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Fu W, Li X, Xu H, Zhao T, Wang F. Effects of spinal anaesthesia and intravenous general anaesthesia on the absorption of normal salinein patients undergoing hysteroscopic endometrial resection: an observational study. BMC Womens Health 2023; 23:240. [PMID: 37161394 PMCID: PMC10169332 DOI: 10.1186/s12905-023-02404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION The absorption of uterine distention fluid during hysteroscopic endometrial resection can cause volumeoverload, which can lead to coagulation dysfunction, acute left heart failure and pulmonary oedema in patients. The effects of spinal anaesthesia and intravenous general anaesthesia on the absorption of normal saline as uterine distention fluid during hysteroscopic surgery remain unclear. The aim of this clinical trial was toobserve the effects of spinal anaesthesia and intravenous general anaesthesia on the absorption of normal saline in patients undergoing hysteroscopic endometrial resection. METHODS A total of 126 patients undergoing elective hysteroscopic endometrial resection were divided into a spinal anaesthesia group (s group) and a propofol-fentanyl intravenous anaesthesia group (PF group), with 63 cases in each group, and both groups were divided into a short-term group (S1 group and PF1 group) and a long-term group (S2 group and PF2 group) according to the operation time. The primary outcome was the absorption of normal saline, and the secondary outcomes included the perioperative SBP, DBP, HR and SpO2 and postoperative haematocrit values, and the incidence of postoperative complications. RESULTS The volume of saline absorbed was significantly increased in the S2 and PF2 groups compared with the S1 and PF1 groups (P < 0.001). There was a significant positive correlation between the amount of normal saline absorbed and the operation time (r = 0.895, P < 0.001). The postoperative haematocrit value was slightly lower than that before the operation in all four groups (P < 0.05), and there were no differences in the incidences of urinary retention, sinus bradycardia or hypotension between groups (P > 0.05). CONCLUSIONS There was no difference in the effects of spinal anaesthesia and intravenous general anaesthesia on the absorption of normal saline during hysteroscopic endometrial resection, and the absorption of normal saline increased accordingly with the extension of operation time.
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Affiliation(s)
- Wuchang Fu
- From the Second Clinical Medical College of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, 637000, China
| | - Xue Li
- From the Affiliated Hospital, North Sichuan Medical College, Nanchong, 637000, China
| | - Hongchun Xu
- From the Affiliated Hospital, North Sichuan Medical College, Nanchong, 637000, China
| | - Ting Zhao
- From North Sichuan Medical College, Nanchong, 637000, China
| | - Fangjun Wang
- From the Affiliated Hospital, North Sichuan Medical College, Nanchong, 637000, China.
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Carbon Monoxide poisoning and Air Embolism following Hysteroscopic Myomectomy: a case report. J Gynecol Obstet Hum Reprod 2022; 51:102431. [PMID: 35718331 DOI: 10.1016/j.jogoh.2022.102431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Uterine myomas are the most common benign uterine tumors. Hysteroscopic myomectomy has grown as a standard minimally invasive surgical procedure, but this technique is not free from complications. CASE An hysteroscopic myomectomy was performed on a 38 years-old woman. During the awakening after the procedure, she presented focal neurological deficits, thus arterial blood gas test and total body computerized tomography (CT) scan were urgently carried out. They revealed a very high carboxyhemoglobin level and abdominal venous air embolism. The patient stayed in Trendelenburg position and under mechanical ventilation with 100% oxygen concentration. Fortunately, a few hours later she was fully awake and was able to be successfully extubated, being discharged to the surgical ward three days later fully recovered. CONCLUSION Carbon monoxide poisoning during hysteroscopic resection is a rare but potentially fatal complication that anesthetists, gynecologists, and critical care physicians should be aware of.
