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van Wessel S, Hamerlynck T, van Vliet H, Weyers S, Schoot B. Clinical evaluation of a new hand-driven hysteroscopic tissue removal device, Resectr ™ 5fr, for the resection of endometrial polyps in an office setting. Arch Gynecol Obstet 2023; 308:893-900. [PMID: 36920533 DOI: 10.1007/s00404-023-06995-w] [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] [Received: 08/22/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE A first clinical evaluation of a new hand-driven hysteroscopic tissue removal device, Resectr™ 5fr, for office polypectomy without any anesthesia. METHODS Women with at least one small endometrial polyp were eligible. Hysteroscopic polypectomy was performed using the Resectr™ 5fr in an office setting, without any anesthesia. RESULTS One hundred and two hysteroscopic polypectomies were included in the analysis. The median installation time was 1.9 min (95% confidence interval (CI) 1.6-2.1). The median time to complete polyp removal was 1.2 min (95% CI 0.8-1.6). The median surgeon's safety, practical, and comfort scores on a 5-point Likert scale were high (5 (5-5), 5 (4-5), and 5 (4-5), respectively). Women's pain score was low (median 1 (0-3)), whereas the satisfaction rate was high (median 5 (5-5)), both on a 5-point Likert scale. There were two conversions (hysteroscopic scissors (n = 1), a new Resectr™ 5fr device (n = 1)). There was one incomplete procedure (tissue hardness). CONCLUSION Hysteroscopic removal of small polyps, using the [Formula: see text] 5fr in an office setting is feasible in terms of installation and resection time. Surgeon's practical, comfort, and safety scores are high, whereas women report low pain scores and high satisfaction rates. TRIAL REGISTRATION: Dutch Clinical Trial Registry (NTR 7119, NL6923): https://www.trialregister.nl/trial/6923 . Date of registration: 27/03/2018.
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Affiliation(s)
- Steffi van Wessel
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Tjalina Hamerlynck
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Huib van Vliet
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Steven Weyers
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Benedictus Schoot
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Raz N, Feinmesser L, Moore O, Haimovich S. Endometrial polyps: diagnosis and treatment options - a review of literature. MINIM INVASIV THER 2021; 30:278-287. [PMID: 34355659 DOI: 10.1080/13645706.2021.1948867] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND AIM Endometrial polyps (EPs) are a common gynecologic condition, associated with abnormal uterine bleeding (AUB), infertility, and premalignant and malignant conditions. Technologies for diagnosis and treatment of EPs are constantly evolving. We aim to provide an updated review on diagnosis and management options for patients with EPs. MATERIAL AND METHODS We conducted an electronic search in databases including MEDLINE, PubMed, Cochrane Central Register and others. We included 68 publications regarding EPs, their clinical burden, diagnostic modalities, treatment options and new technologies. RESULTS Transvaginal ultrasound (TVS) is the common modality for EP detection and color doppler increases its diagnostic accuracy. Dilation and curettage (D&C) should be avoided for diagnosis and treatment of EPs. Hysteroscopy shows high diagnostic value in EPs and allows for both histological diagnosis and effective treatment. Office hysteroscopy and see and treat hysteroscopy without anesthesia is feasible and safe for EP diagnosis and treatment, gaining more trained surgeons globally. Effective and safe technological tools for EP resection include Laser, resectoscopes, morcellators, MyoSure, Truclear and scissors\graspers. CONCLUSIONS EPs are safely and effectively diagnosed and treated with the hysteroscopic tools reviewed in this article. More research is needed to define the best treatment modality.
