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Abd-ElGawad M, Abdelsattar NK, Kamel MA, Sabri YA, Fathy EM, El-Moez NA, Abdellatif YS, Metwally AA. The effect of music intervention in decreasing pain and anxiety during outpatient hysteroscopy procedure: a systematic review and meta-analysis of randomized control trials. BMC Womens Health 2023; 23:360. [PMID: 37408035 DOI: 10.1186/s12905-023-02489-8] [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: 10/16/2022] [Accepted: 06/17/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Hysteroscopy is a common outpatient procedure but procedural pain limits its use. Music could be used as a pain-relieving intervention. We performed a systematic review and meta-analysis to investigate the effect of music on pain and anxiety during outpatient hysteroscopy. METHODS Four electronic databases were searched: PubMed, Scopus, Web of Science, and Cochrane Library, from inception to September 2022. We included only the Randomized Controlled Trials (RCTs) that investigated the effect of music on women who underwent outpatient hysteroscopy in reducing pain and anxiety levels compared to no music. We assessed the quality of included RCTs using the risk of bias tool 1 reported in the Cochrane Handbook of Systematic Reviews of Interventions. Data were pooled as the Mean Differences (MDs) with a 95% Confidence Interval (CI) in a random-effects model, using Review Manager 5.3 software. Also, we assessed the evidence of the results using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Three RCTs (540 women) were included. Music significantly reduced visual analogue scale (VAS) pain scores as well as State-Trait Anxiety Inventory (STAI) scores compared to controls (MD = -1.28; 95% CI [-2.19, -0.36]; P = 0.007) and (MD = -3.91; 95% CI [-6.98, -0.85]; P = 0.01) respectively. Also, the decrease in VAS score for pain was significantly greater in the music group (MD = 1.44; 95% CI [0.44, 2.45]; P = 0.005). However, the change in STAI showed no significant difference between the two groups. The GRADE ratings for all outcomes were very low. CONCLUSION Music is a potentially promising method for controlling pain for patients undergoing outpatient hysteroscopy; however, its effect in controlling anxiety is controversial.
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Affiliation(s)
| | | | | | | | | | | | | | - Ahmed A Metwally
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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van der Meulen JF, Fisch C, Dreessen JRJ, Coppus SFPJ, Kok HS, Bongers MY. Procedural sedation and analgesia with propofol (PSA) for gynecologic surgery: A systematic review of the literature. Eur J Obstet Gynecol Reprod Biol 2023; 287:137-146. [PMID: 37327552 DOI: 10.1016/j.ejogrb.2023.05.035] [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: 02/17/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To identify which gynecologic procedures are eligible to be performed under PSA with propofol and to describe safety and effectiveness of these procedures in this setting. METHODS A systematic review of the literature was conducted in Pubmed (MEDLINE), Embase and The Cochrane Library from inception until September 21st 2022. Cohort studies and randomized controlled trials were included when they reported on clinical outcomes of gynecologic procedures under procedural sedation and analgesia in which propofol was used as an anesthetic. Studies were excluded when sedation without propofol was used, when they only mentioned the use of procedural sedation and analgesia but did not describe any clinical outcome parameters or when < 10 patients were included. The primary outcome parameter was completeness of procedure. Secondary outcome parameters were type of gynecologic procedure, intraoperative complication rate, patient satisfaction, postoperative pain, duration of hospital admission, patient's discomfort and ease of procedure as judged by the surgeon. The Cochrane risk of bias tool and the ROBINS-I tool were used for bias assessment. A narrative synthesis of the findings from the included studies was provided. Numbers and percentages were presented, as well as means with standard deviations and medians with interquartile range where applicable. RESULTS Eight studies were included. A total of 914 patients underwent gynecologic surgical procedures with procedural sedation and analgesia with propofol. Gynecological procedures varied from hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The percentage of complete procedures was 89.8%-100%. Complications occurred in 0-6.5% of patients. Other outcomes were measured in various ways, but overall patient satisfaction was high and postoperative pain was low. CONCLUSION The use of PSA with propofol is promising for a wide range of gynecologic procedures, including hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The use of PSA with propofol seems to be effective and safe and leads to high degree of patient satisfaction. More research is needed in order to determine for which types of procedures PSA can be used.
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Affiliation(s)
- Julia F van der Meulen
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Grow School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
| | - Charlotte Fisch
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Janique R J Dreessen
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen, The Netherlands.
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands.
| | - Helen S Kok
- Department of Obstetrics & Gynecology, Alrijne Ziekenhuis, Leiden, The Netherlands.