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Vilà Famada A, Cos Plans R, Costa Canals L, Rojas Torrijos M, Rodríguez Vicente A, Bainac Albadalejo A. Outcomes of surgical hysteroscopy: 25 years of observational study. J OBSTET GYNAECOL 2021; 42:1365-1369. [PMID: 34913810 DOI: 10.1080/01443615.2021.1971176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this prospective study was to analyse the complications of operative hysteroscopy over the last 25 years and determine whether such complications were related to patient characteristics, surgery type, surgical time or distension-medium balance. Three thousand and sixty-three operative hysteroscopies were performed; 52.7% were polypectomies and 31.5% were myomectomies. Myectomies had the highest incidence of complications, at 14%, followed by septolysis, at 6.9%. The most common complications were mechanical (52%). Myomectomies had seven times higher risk than polypectomies of distension-medium complications (RR 7.5, p<.001) but three times lower risk of mechanical complications (RR 0.32, p<.001). The highest incidence of complications occurred in type I myomas and those larger than 3 cm. If we define fluid-balance complications as only those patients who absorbed more than 1.5 L and developed related symptoms, our overall complication rate, including all mechanical complications, was 5.6%.Impact StatementWhat is already known on this subject? In recent years, the importance of properly preventing and managing hysteroscopic complications has risen in line with the number of diagnostic and operative hysteroscopies performed. Complications in operative hysteroscopy differ between surgery types, patient characteristics and the distending media used.What do the results of this study add? This study provides data from a high number of patients compared to previously published studies on the complications of operative hysteroscopies, and includes a study of the relationship between type of surgery and type of complication.What are the implications of these findings for clinical practice and/or further research? Our study shows the importance of a good preoperative assessment, since the complications of hysteroscopy differ greatly depending on the indication. Thus, within myomectomies, knowing the exact type, size and location of the myoma will allow the surgeon to carefully plan the procedure to avoid complications.
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Affiliation(s)
- Anna Vilà Famada
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Ramon Cos Plans
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Costa Canals
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Rojas Torrijos
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Agueda Rodríguez Vicente
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
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Donan PC, Pace KA, Ruiz CW, Gracia MM. Distending Media Used During Hysteroscopy: Perioperative Nursing Implications. AORN J 2021; 112:634-648. [PMID: 33252805 DOI: 10.1002/aorn.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hysteroscopy is a gynecological procedure that may be indicated for abnormal uterine bleeding, diagnosis and management of infertility, contraception, or sterilization. Surgeons use distending media during hysteroscopy to view the uterine cavity. Media options include carbon dioxide gas and both electrolytic and nonelectrolytic fluids. All distending media is absorbed by the patient's body, but the manner in which each media is absorbed is unique to its chemical composition. Understanding the properties of each distending medium and the risks involved with its use is critical to safe perioperative nursing care for patients undergoing hysteroscopy. This article provides perioperative nurses with a review of uterine anatomy and evidence-based information on the types of distending media used during hysteroscopy and the corresponding perioperative nursing implications.
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Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding. Diagnostics (Basel) 2020; 10:diagnostics10110884. [PMID: 33142970 PMCID: PMC7692264 DOI: 10.3390/diagnostics10110884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022] Open
Abstract
Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system's resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (n = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination.
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Okazaki H, Miura N, Kashima Y, Miyashita R, Oe K, Kawakami K, Ishikawa T, Masui K. Severe hyponatremia with seizures and confirmed mild brain edema by hysteroscopic myomectomy: a case report. JA Clin Rep 2020; 6:74. [PMID: 33001333 PMCID: PMC7530158 DOI: 10.1186/s40981-020-00381-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyponatremia can be developed during hysteroscopic surgery with electrolyte-free irrigation fluid. We experienced severe hyponatremia with postoperative seizures and confirmed mild brain edema. CASE PRESENTATION A quadragenarian female patient underwent a 2-h hysteroscopic myomectomy with electrolyte-free fluid for uterine distension under general anesthesia. Plasma sodium level of 84.1 mmol/L 100 min after the start of surgery indicated excessive absorption of the irrigation fluid. Acute severe hyponatremia was diagnosed with significant edema in the conjunctiva, lip, and extremities. She was treated with a continuous infusion of hypertonic saline. However, seizures and cerebral edema developed 7 h later. The patient recovered without neurological deficits at postoperative day 2. CONCLUSION The electrolyte-free irrigation fluid can be absorbed rapidly during hysteroscopic surgery. Its interruption with hyponatremia should be considered against prolonged surgery. Especially under general anesthesia, caution should be exercised because the typical symptoms of hyponatremia such as nausea and confusion are blinded.