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Affiliation(s)
- Nili Raz
- Gynecology Ambulatory Surgery Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,Technion Israel Institute of Technology, Haifa, Israel
| | - Larissa Feinmesser
- Gynecology Ambulatory Surgery Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,Technion Israel Institute of Technology, Haifa, Israel
| | - Omer Moore
- Gynecology Ambulatory Surgery Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,Technion Israel Institute of Technology, Haifa, Israel
| | - Sergio Haimovich
- Gynecology Ambulatory Surgery Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,Technion Israel Institute of Technology, Haifa, Israel
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3
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Vitale SG, Alonso Pacheco L, Haimovich S, Riemma G, De Angelis MC, Carugno J, Lasmar RB, Di Spiezio Sardo A. Pain management for in-office hysteroscopy. A practical decalogue for the operator. J Gynecol Obstet Hum Reprod 2020; 50:101976. [PMID: 33166706 DOI: 10.1016/j.jogoh.2020.101976] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022]
Abstract
Hysteroscopy is known to be the gold standard for evaluation of intrauterine pathologies, pre-menopausal and post-menopausal abnormal uterine bleeding and, in addition to this, it is a crucial examination in the infertility work-up. In-office operative hysteroscopy incorporates the outstanding possibility of seeing and treating an intracavitary pathology in the same examination, eliminating all the risk related to anesthesia and reducing procedure-related costs. By now, performing operative procedures in the office setting is recognized as feasible and safe. Over the last 20 years, many efforts have been made to implement the in-office operative approach worldwide. However, for some women, in-office hysteroscopy is still considered a painful experience, with reported discomfort at different steps of the hysteroscopic procedures. Moreover, uneventful and tedious sensations might be increased by a high level of anxiety for such examination. For this reason, despite the feasibility of the in-office approach, many clinicians are still afraid of provoking pain during the procedure and rather not to perform surgical procedures in the office, postponing the removal of the pathology in the operating room. To date, there is no consensus concerning pain management for in-office hysteroscopy and different approaches, pharmacological and non-pharmacological aids, as well as several procedural tips and tricks are utilized. Our purpose is to provide a feasible practical decalogue for the operator, to supply adequate management of pain during in-office hysteroscopic procedures, performing challenging operations, shrinking discomfort, aiming to upgrade both women's and operator's satisfaction.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
| | | | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera, Israel
| | - Gaetano Riemma
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida, USA
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4
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Ceci O, Franchini M, Cardinale S, Cannone R, Giarrè G, Fascilla FD, Bettocchi S, Cicinelli E. Comparison of endometrial polyp recurrence in fertile women after office hysteroscopic endometrial polypectomy using two widely spread techniques. J Obstet Gynaecol Res 2020; 46:2084-2091. [PMID: 32715585 DOI: 10.1111/jog.14400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/28/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
AIM To compare the recurrence of benign endometrial polyps after office hysteroscopic polypectomy performed with a bipolar electrode (BE) or a small diameter hysteroscopic tissue removal system (HTRs). METHODS From July 2018 to December 2019 we evaluated the charts of 114 asymptomatic fertile women who underwent office hysteroscopic polypectomy, 1 year before, for a single large benign endometrial polyp (size between 10 and 20 mm) using a 4 mm continuous flow hysteroscope with a BE or a 5 mm HTRs. Patients, divided into two groups according to surgical procedure, each performed exclusively by one expert gynecologist, were scheduled for a 12-month postoperative transvaginal sonography to evaluate the recurrence of endometrial polyps. RESULTS Forty-eight women of the BE group and 42 of the HTRs group were considered for the 1-year transvaginal sonography follow-up. Five polyps were identified in the BE group and three in the HTRs group (5/48 vs 3/42, P = n.s.). All polyps were removed hysteroscopically (in three out of five and in two out of three cases, respectively, in the same places of the previous polypectomy) and evaluated as 'benign' by the pathologist. CONCLUSION Office hysteroscopic endometrial polypectomy with small HTRs compared to BE revealed at a 1-year follow-up no difference in terms of complete removal and recurrence of polyps. HTRs polypectomy resulted in less pain and significantly quicker time of procedure compared to BE. This data should be kept in mind for patient comfort any time hysteroscopic polypectomy is planned in an office setting.