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Grow School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Vitale SG, Watrowski R, Barra F, D’Alterio MN, Carugno J, Sathyapalan T, Kahramanoglu I, Reyes-Muñoz E, Lin LT, Urman B, Ferrero S, Angioni S. Abnormal Uterine Bleeding in Perimenopausal Women: The Role of Hysteroscopy and Its Impact on Quality of Life and Sexuality. Diagnostics (Basel) 2022; 12:diagnostics12051176. [PMID: 35626331 PMCID: PMC9140476 DOI: 10.3390/diagnostics12051176] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Abnormal uterine bleeding (AUB) is a frequent symptom in perimenopausal women. It is defined as uterine bleeding in which the duration, frequency, or amount of bleeding is considered excessive and negatively affects the woman’s quality of life (QoL) and psychological well-being. In cases of structural uterine pathology, hysterectomy (usually performed via a minimally invasive approach) offers definitive symptom relief and is associated with long-lasting improvement of QoL and sexuality. However, over the past 30 years, uterus-preserving treatments have been introduced as alternatives to hysterectomy. Hysteroscopic polypectomy, myomectomy, or endometrial resection/endometrial ablation are minimally invasive techniques that can be used as an alternative to hysterectomy to treat AUB due to benign conditions. Although associated with high patient satisfaction and short-term improvement in their QoL, hysteroscopic treatments do not eliminate the risk of AUB recurrence or the need for further intervention. Therefore, considering the impact of different treatment options on QoL and sexuality during preoperative shared decision making could help identify the most appropriate and personalized treatment options for perimenopausal women suffering from AUB.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy
- Correspondence: (S.G.V.); (R.W.)
| | - Rafał Watrowski
- Faculty of Medicine (Associate), University of Freiburg, 79106 Freiburg, Germany
- Correspondence: (S.G.V.); (R.W.)
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genoa, Italy; (F.B.); (S.F.)
| | - Maurizio Nicola D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (M.N.D.); (S.A.)
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, University of Miami, Miami, FL 33146, USA;
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull HU6 7RX, UK;
| | - Ilker Kahramanoglu
- Department of Gynecologic Oncology, Emsey Hospital, 34912 Istanbul, Turkey;
| | - Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City 81362, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Pei-Tou, Taipei 11265, Taiwan
- Department of Biological Science, National Sun Yat-sen University, 70 Lienhai Rd., Kaohsiung City 80424, Taiwan
| | - Bulent Urman
- Centre for Reproductive Endocrinology and Infertility, American Hospital, 34365 Istanbul, Turkey;
- Department of Obstetrics and Gynecology, Reproductive Endocrinology, Infertility Centre Istanbul, Koc University, 34450 Istanbul, Turkey
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genoa, Italy; (F.B.); (S.F.)
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (M.N.D.); (S.A.)
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Valero I, García-Jiménez R, Florez N, Weber-Fernandez AM, Oña López MR, Lara MD. Mini-resectoscope vs morcellator for in-office hysteroscopic myomectomy: Evaluation of results and patient satisfaction. Eur J Obstet Gynecol Reprod Biol 2022; 270:95-99. [PMID: 35033932 DOI: 10.1016/j.ejogrb.2021.12.039] [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: 09/16/2021] [Revised: 12/26/2021] [Accepted: 12/30/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The development of hysteroscopic techniques has led to an advance in submucous myoma treatment, offering a safe and effective minimally invasive alternative. Our objective was to compare the results of hysteroscopic myomectomy when using whether the mini-resectoscope or the MyoSure morcellator, as well as patient satisfaction after the procedure. MATERIAL AND METHODS A prospective, cross-sectional, observational study including 80 patients distributed into two groups: Mini-Resectoscope group (MRG) or MyoSure group (MSG), depending on the instrument used for the in-office hysteroscopic myomectomy. Resection time, pain during entry, pain during resection, number of resections required, complete resection, and total satisfaction were recorded. RESULTS MSG had statistically significant shorter time of entrance. There were no other statistically significant differences between groups. CONCLUSIONS In-office hysteroscopic myomectomy is associated with high levels of patient satisfaction, without differences between the mini-resectoscope or the MyoSure, allowing high rates of complete resection using both instruments. Thus, it is a feasible technique which could be performed with both instruments, depending on the operator's expertise.
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Affiliation(s)
- Irene Valero
- Obstetrics and Gynecology Department, Juan Ramon Jimenez Hospital, Huelva, Spain
| | - Rocio García-Jiménez
- Obstetrics and Gynecology Department, Valme University Hospital, Seville, Spain.
| | - Natalia Florez
- Obstetrics and Gynecology Department, Valme University Hospital, Seville, Spain
| | | | | | - Maria Dolores Lara
- Obstetrics and Gynecology Department, Valme University Hospital, Seville, Spain
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Ghoubara A, Gunasekera S, Rao L, Ewies A. Re-intervention and patient satisfaction rates following office radiofrequency endometrial ablation: a comparative retrospective study of 408 cases. J OBSTET GYNAECOL 2021; 42:1358-1364. [PMID: 34689685 DOI: 10.1080/01443615.2021.1965560] [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: 10/20/2022]
Abstract
This retrospective study assessed the efficacy and long-term satisfaction of radiofrequency endometrial ablation outside the context of clinical trials in 408 women, and compared the outcome between office-setting (211, 52%) and day-case procedures under general anaesthetics (197, 48%). The Kaplan Meir time-to-event analysis showed that the cumulative number of women undergoing surgical re-intervention was 32 with a probability of 9.4% (95% CI: 6.3 - 12.5%) at 2-years, and 45 with a probability of 14.5% (95% CI: 10.3 - 18.2%) at 5-years. There was no statistically significant difference in the re-intervention rate between office and day-case groups (HR = 0.7, 95% CI: 0.68 - 3.1, p = .3). The satisfaction rate, measured by Visual Analogue Scale, was not statistically different (p = .5) between office (109; 80.7%) and day-case (96; 82.8%) groups. This study showed lower surgical re-intervention rate than previously reported in observational studies, and high rates of long-term women satisfaction. The outcomes were similar in office and day-case settings.Impact statementWhat is already known on this subject? Previous studies have shown the safety and effectiveness of radiofrequency endometrial ablation for treating heavy periods. However, studies investigating it, outside clinical trials, either included a small sample size, a short-term follow-up, poor reporting so that it is impossible to judge whether some women underwent re-intervention in another centre, failed to discriminate in analysis between second-generation techniques, or assessed only short-term satisfaction.What do the results of this study add? This is the largest series reported from a single centre and the first study reporting long-term satisfaction in women, outside clinical trials. Surgical re-intervention was used as the primary outcome measure which is an objective measure rather than the change in the monthly flow which is rather subjective. More importantly, the study records the similarity, in the outcome and women's satisfaction rate, between office and day-case procedures under general anaesthetics.What are the implications of these findings for clinical practice and/or further research? Endometrial ablation service is widely implemented in office-setting in the UK. We hope the result of this study encourages implementation on a larger scale in office across centres in the world with its multiple advantages both to women and service alike.