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Affiliation(s)
- Haruko Okazaki
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Norikazu Miura
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Yuki Kashima
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Ryoichi Miyashita
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Katsunori Oe
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Keiko Kawakami
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Tetsuya Ishikawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Kenichi Masui
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
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Lima MPJDS, Costa-Paiva L, Brito LGO, Baccaro LF. Factors Associated with the Complications of Hysteroscopic Myomectomy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:476-485. [PMID: 32898912 PMCID: PMC10309217 DOI: 10.1055/s-0040-1713915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate the factors associated with complete myomectomy in a single surgical procedure and the aspects related to the early complications. METHODS A cross-sectional study with women with submucous myomas. The dependent variables were the complete myomectomy performed in a single hysteroscopic procedure, and the presence of early complications related to the procedure. RESULTS We identified 338 women who underwent hysteroscopic myomectomy. In 89.05% of the cases, there was a single fibroid to be treated. According to the classification of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French), most fibroids were of grade 0 (66.96%), followed by grade 1 (20.54%), and grade 2 (12.50%). The myomectomies were complete in 63.31% of the cases, and the factors independently associated with complete myomectomy were the diameter of the largest fibroid (prevalence ratio [PR]: 0.97; 95% confidence interval [95%CI]: 0.96-0.98) and the classification 0 of the fibroid according to the FIGO (PR: 2.04; 95%CI: 1.18-3.52). We observed early complications in 13.01% of the hysteroscopic procedures (4.44% presented excessive bleeding during the procedure, 4.14%, uterine perforation, 2.66%, false route, 1.78%, fluid overload, 0.59%, exploratory laparotomy, and 0.3%, postoperative infection). The only independent factor associated with the occurrence of early complications was incomplete myomectomy (PR: 2.77; 95%CI: 1.43-5.38). CONCLUSIONS Our results show that hysteroscopic myomectomy may result in up to 13% of complications, and the chance of complete resection is greater in small and completely intracavitary fibroids; women with larger fibroids and with a high degree of myometrial penetration have a greater chance of developing complications from hysteroscopic myomectomy.
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Affiliation(s)
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Luiz Francisco Baccaro
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Meneses T, Faria J, Martins AT, Delgado E, Silva MDC. Septic shock following hysteroscopy - A case report. Case Rep Womens Health 2020; 26:e00182. [PMID: 32082994 PMCID: PMC7021535 DOI: 10.1016/j.crwh.2020.e00182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Minimally invasive gynecological surgery such as hysteroscopy has a small risk of complications. These include uterine perforation (with or without adjacent pelvic organ lesion), bleeding and infection, and are more common in the presence of risk factors such as smoking, history of pelvic inflammatory disease (PID) and endometriosis. Case Presentation A patient submitted to a diagnostic hysteroscopy with no immediate complications was admitted five days later to the emergency department in septic shock. The diagnosis of ruptured tubal abscess was made, requiring emergency laparotomy with sub-total hysterectomy and bilateral adnexectomy. Despite multiple organ failure requiring admission to the intensive care unit, the patient made a full recovery. Conclusion Ascending infection can be a life-threatening complication of hysteroscopy, even in the absence of previously known risk factors. Septic shock can be a serious complication of office hysteroscopy. Ascending infection can occur even with no prior history of sexual intercourse. Patient awareness of alarm signs is key in preventing complications. Prompt recognition and treatment of sepsis are needed to avoid morbidity.
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Vidal-Mazo C, Forero-Diaz C, Lopez-Gonzalez E, Yera-Gilabert M, Machancoses FH. Clinical recurrence of submucosal myoma after a mechanical hysteroscopic myomectomy: Review after 5 years follow up. Eur J Obstet Gynecol Reprod Biol 2019; 243:41-45. [PMID: 31671290 DOI: 10.1016/j.ejogrb.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluation of five years follow up of the clinical recurrence after hysteroscopic myomectomies with MyoSure® morcellator in our district. STUDY DESIGN Premenopausal patients from April 2013 to October 2018, with symptoms of abnormal uterine bleeding, and/or infertility, and sonographic suspicion of submucosal myoma, confirmed by diagnostic hysteroscopy prior to myomectomy were included in the prospective, not randomized cohort study (N = 320). All patients had a follow up visit between three to six months post procedure. Further follow up was established by chart review. The information was extracted from the medical records. Patient characteristics were expressed as mean ± SD or median (interquartile range) for continuous data (assumption of normality assessed using the Kolmogorov-Smirnov test). Dependence relationship between presence of corporal myomas and the performance of a major long-term surgery, and between the amount of submucosal myomas and clinical recurrence throughout the 5 years of follow-up were studied were studied by χ2. RESULTS After one year follow up, no recurrence or symptoms were noted. 53 (16.6%) re-morcellations were performed due to incomplete resection. At the second year, three women who were discharged previously were classified as recurrence (0.9%). There were 99 women remaining to be evaluated (30.90%) in the second year. A percentage estimation of 5-6 recurrences with the 100% of women evaluated. In the third year, only one woman was classified as recurrence (0.3%), with 176 (55%) women not evaluated. At the fourth and fifth year of follow-up, 75% are still awaiting complete of the study five years. No relationship was observed in the presence of corporal myomas and recurrence throughout the 5 years of follow-up (χ2 = 0.000, p = 0.994). Dependence relationship was observed between the presence of corporal myomas and the performance of a major long-term surgery (χ2 = 11.757, p = .001, OR = 3.528). CONCLUSION In office hysteroscopic mechanical myomectomy with MyoSure® morcellator of submucosal fibromas was a highly effective therapy for women, at three years of follow-up. It appears to give satisfactory long-term results with a low recurrence rate and without significant complications.
