrual bleeding

Heavy menstrual bleeding (HMB) is a significant health problem in premenopausal women; it can reduce their quality of life and cause anaemia. First-line therapy has traditionally been medical therapy but this is frequently ineffective. On the other hand, hysterectomy is obviously 100% effective in stopping bleeding but is more costly and can cause severe complications. Endometrial ablation is less invasive and preserves the uterus, although long-term studies have found that the costs of ablative surgery approach the cost of hysterectomy due to the requirement for repeat procedures. A large number of techniques have been developed to 'ablate' (remove) the lining of the endometrium. The gold standard techniques (laser, transcervical resection of the endometrium and rollerball) require visualisation of the uterus with a hysteroscope and, although safe, require skilled surgeons. A number of newer techniques have recently been developed, most of which are less time consuming. However, hysteroscopy may still be required as part of the ablative techniques and some of these techniques must be considered to be still under development, requiring refinement and investigation. To compare the efficacy, safety and acceptability of of endometrial destruction techniques to reduce heavy menstrual bleeding (HMB) in premenopausal women. We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials CENTRAL), MEDLINE, EMBASE, CINAHL, and PsycInfo, (from inception to June 2013). We also searched trials registers, other sources of unpublished or grey literature and reference lists of retrieved studies, and made contact with experts in the field and pharmaceutical companies that manufacture ablation devices. Randomised controlled trials (RCTs) comparing different endometrial ablation techniques in women with a complaint of HMB without uterine pathology were eligible. The outcomes included reduction of HMB, improvement in quality of life, operative outcomes, satisfaction with the outcome, complications and need for further surgery or hysterectomy. Two review authors independently selected trials for inclusion, assessed trials for risk of bias and extracted data. Attempts were made to contact authors for clarification of data in some trials. Adverse events were only assessed if they were separately measured in the included trials. Comparisons were made with individual techniques and an overall comparison between first and second-generation ablation methods was also undertaken. Twenty five trials (4040 women) with sample sizes ranging from 20 to 372 were included in the review. A majority of the trials had a specified method of randomisation, adequate description of dropouts and no evidence of selective reporting. Less than half had adequate allocation concealment and most were unblinded.There was insufficient evidence to suggest superiority of a particular technique in the pairwise comparisons between individual ablation and resection methods.In the overall comparison of the newer 'blind' techniques (second-generation) with the gold standard hysteroscopic ablative techniques (first-generation) there was no evidence of overall differences in the improvement in HMB (12 RCTs) or patient satisfaction (11 RCTs).Surgery was an average of 15 minutes shorter (mean difference (MD) 14.9, 95% CI 10.1 to 19.7, 9 RCTs; low quality evidence), local anaesthesia was more likely to be employed (relative risk (RR) 2.8, 95% CI 1.8 to 4.4, 6 RCTs; low quality evidence) and equipment failure was more likely (RR 4.3, 95% CI 1.5 to 12.4, 3 RCTs; moderate quality evidence) with second-generation ablation. Women undergoing newer (second-generation) ablative procedures were less likely to have fluid overload, uterine perforation, cervical lacerations and hematometra than women undergoing the more traditional type of ablation and resection techniques (RR 0.18, 95% CI 0.04 to 0.79, 4 RCTs; RR 0.32, 95% CI 0.1 to 1.0, 8 RCTs; RR 0.22, 95% CI 0.08 to 0.61, 8 RCTs; and RR 0.32, 95% CI 0.12 to 0.85, 5 RCTs; all moderate quality evidence, respectively). However, women were more likely to have nausea and vomiting and uterine cramping (RR 2.0, 95% CI 1.3 to 3.0, 4 RCTs; and RR 1.2, 95% CI 1.0 to 1.4, 2 RCTs; both moderate quality evidence, respectively). The risk of requiring either further surgery of any kind or hysterectomy specifically was reduced with second-generation ablative methods compared to first-generation ablation up to 10 years after surgery (RR 0.69, 95% CI 0.48 to 0.99, 1 RCT; and RR 0.60, 95% CI 0.38 to 0.96, 1 RCT; both moderate quality evidence, respectively) but not at earlier follow up. Additional research is required to confirm this finding. Endometrial ablation techniques offer a less invasive surgical alternative to hysterectomy. The rapid development of a number of new methods of endometrial destruction has made systematic comparisons between individual methods and with the 'gold standard' first-generation techniques difficult. Most of the newer techniques are technically easier to perform than traditional hysteroscopy-based methods but technical difficulties with the new equipment need to be addressed. Overall, the existing evidence suggests that success, satisfaction rates and complication profiles of newer techniques of ablation compare favourably with hysteroscopic techniques.

Analysis of uterine and ovarian arterial blood flow and ovarian hormone levels prior to and after hysteroscopic endometrial resection

The objective of this study was to evaluate the effect of hysteroscopic endometrial ablation on the ovarian and uterine artery blood flow and on follicle stimulating hormone (FSH) and oestradiol (E2) levels. A total of 26 consecutive women with abnormal uterine bleeding refractory to medical treatment had undergone hysteroscopic electrosurgical transcervical resection of the endometrium (TCRE). Ultrasonographic measurement of ovarian volumes and colour Doppler flow assessment of the uterine and ovarian arteries were performed on all patients before surgery (group 1) and 1 week (group 2) and 6 months (group 3) after surgery. Blood samples were also collected for determination of FSH and E2 levels, 4 weeks before and 1 month after surgery. No statistically significant change was observed between preoperative and postoperative (1st week and 3rd month) volumes of the ovaries. The mean pulsatility index (PI) of the uterine and ovarian artery did not show statistically significant differences between postoperative 1st week and 3rd month measurements of uterine and ovarian artery PI. The increase in serum levels of FSH and E2 after endometrial resection did not reach statistical significance. Although women may present with climacteric complaints of hot flushes and nocturnal sweating after endometrial resection, this is probably a psychological response to hypomenorrhoea and amenorrhoea, as no statistically significant changes in FSH and E2 levels and uterine/ovarian blood flow were demonstrated in the early postoperative period.