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Affiliation(s)
- Ahmed Ghoubara
- Department of Obstetrics and Gynaecology, Aswan University Hospital, Aswan University, Aswan, Egypt.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Seuvandhi Gunasekera
- Department of Gynaecology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Lavanya Rao
- Department of Gynaecology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Ayman Ewies
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Gynaecology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Pervaiz Z, Korrapati S, Ghoubara A, Ewies A. Office hysteroscopic morcellation service: Evaluation of women experience and factors affecting satisfaction. Eur J Obstet Gynecol Reprod Biol 2021; 264:294-298. [PMID: 34352426 DOI: 10.1016/j.ejogrb.2021.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the hysteroscopic morcellation service in office-setting in everyday practice outside the context of clinical trials. The primary objectives were to assess level of acceptability and factors affecting women satisfaction. The secondary objectives included assessment of complete resection rate, complications rate, pain score during the procedure and on discharge, and the correlation between the lesion size as subjectively estimated by the hysteroscopists versus the volume of morcellated tissues as semi-quantitively measured by the laboratory. METHOD The clinical data was compiled for 287 consecutive women undergoing hysteroscopic morcellation in office-setting from 1 January 2017 to 31 March 2021 in a teaching hospital in the UK. A questionnaire, formulated on the Visual Analogue Scale (VAS), was completed immediately after the procedure by the last 110 women undergoing the procedure. RESULTS The mean age of the cohort (n = 278) was 54.5 years (SD ± 12.5). Only 7 (2.4%) women required two-stage procedure because of size (fibroid ≥ 4 cm), vascularity or multiplicity of lesions. No complications were encountered. The majority of women completing the questionnaire (n = 110) found office procedure acceptable (105, 95.5%, VAS ≥ 7), were willing to have it again if indicated (102, 92.7%, VAS ≥ 7), would recommend it to family and friends (105, 95.5%, VAS ≥ 7) and confirmed receiving adequate preoperative information by doctors and nurses (107, 97.3%, VAS ≥ 7). The level of preoperative explanation and information-giving showed significant (p < 0.01) positive correlation with the level of acceptability and recommendation to others and significant (p = .007) negative correlation with the pain experienced on discharge. The median (IQR) estimated size at hysteroscopy was 2 cm (1-6 cm) for polyps and 2.5 cm (1-4 cm) for fibroid. The median (IQR) volume of the morcellated specimens as estimated by laboratory was 2000 mm3 (1100-3800 mm3). The estimated size at hysteroscopy was positively correlated with the specimen's volume (Spearman's rho (r) = 0.31, 95% = CI, 0.14-0.45, p < 0.01). CONCLUSION Office hysteroscopic morcellation is associated with high satisfaction rate and low pain score on discharge. Good preoperative explanation and information-giving was the crucial factor that increased women satisfaction. Subjective estimation of lesion size by hysteroscopists may be an accurate and simple method of measurement.
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Affiliation(s)
- Zahra Pervaiz
- Department of Gynecology, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham B18 7QH, UK
| | - Sivanandana Korrapati
- Department of Gynecology, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham B18 7QH, UK
| | - Ahmed Ghoubara
- Department of Gynecology, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham B18 7QH, UK; Department of Obstetrics and Gynecology, Aswan University Hospital, Aswan University, Sahary City, Aswan 81528, Egypt
| | - Ayman Ewies
- Department of Gynecology, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham B18 7QH, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham B15, 2TT, UK.