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Affiliation(s)
- Cinta Vidal-Mazo
- Unidad de Gestión Clínica de Obstetricia y Ginecología, Hospital Juan Ramón Jiménez, Huelva, 21005, Spain.
| | - Carmen Forero-Diaz
- Unidad de Gestión Clínica de Obstetricia y Ginecología, Hospital Juan Ramón Jiménez, Huelva, 21005, Spain
| | - Elga Lopez-Gonzalez
- Unidad de Gestión Clínica de Obstetricia y Ginecología, Hospital Juan Ramón Jiménez, Huelva, 21005, Spain
| | - Marta Yera-Gilabert
- Unidad de Gestión Clínica de Obstetricia y Ginecología, Hospital Juan Ramón Jiménez, Huelva, 21005, Spain
| | - Francisco H Machancoses
- Predepartmental Unit of Medicine, Faculty of Health Sciences, Jaume I University, Castellón de la Plana, 12071, Spain
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Vitale SG, Caruso S, Vitagliano A, Vilos G, Di Gregorio LM, Zizolfi B, Tesarik J, Cianci A. The value of virtual reality simulators in hysteroscopy and training capacity: a systematic review. MINIM INVASIV THER 2019; 29:185-193. [DOI: 10.1080/13645706.2019.1625404] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Caruso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | - George Vilos
- Department of Obstetrics and Gynaecology, University of Western Ontario, London, ON, Canada
| | - Luisa Maria Di Gregorio
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Brunella Zizolfi
- Department of Public Health, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | | | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Savran MM, Nielsen AB, Poulsen BB, Thorsen PB, Konge L. Using virtual-reality simulation to ensure basic competence in hysteroscopy. Surg Endosc 2018; 33:2162-2168. [PMID: 30334158 DOI: 10.1007/s00464-018-6495-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hysteroscopy is a technically challenging procedure. Specialty curricula of obstetrics and gynaecology appraise hysteroscopy for trainees but there is no present evidence-based training program that certifies the fundamental technical skills before performance on patients. The objectives of this study were to develop and gather validity evidence for a simulation-based test that can ensure basic competence in hysteroscopy. METHODS We used the virtual-reality simulator HystMentor™. Six experts evaluated the feasibility and clinical relevance of the simulator modules. Six modules were selected for the test and a pilot study was carried out. Subsequently, medical students, residents, and experienced gynaecologists were enrolled for testing. Outcomes were based on generated simulator metrics. Validity evidence was explored for all five sources of evidence (content, response process, internal structure, relations to other variables, consequences of testing). RESULTS Inter-case reliability was high for four out of five metrics (Cronbach's alpha ≥ 0.80). Significant differences were identified when comparing the three groups' performances (p values < 0.05). Participants' clinical experience was significantly correlated to their simulator test score (Pearson's r = 0.49, p < 0.001). A single medical student managed to achieve the established pass/fail score (6.7% false positive) and three experienced gynaecologists failed the test (27.3% false negative). CONCLUSIONS We developed a virtual-reality simulation-based test in hysteroscopy with supporting validity evidence. The test is intended to ensure competency in a mastery learning program where trainees practise on the simulator until they are able to pass before they proceed to supervised training on patients.
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Affiliation(s)
- Mona M Savran
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Capital Region of Denmark, Denmark.
| | - Anders Bo Nielsen
- SimC, Odense University Hospital, Odense, Region of Southern Denmark, Denmark
| | - Bente Baekholm Poulsen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Region of Southern Denmark, Denmark
| | - Poul Bak Thorsen
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- SimC, Odense University Hospital, Odense, Region of Southern Denmark, Denmark.,Center for HR, Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Capital Region of Denmark, Denmark
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Dealberti D, Riboni F, Vitale SG, Santangelo F, Zizolfi B, Vitagliano A. Author's Reply. J Minim Invasive Gynecol 2018; 25:930-931. [DOI: 10.1016/j.jmig.2018.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 11/26/2022]
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Abstract
The rapid evolution in ambulatory hysteroscopy (AH) has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB). The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting.