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Affiliation(s)
- Oronzo Ceci
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy
| | - Mario Franchini
- Department of Gynecology, Tuscany Regional Health Agency, Florence, Italy
| | - Silvia Cardinale
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy
| | - Rossella Cannone
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy
| | - Giovanna Giarrè
- Department of Gynecology Palagi, Freestanding Unit, Health Authority, Florence, Italy
| | - Fabiana D Fascilla
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy
| | - Stefano Bettocchi
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy
| | - Ettore Cicinelli
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy
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Fagioli R, Vitagliano A, Carugno J, Castellano G, De Angelis MC, Di Spiezio Sardo A. Hysteroscopy in postmenopause: from diagnosis to the management of intrauterine pathologies. Climacteric 2020; 23:360-368. [PMID: 32396739 DOI: 10.1080/13697137.2020.1754387] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With the increase in life expectancy, women now live up to one-third of their life in menopause. Postmenopausal bleeding (PMB) is a common gynecologic complaint encountered by the clinician. Endometrial cancer is present in about 10% of patients with PMB. Nevertheless, many other conditions such as endometrial or cervical polyps, genital atrophy, or non-gynecologic conditions may also be present. Hysteroscopy has replaced blind diagnostic procedures and is now considered the gold-standard technique for the diagnosis and management of intrauterine pathology. Gynecologists in clinical practice should be familiar with the use of hysteroscopy in the diagnosis and treatment of the menopausal patient presenting with gynecologic complaints. The aim of this article is to report the current evidence on the role of hysteroscopy in the evaluation and management of the postmenopausal patient with intrauterine pathology.
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Affiliation(s)
- R Fagioli
- Department of Obstetrics, Gynecology, Urology Sciences and Reproductive Medicine, University of Naples Federico II, Naples, Italy
| | - A Vitagliano
- Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy
| | - J Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - G Castellano
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - M C De Angelis
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - A Di Spiezio Sardo
- Department of Public Health, University of Naples Federico II, Naples, Italy
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6
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Ceci O, Franchini M, Cannone R, Giarrè G, Bettocchi S, Fascilla FD, Cicinelli E. Office treatment of large endometrial polyps using truclear 5C: Feasibility and acceptability. J Obstet Gynaecol Res 2018; 45:626-633. [PMID: 30506805 DOI: 10.1111/jog.13874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 11/02/2018] [Indexed: 11/27/2022]
Abstract
AIM This retrospective multicenter study was carried out to evaluate feasibility, effectiveness and patient acceptability of a small diameter hysteroscopic tissue removal system in the treatment of large endometrial polyps (≥20 mm), usually not removed in an office setting. METHODS Hundred and forty-six women with a single greater than 10-mm diameter polyp considered for polypectomy between April 2016 and August 2017. Sixty-five of these patients had a polyp size greater than 20 mm. All hysteroscopic polypectomy, using Hysteroscopic Tissue Removal system (TruClear 5C System Medtronic), were performed in an office setting with vaginoscopic approach. RESULTS Procedural success, time to complete the polypectomy and patient pain scores were evaluated. Polyps less than 20 mm were completely removed in 79/81 cases (97.53%). The completeness of greater than or equal to 20-mm polyp removal was achieved in 63/65 cases (96.92%). The median time for polypectomy was 4.19 ± 1.03 min for polyps less than 20 mm and 4.97 ± 1.30 min for polyps greater than or equal to 20 mm, respectively. Pain was minimal and brief, and the mean pain score measured on a 10-point visual analog scale at the end of polypectomy showed no significant difference between the two groups. In 4/79 (5.06%) cases with polyps less than 20 mm and in 4/63 (6.35%) cases with polyps greater than or equal to 20 mm women reported moderate pain. All specimens were adequate for pathologic measurements. CONCLUSION Hysteroscopic treatment of polyps greater than or equal to 20 mm in size with TruClear 5C is feasible and well tolerated in an office setting with no significant difference regarding completeness compared to polyps less than 20 mm, but with a minimal increase in procedure times.