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Cornelissen LGH, Kortekaas JC, Schoot BC, van Vliet HAAM. Four year evaluation of therapeutic hysteroscopy under procedural sedation in an outpatient clinic. Eur J Obstet Gynecol Reprod Biol 2021; 261:65-71. [PMID: 33894620 DOI: 10.1016/j.ejogrb.2021.04.002] [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] [Received: 08/23/2020] [Revised: 03/27/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Due to the evolution of hysteroscopic instruments, therapeutic hysteroscopic procedures are increasingly performed in an outpatient, office-based setting. The most important limiting factor of performing these hysteroscopic treatments is patient discomfort. Procedural Sedation Analgesia (PSA) decreases patient discomfort and anxiety. The main goal of this study is to determine safety, feasibility and patient satisfaction of therapeutic hysteroscopy performed under procedural sedation in an outpatient clinic. Our second objective was to compare 9 mm scopes with smaller diameter scopes. STUDY DESIGN All consecutive patients suitable for procedural sedation and scheduled for a therapeutic hysteroscopy in the outpatient clinic were prospectively included from February 2014 to November 2018 in a teaching hospital in the Netherlands. A variety of therapeutic hysteroscopies procedures was performed including myomectomy, removal of retained products of conception and endometrial ablation. Therapeutic hysteroscopes with 3.8 mm, 5 mm and 9 mm diameter were used. In all selected women procedure time, admission time, pain scores, anaesthesiologic and procedural complications were assessed. All women received a questionnaire on patient satisfaction. RESULTS In total 455 patients underwent a therapeutic hysteroscopy. Median procedure time was 11 min (2-63 min) and median admission time was 130 min (30-480 min). Median pain score according to the visual analog scale (VAS) before, during and after procedure were respectively 0 (0-10), 0 (0-4) and 0 (0-9). Anaesthesiologic complication rate was 4.4 %, all minor. Procedural complications consisted of infection postoperatively (0.4 %), excessive blood loss during procedure (0.6 %) and perforation (0.4 %). Procedure was incomplete in 3.3 % of all procedures. Patient satisfaction was high, as 96 % of the women were satisfied. No differences were found in pain scores, VAS 0 versus 1 after the procedure, between 3.8 or 5 mm and 9 mm scopes. CONCLUSION It is safe and feasible to perform a therapeutic hysteroscopy under procedural sedation in an outpatient setting, with low pain scores and a high degree of patient satisfaction, also when large diameter instruments are used.
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Affiliation(s)
| | - Joep C Kortekaas
- Department of Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Benedictus C Schoot
- Department of Gynecology, Catharina Hospital, Eindhoven, the Netherlands; Department of Gynecology, UZ Gent, Gent, Belgium
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Khandwala S, Cruff J. Single-incision Midurethral Sling by the Dynamic Intraoperative Standing Sling Technique as an Office-based Procedure: A Pilot Study. Urology 2020; 149:34-39. [PMID: 33227301 DOI: 10.1016/j.urology.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the safety, feasibility, and short-term success of placing Solyx (Boston Scientific, Marlborough, MA) single-incision midurethral sling (SIMUS) using the Dynamic Intraoperative Standing Sling Technique (DISST) in an office setting under local anesthesia. METHODS The safety and efficacy of the in-office Solyx DISST procedure for treatment of stress urinary incontinence was assessed 6 months from the procedure. Improvement in stress urinary incontinence was measured using validated questionnaires (Medical, Epidemiologic, and Social Aspects of Aging, MESA; Incontinence Impact Questionnaire-7, IIQ-7; Pelvic Organ Prolapse/Urinary Incontinence Sexual Function, PISQ-12) and by a negative standing provocative stress test. Postoperative complications were documented along with subjective pain diaries, return to work/activities, and overall satisfaction. RESULTS From July 2019 through February 2020, 20 subjects underwent in-office Solyx procedure by the DISST technique. Six of the 20 (30%) subjects required intraoperative sling adjustments. There were no complications as related to the office-based procedure. Participants reported a favorable intraoperative experience. Subjects had excellent postoperative pain control and early return to work and normal activities. At 6 months, all 20 subjects had negative standing provocative stress tests, showed statistically significant improvements on MESA, IIQ-7, and PISQ-12, and reported high satisfaction and acceptance for the procedure and outcomes. There were no late (>6 weeks) complications associated with the Solyx procedure. CONCLUSIONS It appears safe and feasible to perform Solyx SIMUS by the DISST method in the office. Subjects remained dry and reported excellent improvement in symptoms and quality of life 6 months from surgery.
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Affiliation(s)
- Salil Khandwala
- Advanced Urogynecology of Michigan, Dearborn, MI; Beaumont Health, Department of Female Pelvic Medicine & Reconstructive Surgery, Wayne, MI.