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Affiliation(s)
- Shilpa Kolhe
- Ambulatory Gynaecology Unit, Royal Derby Hospital, Derby, UK
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Palancsai Siftar J, Sobocan M, Takac I. The passage of fluid into the peritoneal cavity during hysteroscopy in pre-menopausal and post-menopausal patients. J OBSTET GYNAECOL 2018; 38:956-960. [PMID: 29557212 DOI: 10.1080/01443615.2017.1420047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The present study aimed to determine the amount of fluid medium passing through the Fallopian tubes into the peritoneal cavity during a hysteroscopy. This was done to understand the pathophysiology of complications related to the hysteroscopy. Conducted in a general hospital setting, the study examined the fluid inflow-outflow during a hysteroscopy both in pre- and post-menopausal women. A hysteroscopy was performed vaginoscopically for both diagnostic and therapeutic procedures. The study involved 117 patients. 84 (71.8%) of them were pre-menopausal and 33 (28.2%) were classified as post-menopausal. The fluid volume difference in the peritoneal cavity prior to hysteroscopy was 26.0 ± 4.2 mL in the pre-menopausal and 7.7 ± 2.4 mL (p = .001) in the post-menopausal group. The pre-menopausal group's flow rate through the Fallopian tubes was 1.5 ± 0.2 mL/min. In the post-menopausal group, it was 0.4 ± 0.1 mL/min (p < .05). It was found that during the hysteroscopy in the pre-menopausal patients, more fluid flows through the Fallopian tubes and at a higher flow rate. Impact statement What is already known on this subject? The complications during a hysteroscopy (HSC) are usually fluid-related and can result in adverse events such as a fluid overload, the dissemination of malignant cells, or electrolyte misbalance. Currently, there is a poor understanding of how HSC fluid behaviour impacts on the pathophysiology of these adverse procedure effects. What do the results of this study add? There have been no quantitative studies of the behaviour of fluid inside the uterine cavity during HSC, which means a quantification of fluid inflow and absorption is required. Our study adds a quantitative understanding of fluid behaviour during HSC. It shows increased rates of fluid passage, as well as fluid speed, into the peritoneal cavity in pre-menopausal patients. What are the implications of these findings for clinical practice and/or further research? Due to the higher rates of fluid passage and speed in pre-menstrual patients, caution regarding the complications during hysteroscopy and further studies are needed on the impact of different fluid distribution.
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Affiliation(s)
- Janka Palancsai Siftar
- a Department of Obstetrics and Gynecology , General Hospital Izola, Izola , Slovenia.,b Faculty of Medicine , University of Maribor, Maribor , Slovenia
| | - Monika Sobocan
- b Faculty of Medicine , University of Maribor, Maribor , Slovenia.,c University Department of Gynecology and Perinatology , University Medical Center Maribor , Maribor , Slovenia
| | - Iztok Takac
- b Faculty of Medicine , University of Maribor, Maribor , Slovenia.,c University Department of Gynecology and Perinatology , University Medical Center Maribor , Maribor , Slovenia
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Endometrial resection and global ablation in the normal uterus. Best Pract Res Clin Obstet Gynaecol 2018; 46:84-98. [DOI: 10.1016/j.bpobgyn.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022]
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Li C, Dai Z, Gong Y, Xie B, Wang B. A systematic review and meta-analysis of randomized controlled trials comparing hysteroscopic morcellation with resectoscopy for patients with endometrial lesions. Int J Gynaecol Obstet 2016; 136:6-12. [PMID: 28099700 DOI: 10.1002/ijgo.12012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/03/2016] [Accepted: 10/10/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Chunbo Li
- Department of Obstetrics and Gynaecology; Shanghai First Maternity and Infant Hospital; Tongji University School of Medicine; Shanghai China
| | - Zhiyuan Dai
- Department of Obstetrics and Gynaecology; Shanghai First Maternity and Infant Hospital; Tongji University School of Medicine; Shanghai China
| | - Yuping Gong
- Department of General Surgery; Zhongshan Hospital of Fudan University; Shanghai China
| | - Bingying Xie
- Department of Gynaecology and Obstetrics; Gynaecology and Obstetrics Hospital of Fudan University; Shanghai China
| | - Bei Wang
- Department of Anesthesia; Zhongshan Hospital of Fudan University; Shanghai China
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