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Affiliation(s)
- Oronzo Ceci
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Mario Franchini
- Department of Gynecology, Tuscany Regional Health Agency, Florence, Italy
| | - Rossella Cannone
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Giovanna Giarrè
- Department of Gynecology Palagi, Freestanding Unit, Health Authority, Florence, Italy
| | - Stefano Bettocchi
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Fabiana D Fascilla
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
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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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8
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Hysteroscopic Endometrial Polypectomy: Clinical and Economic Data in Decision Making. J Minim Invasive Gynecol 2018; 25:418-425. [DOI: 10.1016/j.jmig.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/17/2017] [Accepted: 08/03/2017] [Indexed: 11/20/2022]
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9
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Resectoscopic Surgery for Polyps and Myomas: A Review of the Literature. J Minim Invasive Gynecol 2017; 24:1104-1110. [PMID: 28843536 DOI: 10.1016/j.jmig.2017.08.645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 11/21/2022]
Abstract
Resectoscopic surgery is routinely performed to remove endometrial polyps and uterine myomas. A search of Medline, PubMed, and the Cochrane Library was conducted through November 2016 for studies written in English, regardless of sample size or study type. The studies were then filtered by selecting those evaluating resectoscopic surgery. An analysis of peer-reviewed, published literature was performed to examine the clinical application of this treatment modality on patients requiring polypectomy and myomectomy. Different surgical techniques were also compared: hysteroscopy with scissors, forceps, or a cold loop; resectoscopy with radiofrequency energy; and mechanical resection. The literature finds that operative time during resectoscopic surgery is significantly longer than with mechanical resection. Resectoscopic myomectomy, however, may be necessary for removal of larger or more deeply embedded myomas. Ultimately, both techniques result in symptom resolution and a low recurrence rate.
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10
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Endometrial Polyps and Abnormal Uterine Bleeding (AUB-P): What is the relationship, how are they diagnosed and how are they treated? Best Pract Res Clin Obstet Gynaecol 2017; 40:89-104. [DOI: 10.1016/j.bpobgyn.2016.09.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/23/2016] [Indexed: 12/11/2022]
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11
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Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol 2017; 40:3-22. [DOI: 10.1016/j.bpobgyn.2016.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/23/2016] [Indexed: 02/01/2023]
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12
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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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13
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Dueholm M, Hjorth IMD. Structured imaging technique in the gynecologic office for the diagnosis of abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol 2016; 40:23-43. [PMID: 27818130 DOI: 10.1016/j.bpobgyn.2016.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/23/2016] [Indexed: 12/11/2022]
Abstract
The aim in the diagnosis of abnormal uterine bleeding (AUB) is to identify the bleeding cause, which can be classified by the PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system. In a gynecologic setting, the first step is most often to identify structural abnormalities (PALM causes). Common diagnostic options for the identification of the PALM include ultrasonography, endometrial sampling, and hysteroscopy. These options alone or in combination are sufficient for the diagnosis of most women with AUB. Contrast sonography with saline or gel infusion, three-dimensional ultrasonography, and magnetic resonance imaging may be included. AIM The aim of this article is to describe how a simple structured transvaginal ultrasound can be performed and implemented in the common gynecologic practice to simplify the diagnosis of AUB and determine when additional invasive investigations are required. Structured transvaginal ultrasound for the identification of the most common endometrial and myometrial abnormalities and the most common ultrasound features are described. Moreover, situations where magnetic resonance imaging may be included are described. This article proposes a diagnostic setup in premenopausal women for the classification of AUB according to the PALM-COEIN system. Moreover, a future diagnostic setup for fast-track identification of endometrial cancer in postmenopausal women based on a structured evaluation of the endometrium is described.
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Affiliation(s)
- Margit Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark.