| | - Jason Cruff
- Advanced Urogynecology of Michigan, Dearborn, MI; Beaumont Health, Department of Female Pelvic Medicine & Reconstructive Surgery, Wayne, MI
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Billig JI, Nasser JS, Chen JS, Lu YT, Chung KC, Kuo CF, Sears ED. Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings. JAMA Netw Open 2020; 3:e2015951. [PMID: 33048128 PMCID: PMC8094424 DOI: 10.1001/jamanetworkopen.2020.15951] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Surgical procedures can be performed in different settings, but the association between the operative setting and patient safety and cost to the patient and payer is unknown. OBJECTIVE To examine differences in complications, total payments, and out-of-pocket (OOP) spending for minor hand surgical procedures performed in office, ambulatory surgery center (ASC), and hospital outpatient department (HOPD) operative settings. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based cohort study was conducted using deidentified claims data from private employer-sponsored health insurance from January 1, 2009, to December 31, 2017. Patients aged 18 years or older undergoing carpal tunnel release, trigger finger release, excision of wrist ganglion, and excision of small hand masses (N = 468 365) were included. EXPOSURES Operative setting, defined as procedures performed in the clinic setting, ASC, and HOPD. MAIN OUTCOMES AND MEASURES Complications during the 90-day postoperative period, total payments (total facility and payer reimbursement), and OOP spending. RESULTS Of the 468 365 patients, 296 378 women (63.3%) and 171 987 men (36.7%) underwent minor hand surgical procedures from 2009 to 2017, with 284 889 procedures (60.8%) performed in HOPDs, 158 659 procedures (33.9%) performed in ASCs, and 24 817 procedures (5.3%) performed in the office setting. Ninety-day complications occurred in 3.4% of procedures performed in HOPDs, 3.3% in ASCs, and 2.9% in office settings (P < .001). After controlling for patient characteristics, procedures performed outside of the office had higher odds of complications (HOPDs: odds ratio [OR], 1.32; 95% CI, 1.22-1.43; ASCs: OR, 1.24; 95% CI, 1.14-1.34). Compared with the office setting, procedures performed in HOPDs incurred an extra $1216 in total payments (95% CI, $1184-$1248) and $115 in OOP expenses (95% CI, $109-$121). Procedures performed in ASCs cost an additional $709 (95% CI, $676-$741) and $140 in OOP expenses (95% CI, $134-$146). Transitioning ASC and HOPD procedures to the office setting could have saved an estimated $6 million annually in OOP expenses during the study period. CONCLUSIONS AND RELEVANCE The findings of this study suggest that minor hand surgery performed in the office setting is safe and less costly compared with ambulatory and hospital-based operations. Shifting minor surgical procedures to the office setting may lead to substantial cost savings for payers and patients without compromising care quality.
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Affiliation(s)
- Jessica I. Billig
- Veterans Affairs (VA)/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor
| | - Jacob S. Nasser
- Medical student, George Washington School of Medicine, Washington, DC
| | - Jung-Sheng Chen
- Center for Artificial Intelligence in Medicine, Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Ting Lu
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor
| | - Kevin C. Chung
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor
| | - Chang-Fu Kuo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Erika D. Sears
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Bennett A, Thavorn K, Arendas K, Coyle D, Singh SS. Outpatient uterine assessment and treatment unit in patients with abnormal uterine bleeding: an economic modelling study. CMAJ Open 2020; 8:E810-E818. [PMID: 33293330 PMCID: PMC7743907 DOI: 10.9778/cmajo.20190170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Most often in Canada, the evaluation and management of abnormal uterine bleeding occurs under general anesthesia in the operating room. We aimed to assess the potential cost-effectiveness of an outpatient uterine assessment and treatment unit (UATU) compared with the current standard of care when diagnosing and treating abnormal uterine bleeding in women. METHODS We performed a cost-effectiveness analysis and developed a probabilistic decision tree model to simulate the total costs and outcomes of women receiving outpatient UATU or usual care over a 1-year time horizon (Apr. 1, 2014, to Mar. 31, 2017) at a tertiary care hospital in Ontario, Canada. Probabilities, resource use and time to diagnosis and treatment were obtained from a retrospective chart review of 200 randomly selected women who presented with abnormal uterine bleeding. Results were expressed as overall cost and time savings per patient. Costs are reported in 2018 Canadian dollars. RESULTS Compared with usual care, care in the UATU was associated with a decrease in overall cost ($1332, 95% confidence interval [CI] -$1742 to -$1008) and a decrease in overall time to treatment (-75, 95% CI -89 to -63, d). The point at which the UATU would no longer be cost saving is if the additional cost to operate and maintain the UATU is greater than $1600 per patient. INTERPRETATION From the perspective of Canada's health care system, an outpatient UATU is more cost effective than usual care and saves time. Future studies should focus on the relative efficacy of a UATU and the total budget required to operate and maintain a UATU.
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Affiliation(s)
- Alexandria Bennett
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont
| | - Kednapa Thavorn
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont.
| | - Kristina Arendas
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont
| | - Doug Coyle
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont
| | - Sukhbir S Singh
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont
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11
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Di Spiezio Sardo A, Giampaolino P, Manzi A, De Angelis MC, Zizolfi B, Alonso L, Carugno J. The Invisible External Cervical Os. Tips and Tricks to Overcome this Challenge during In-Office Hysteroscopy. J Minim Invasive Gynecol 2020; 28:172-173. [PMID: 32526381 DOI: 10.1016/j.jmig.2020.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Hysteroscopy is considered the gold standard technique for the diagnosis and management of intrauterine pathology allowing to "see and treat" patients in 1 session if desired [1-3]. Pain and the inability to enter the uterine cavity are the most common limitations of hysteroscopy, especially when performed in an office setting [4-7]. Cervical stenosis is a common hysteroscopic finding frequently encountered in postmenopausal women, especially in patients with a history of cervical procedures such as cone biopsy [8]. It represents a challenge even for the most expert hysteroscopist. Overcoming the stenosis of the external cervical os is technically more demanding than facing the obliteration of the internal os. The aim of this video article is to illustrate the use of simple techniques that allow the hysteroscopist to safely identify the location of the external cervical os and to overcome the difficulties in entering the uterine cavity during in-office hysteroscopy in patients with severe cervical stenosis including those with complete obliteration of the external cervical os. These techniques are easy to adopt and can be used in different clinical situations in which the hysteroscopic evaluation of the uterine cavity is needed in women with severe cervical stenosis. DESIGN A series of videos of challenging cases with severe cervical stenosis with complete obliteration of the external cervical os are presented that demonstrate maneuvers to properly identify and enter the cervical canal, unfolding key aspects of the procedure. Tips and tricks to facilitate the adoption of these useful maneuvers into clinical practice are highlighted. SETTING In-office diagnostic hysteroscopy was performed using a 5-mm rigid continuous flow operative hysteroscope. Patients were placed in a dorsal lithotomy position. The vaginoscopy "no touch" technique was used [9]. No anesthesia or sedation was administered to any of the patients. Normal saline was used as distention media. INTERVENTIONS Taking advantage of the magnification provided by the hysteroscope, the location of the external cervical os was determined. In cases in which the external cervical os was not clearly recognized, the cervix was gently probed with the use of the uterine palpator, grasper, or scissors (Fig. 1). Recognition of the landmarks of the cervical canal provides reassurance of the adequate identification of the external cervical os and facilitates the use of the correct plane of dissection that leads into the uterine cavity (Fig. 2). Additional maneuvers that are useful to navigate the endocervical canal to overcome stenosis of the internal cervical os are also illustrated. CONCLUSION The combination of a delicate technique and operator experience aids in overcoming the challenge of cervical stenosis in an office setting. Adopting the presented tips and tricks to enter the uterine cavity in the presence of severe cervical stenosis will reduce the rate of failed hysteroscopic procedures, decreasing the need to take patients to the operating room and the use of general anesthesia.
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Affiliation(s)
- Attilio Di Spiezio Sardo
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Pierluigi Giampaolino
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Alfonso Manzi
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Maria Chiara De Angelis
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Brunella Zizolfi
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Luis Alonso
- Department of Gynecologic Endoscopy, Centro Gutenberg, Malaga, Spain (Dr. Alonso)
| | - Jose Carugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, Florida (Dr. Carugno).
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12
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Vitale SG, Caruso S, Ciebiera M, Török P, Tesarik J, Vilos GA, Cholkeri-Singh A, Gulino FA, Kamath MS, Cianci A. Management of anxiety and pain perception in women undergoing office hysteroscopy: a systematic review. Arch Gynecol Obstet 2020; 301:885-894. [PMID: 32140807 DOI: 10.1007/s00404-020-05460-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this review is to provide an overview of the literature about the perception and management of anxiety and pain in women undergoing an office hysteroscopic procedure. METHODS We performed a systematic literature search in Embase, PubMed/MEDLINE, Cochrane Library and Web of Science for original studies written in English (registered in PROSPERO 2019-CRD42019132341), using the terms 'hysteroscopy' AND 'pain' AND 'anxiety' published up to January 2019. Only original articles (randomized, observational and retrospective studies) about management of anxiety and pain related to the hysteroscopic procedure were considered eligible. RESULTS Our literature search produced 84 records. After exclusions, 11 studies including 2222 patients showed the following results: (a) pain experienced during hysteroscopy is negatively affected by preprocedural anxiety; (b) pharmacological interventions seem to be help in reducing pain during hysteroscopy; (c) waiting time before the procedure is a significant factor affecting patients' anxiety; (d) music during the procedure may be helpful in reducing anxiety. CONCLUSIONS The utilization of office hysteroscopy is hampered by varying levels of anxiety and pain perceived by women who are candidates for the procedure. For these reasons, it is essential to identify effective pharmacological and non-pharmacological strategies to alleviate these factors. We recommend further studies especially focusing on non-pharmacological interventions to facilitate the dissemination of good clinical practices among hysteroscopists.
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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.
| | - Salvatore Caruso
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Michal Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynaecology, University of Debrecen, Debrecen, Hungary
| | | | - George Angelos Vilos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Aarathi Cholkeri-Singh
- Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Ferdinando Antonio Gulino
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | - Antonio Cianci
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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13
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Shen D, Ma K, Tian M, Li L, Jiang Q, Wang X. A lariat-based dilatation device for hysteroscopy: an in vitro study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:462. [PMID: 31700898 DOI: 10.21037/atm.2019.08.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Hysteroscopy is regarded as the golden standard for the therapeutic and diagnostic methods of many uterine diseases. Carbon dioxide, normal saline and pharmaceuticals are generally used to dilate the uterus to obtain enough operating space and clear vision during the surgery. However, these methods often cause various syndromes. Methods In this study, we designed a novel mechanical dilator and operating system. The dilator contains a structure with a diameter of 9 mm in its initial status to pass through the narrow cervix after initial cervical dilation by cervical dilator and then its diameter can be expanded up to 60 mm in the working status to achieve a favorable operating space. The operating system is composed of an endoscope and the surgical instrument driving tube. The endoscope was motioned by pre-bent hyperelastic wires and the surgical instrument was driven by a pre-bent driving tube. To obtain the parameters for successful expansion and operation, the relationships between the tension, the diameter of the dilator and the visual and operating space of the operating system were analyzed in detail. On the basis of the obtained parameters, the surgical experiment was performed and the experimental results demonstrated the ability of this dilator to expand and the ability of the operator to operate in small spaces for hysteroscopy. Results According to the achieved results, the dilator could support the inner wall of the simulated organ to act like a cage, so that the space in the cage was large enough. The operating system can thrust into the intracavity of the simulated uterus through the channel (with a diameter of 6 mm) of the dilator to search for and excise the raised polyp. Conclusions It can be concluded that the proposed dilator and operating system can be efficiently applied in organ expansion and operation in hysteroscopy.