| | - Ina Marie D Hjorth
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark
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14
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Shazly SA, Laughlin-Tommaso SK, Breitkopf DM, Hopkins MR, Burnett TL, Green IC, Farrell AM, Murad MH, Famuyide AO. Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2016; 23:867-77. [DOI: 10.1016/j.jmig.2016.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
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15
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Clark TJ, Middleton LJ, Cooper NA, Diwakar L, Denny E, Smith P, Gennard L, Stobert L, Roberts TE, Cheed V, Bingham T, Jowett S, Brettell E, Connor M, Jones SE, Daniels JP. A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding. Health Technol Assess 2016; 19:1-194. [PMID: 26240949 DOI: 10.3310/hta19610] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Uterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited. OBJECTIVES To test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined. DESIGN A multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study. SETTING Outpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals. PARTICIPANTS Women with AUB - defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding - and hysteroscopically diagnosed uterine polyps. INTERVENTIONS We randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia. MAIN OUTCOME MEASURES The primary outcome was successful treatment at 6 months, determined by the woman's assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained. RESULTS At 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively. CONCLUSIONS When treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower. TRIAL REGISTRATION Current Controlled Trials ISRCTN 65868569. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- T Justin Clark
- Birmingham Women's Hospital NHS Foundation Trust, Edgbaston, Birmingham, UK.,School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Lee J Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Natalie Am Cooper
- Women's Health Research Unit, The Blizard Institute, Queen Mary University of London, London, UK
| | - Lavanya Diwakar
- Health Economics Unit, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Elaine Denny
- Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Edgbaston, Birmingham, UK
| | - Paul Smith
- Birmingham Women's Hospital NHS Foundation Trust, Edgbaston, Birmingham, UK.,School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Laura Gennard
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Lynda Stobert
- Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Edgbaston, Birmingham, UK
| | - Tracy E Roberts
- Health Economics Unit, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Versha Cheed
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Tracey Bingham
- Birmingham Women's Hospital NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Sue Jowett
- Health Economics Unit, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Mary Connor
- Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Sian E Jones
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jane P Daniels
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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16
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Cooper NAM, Robinson LLL, Clark TJ. Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2015; 41:284-91. [DOI: 10.1136/jfprhc-2014-100872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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McIlwaine P, McElhinney B, Karthigasu KA, Hart R. A prospective study of the use of the Myosure resectoscope to manage endometrial polyps in an outpatient setting. Aust N Z J Obstet Gynaecol 2015; 55:482-6. [DOI: 10.1111/ajo.12382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/16/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Patrick McIlwaine
- Gynaecological Endoscopy Unit; King Edward Memorial Hospital; Subiaco WA Australia
| | | | - Krishnan Andrew Karthigasu
- Gynaecological Endoscopy Unit; King Edward Memorial Hospital; Subiaco WA Australia
- Hollywood Medical Centre; Nedlands, Perth WA Australia
- School of Women's and Infants' Health; The University of Western Australia; Crawley WA Australia
| | - Roger Hart
- School of Women's and Infants' Health; The University of Western Australia; Crawley WA Australia
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18
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Kolhe S. Setting up of ambulatory hysteroscopy service. Best Pract Res Clin Obstet Gynaecol 2015; 29:966-81. [PMID: 25979350 DOI: 10.1016/j.bpobgyn.2015.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
There is an obvious trend towards developing ambulatory procedures in gynaecology with ambulatory hysteroscopy as its mainstay. In the recent years, the fast pace of modern technological advances in gynaecologic endoscopy, and particularly in the field of hysteroscopy, have been both thrilling and spectacular. Despite this, the uptake of operative hysteroscopy in ambulatory settings has been relatively slow. There is some apprehension amongst gynaecologists to embark on therapeutic outpatient hysteroscopy, and an organisational change is required to alter the mindset. Although there are best practice guidelines for outpatient hysteroscopy, there are unresolved issues around adequate training and accreditation of future hysteroscopists. Virtual-reality simulation training for operative hysteroscopy has shown promising preliminary results, and it is being aggressively evaluated and validated. This review article is an attempt to provide a useful practical guide to all those who wish to implement ambulatory hysteroscopy services in their outpatient departments.
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Affiliation(s)
- Shilpa Kolhe
- Royal Derby Hospital NHS Foundation Trust, Department of Obstetrics and Gynaecology, Level 2, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK.