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Affiliation(s)
- Donghua Shen
- School of Mechanical Engineering, Southeast University, Nanjing 211189, China
| | - Kaiwei Ma
- School of Mechanical Engineering, Southeast University, Nanjing 211189, China
| | - Mengqian Tian
- School of Mechanical Engineering, Southeast University, Nanjing 211189, China
| | - Lan Li
- School of Mechanical Engineering, Southeast University, Nanjing 211189, China.,Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China
| | - Qing Jiang
- Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China
| | - Xingsong Wang
- School of Mechanical Engineering, Southeast University, Nanjing 211189, China
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14
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Ukybassova T, Terzic M, Dotlic J, Imankulova B, Terzic S, Shauyen F, Garzon S, Guo L, Sui L. Evaluation of Uterine Artery Embolization on Myoma Shrinkage: Results from a Large Cohort Analysis. Gynecol Minim Invasive Ther 2019; 8:165-171. [PMID: 31741842 PMCID: PMC6849095 DOI: 10.4103/gmit.gmit_50_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 07/08/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: There are still contradictory opinions on the success rates of uterine artery embolization (UAE) for the treatment of myomas. In this scenario, our study aims to assess the effect of UAE on myoma shrinkage. Materials and Methods: The study included 337 women in reproductive age affected by a single symptomatic intramural myoma and declined surgery, undergoing UAE. The uterus and myoma diameters and volumes were determined on ultrasonographic scans before and 3, 6, and 12 months after the procedure. Results: The mean uterine volume before intervention was 226.46 ± 307.67 mm3, whereas myoma volume was 51.53 ± 65.53 mm3. Further myoma progression was registered in only four patients. In remaining women, uterus volume in average decreased for 149.99 ± 156.63 mm3, whereas myomas decreased for 36.57 ± 47.96 mm3. The mean volume reduction rate of the uterus was 49.54 ± 35.62 and for myoma was 57.58 ± 30.71. A significant decrease in both uterine and myoma volume was registered in every stage of the follow-up. The highest average decrease in uterine volume was in the first 3 months and myoma volume between 3 and 6 months following UAE. After 12 months follow-up, successful outcome (volume regression >50% respect to the baseline) was registered for uterus in 97.4% and for myoma in 67.9% of investigated patients. Conclusion: UAE was proven to allow a good success rate and can be considered as an effective alternative procedure for myoma treatment.
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Affiliation(s)
- Talshyn Ukybassova
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
| | - Milan Terzic
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan.,Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Balkenzhe Imankulova
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
| | - Sanja Terzic
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Fariza Shauyen
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Luopei Guo
- Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Long Sui
- Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
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15
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van der Meulen JF, Bongers MY, Coppus SFPJ, Bosmans JE, Maessen JMC, Oude Rengerink K, Overdijk LE, Radder CM, van der Voet LF, Smeets NAC, van Vliet HAAM, Hehenkamp WJK, Manger AP, Spaans WA, Bakkum EA, Horrée N, Briët JM, van der Steeg JW, Kok HS. The (cost) effectiveness of procedural sedation and analgesia versus general anaesthesia for hysteroscopic myomectomy, a multicentre randomised controlled trial: PROSECCO trial, a study protocol. BMC WOMENS HEALTH 2019; 19:46. [PMID: 30902087 PMCID: PMC6431064 DOI: 10.1186/s12905-019-0742-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 03/12/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND In women with abnormal uterine bleeding, fibroids are a frequent finding. In case of heavy menstrual bleeding and presence of submucosal type 0-1 fibroids, hysteroscopic resection is the treatment of first choice, as removal of these fibroids is highly effective. Hysteroscopic myomectomy is currently usually performed in the operating theatre. A considerable reduction in costs and a higher patient satisfaction are expected when procedural sedation and analgesia with propofol (PSA) in an outpatient setting is applied. However, both safety and effectiveness - including the necessity for re-intervention due to incomplete resection - have not yet been evaluated. METHODS This study is a multicentre randomised controlled trial with a non-inferiority design and will be performed in the Netherlands. Women > 18 years with a maximum of 3 symptomatic type 0 or 1 submucosal fibroids with a maximum diameter of 3.5 cm are eligible to participate in the trial. After informed consent, 205 women will be randomised to either hysteroscopic myomectomy using procedural sedation and analgesia with propofol in an outpatient setting or hysteroscopic myomectomy using general anaesthesia in a clinical setting in the operating theatre. Primary outcome will be the percentage of complete resections, based on transvaginal ultrasonography 6 weeks postoperatively. Secondary outcomes are cost effectiveness, menstrual blood loss (Pictorial blood assessment chart), quality of life, pain, return to daily activities/work, hospitalization, (post) operative complications and re-interventions. Women will be followed up to one year after hysteroscopic myomectomy. DISCUSSION This study may demonstrate comparable effectiveness of hysteroscopic myomectomy under procedural sedation and analgesia versus general anaesthesia in a safe and patient friendly environment, whilst achieving a significant cost reduction. TRIAL REGISTRATION Dutch trial register, number NTR5357 . Registered 11th of August 2015.