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19
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Feasibility of Resectoscopic Operative Hysteroscopy in a UK Outpatient Clinic Using Local Anesthetic and Traditional Reusable Equipment, With Patient Experiences and Comparative Cost Analysis. J Minim Invasive Gynecol 2014; 21:830-6. [DOI: 10.1016/j.jmig.2014.03.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/17/2014] [Accepted: 03/15/2014] [Indexed: 11/22/2022]
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20
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Gambadauro P, Martínez-Maestre MA, Torrejón R. When is see-and-treat hysteroscopic polypectomy successful? Eur J Obstet Gynecol Reprod Biol 2014; 178:70-3. [DOI: 10.1016/j.ejogrb.2014.03.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
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21
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AlHilli MM, Nixon KE, Hopkins MR, Weaver AL, Laughlin-Tommaso SK, Famuyide AO. Long-Term Outcomes After Intrauterine Morcellation vs Hysteroscopic Resection of Endometrial Polyps. J Minim Invasive Gynecol 2013; 20:215-21. [DOI: 10.1016/j.jmig.2012.10.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/12/2012] [Accepted: 10/18/2012] [Indexed: 11/30/2022]
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22
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New mini-resectoscope: analysis of preliminary quality results in outpatient hysteroscopic polypectomy. Arch Gynecol Obstet 2013; 288:349-53. [PMID: 23417150 DOI: 10.1007/s00404-013-2754-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE We investigated the feasibility and acceptability of office hysteroscopic polypectomy using a new continuous-flow operative 16 Fr Gubbini's mini-resectoscope. This is a prospective clinical study (Canadian Task Force classification III). METHODS The office hysteroscopic polypectomy was performed with a mini-resectoscope without analgesia or anesthesia. We evaluated the polyp size and the number, the effectiveness of resection, the operating time, the pelvic pain and complications. RESULTS The office hysteroscopic polypectomy was successfully performed in all 33 patients. The polyps ranged in size from 5 to 50 mm with a mean of 18.15 ± 11.45 mm. We analyzed the operating time with a mean of 11.45 ± 4.71 min: 29 procedures took less than 15 min from the start of vaginoscopy to the end of surgery. Overall mean visual analog scale (VAS) calculated was 2.48 ± 1.37 (range 0-6). The correlation between the size of the polyps and operating time was statistically significant (p < 0.001). No major complications were recorded. CONCLUSION Our preliminary data demonstrated that can be possible to remove endometrial polyps by hysteroscopy, using the mini-resectoscope, in an office setting. All procedures were completed successfully and well tolerated with a little discomfort permitting the removal also of big sized polyps without a statistical correlation between VAS and size of polyps or operating time. The outpatient polypectomy is a less-costing procedure and represents an acceptable and effective alternative to inpatient resectoscopic polypectomy, leading to a complete polyp excision in nearly all patients.
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23
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Rovira Pampalona J, Ratia García E, Muñoz Casas E, Mateu Pruñonosa JC, Degollada Bastos M, Guerra Garcia Á, Brescó Torras P. Morcelador histeroscópico (Truclear System®): nuestra experiencia inicial. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.pog.2012.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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Cicinelli E, Tinelli R, Loiudice L, Loiudice I, Quattromini P, Fusco A, Cicinelli MV, Pinto V. AlphaScope vs lens-based hysteroscope for office polypectomy without anesthesia: randomized controlled study. J Minim Invasive Gynecol 2012; 18:796-9. [PMID: 22024266 DOI: 10.1016/j.jmig.2011.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 08/05/2011] [Accepted: 08/12/2011] [Indexed: 11/28/2022]
Abstract
In this randomized controlled study, effectiveness, operative time, and acceptability of endometrial polypectomy were compared using an AlphaScope vs an office operative lens-based hysteroscope (LBH). One hundred fifty women with a diagnosis of endometrial polyp were operated on using an AlphaScope or LBH in the office setting. In 73 procedures using the AlphaScope (97.3%) and 68 using the LBH (90.7%), the polyp was successfully removed completely. In the AlphaScope group, 2 procedures were incomplete because of excessive endometrial mucosa thickness. In the LBH group, 3 procedures were incomplete because of difficulty in management of a large polyp, and 4 procedures were stopped because of patient pain and low compliance. Time to completion of the procedure and complete removal of the polyp was significantly shorter in the AlphaScope group than in the LBH group (p < .05). Similarly, the pain score at the end of the procedure was significantly lower in the AlphaScope group than in the LBH group (p < .05). The AlphaScope is an effective operative hysteroscope that increases the possibility of performing endometrial polypectomy in the office setting without anesthesia and improves the indications for and acceptability of office hysteroscopy.
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Affiliation(s)
- Ettore Cicinelli
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Bari, Bari, Italy.
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25
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Cicinelli E. Hysteroscopy without anesthesia: review of recent literature. J Minim Invasive Gynecol 2010; 17:703-8. [PMID: 20955981 DOI: 10.1016/j.jmig.2010.07.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 07/03/2010] [Indexed: 10/18/2022]
Abstract
The need for anesthesia or analgesia for performing hysteroscopy is still matter of debate. Many factors explain the lack of agreement about anesthesia in hysteroscopy depending on the instrumentation, technique employed, need of performing surgical procedure, operator skill and patients' characteristics. Diagnostic minihysteroscopy (3.5 mm or less in size) is less painful and easier to perform than hysteroscopy performed with instruments sized around 5 mm. Thanks to miniaturized instruments, office hysteroscopy allows a growing number of women to be treated in an office setting avoiding the operating room. The main limitation to its widespread use is pain and low patient tolerance. Intrauterine surgical procedures involving only the endometrial mucosa (biopsies, adhesiolisis, cervical and endometrial polyectomies) are not painful. For endometrial polypectomy size of polyps (<2.2m) and duration of the procedure (more than 15 min) are limiting factors. Most literature suggests that office hysteroscopy in experienced hands is a well-tolerated technique and requires the use of analgesics only in selected patients like women with previous caesarean section, history of chronic pelvic pain, anxiety and in menopause.
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Affiliation(s)
- Ettore Cicinelli
- Fourth Department of Obstetrics and Gynecology, Faculty of Medicine, University of Bari, Bari, Italy.
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26
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Clinical implementation of the hysteroscopic morcellator for removal of intrauterine myomas and polyps. A retrospective descriptive study. ACTA ACUST UNITED AC 2010; 8:193-196. [PMID: 21654903 PMCID: PMC3083510 DOI: 10.1007/s10397-010-0627-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 08/26/2010] [Indexed: 11/02/2022]
Abstract
The aim of this study is to report our experience with a novel technique, the hysteroscopic morcellator (HM), for removal of intrauterine myomas and polyps. We performed a retrospective study on 315 women undergoing operative hysteroscopy with the HM in our university-affiliated teaching hospital. We collected data on installation and operating times, fluid deficit, peri- and postoperative complications. In 37 patients undergoing myomectomy with the HM, mean installation time was 8.7 min, mean operating time, 18.2 min, and median fluid deficit, 440 mL. Three out of 37 HM procedures were converted to resectoscopy, related to a type 2 myoma. In 278 patients, mean installation and operating times for polypectomy with the HM were 7.3 min and 6.6 min, respectively. All procedures were uneventful. Implementation of the HM for removal of type 0 and 1 myomas ≤3 cm, and removal of polyps appears safe and effective. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10397-010-0627-7) contains supplementary material, which is available to authorized users.
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Siristatidis C, Chrelias C, Salamalekis G, Kassanos D. Office hysteroscopy: current trends and potential applications: a critical review. Arch Gynecol Obstet 2010; 282:383-8. [PMID: 20349076 DOI: 10.1007/s00404-010-1437-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 03/09/2010] [Indexed: 11/27/2022]
Abstract
Office hysteroscopy is an excellent method of identifying and treating intracavitary uterine lesions. It has become easy to learn and perform; as an aid of modern technological applications, it is safe, accurate, provides immediate results under direct visualisation, and offers the additional benefit of histological confirmation and the discomfort of patients is minimal. We applied an extended literature search to explore the special features and details of the technique itself, as it evolved since it first appeared 30 years back. Our initial goal was to examine potential changes/improvements of the modality, in terms of the instrumentation used and the technique itself, the indications of use, its incorporation in daily practice, and patients' and clinicians' acceptability.
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28
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Current World Literature. Curr Opin Obstet Gynecol 2009; 21:353-63. [DOI: 10.1097/gco.0b013e32832f731f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Hysteroscopic bipolar surgery: a valuable progress or a technique under investigation? Curr Opin Obstet Gynecol 2009; 21:329-34. [DOI: 10.1097/gco.0b013e32832e07ac] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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