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Affiliation(s)
- Julia F van der Meulen
- Department of Obstetrics & Gynaecology, Máxima Medical Centre, PO Box 777, 5500, MB, Veldhoven, The Netherlands. .,Grow school of oncology and developmental biology, MUMC, Maastricht, The Netherlands.
| | - Marlies Y Bongers
- Department of Obstetrics & Gynaecology, Máxima Medical Centre, PO Box 777, 5500, MB, Veldhoven, The Netherlands.,Grow school of oncology and developmental biology, MUMC, Maastricht, The Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics & Gynaecology, Máxima Medical Centre, PO Box 777, 5500, MB, Veldhoven, The Netherlands.,Department of Obstetrics & Gynaecology, UMC St Radboud, Nijmegen, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Section of Health Economics & Health Technology Assessment, VU Medical Centre, Amsterdam, The Netherlands
| | - José M C Maessen
- Department of Quality and Safety, MUMC, Maastricht, The Netherlands
| | - Katrien Oude Rengerink
- Julius Center of Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.,Department of Obstetrics & Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lucilla E Overdijk
- Department of Anaesthesiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Celine M Radder
- Department of Obstetrics & Gynaecology, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands
| | - Lucet F van der Voet
- Department of Obstetrics & Gynaecology, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Nicol A C Smeets
- Department of Obstetrics & Gynaecology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Huib A A M van Vliet
- Department of Obstetrics & Gynaecology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics & Gynaecology, VU Medical Centre, Amsterdam, The Netherlands
| | - Arentje P Manger
- Department of Obstetrics & Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - Wilbert A Spaans
- Department of Obstetrics & Gynaecology, MUMC, Maastricht, The Netherlands
| | - Erica A Bakkum
- Department of Obstetrics & Gynaecology, Onze Lieve Vrouwe Gasthuis Oost, Amsterdam, The Netherlands
| | - Nicole Horrée
- Department of Obstetrics & Gynaecology, Flevoziekenhuis, Almere, The Netherlands
| | - Justine M Briët
- Department of Obstetrics & Gynaecology, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Jan Willem van der Steeg
- Department of Obstetrics & Gynaecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Helen S Kok
- Department of Obstetrics & Gynaecology, Alrijne Ziekenhuis, Leiden, The Netherlands
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16
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Checa M, Bellver J, Bosch E, Espinós J, Fabregues F, Fontes J, García-Velasco J, Requena A. Hysteroscopic septum resection and reproductive medicine: A SWOT analysis. Reprod Biomed Online 2018; 37:709-715. [DOI: 10.1016/j.rbmo.2018.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
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17
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Lee CE, Epp A. Safety and Efficiency in a Canadian Outpatient Gynaecological Surgical Centre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:426-431. [DOI: 10.1016/j.jogc.2017.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
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18
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Salazar CA, Isaacson KB. Office Operative Hysteroscopy: An Update. J Minim Invasive Gynecol 2017; 25:199-208. [PMID: 28803811 DOI: 10.1016/j.jmig.2017.08.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/02/2017] [Accepted: 08/05/2017] [Indexed: 02/06/2023]
Abstract
Hysteroscopy is considered the gold standard for the evaluation of intracavitary pathology in both premenopausal and postmenopausal patients associated with abnormal uterine bleeding, as well as for the evaluation of infertile patients with suspected cavity abnormalities. Office-based operative hysteroscopy allows patients to resume activities immediately and successfully integrates clinical practice into a "see and treat" modality, avoiding the added risks of anesthesia and the inconvenience of the operating room. For 2017, the Centers for Medicare and Medicaid Services has provided a substantial increase in reimbursement for a select number of office-based hysteroscopic procedures. This review provides an update on the indications, equipment, and procedures for office hysteroscopy, as well as the management of complications that may arise within an office-based practice.
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Affiliation(s)
| | - Keith B Isaacson
- Newton Wellesley Hospital, Harvard Medical School, Newton, Massachusetts.
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19
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Asgari Z, Razavi M, Hosseini R, Nataj M, Rezaeinejad M, Sepidarkish M. Evaluation of Paracervical Block and IV Sedation for Pain Management during Hysteroscopic Polypectomy: A Randomized Clinical Trial. Pain Res Manag 2017; 2017:5309408. [PMID: 28676733 PMCID: PMC5476897 DOI: 10.1155/2017/5309408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/08/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to compare the effectiveness of paracervical block (PB) and IV sedation (IVS) on women's pain perception during operative hysteroscopy. METHODS A total of 84 patients with uterine polyps were randomized to either PB or IV sedation or general anesthesia (GA) as control group. In PB group, the patients received oral diazepam 10 mg and 100 mg diclofenac Na suppository 60 min before surgery and 10 cc of 2% buffered lidocaine was injected at cervix. Conscious sedation was performed with the IV administration of 2-3 mg/kg/h propofol 1% and midazolam 0.02 mg/kg and fentanyl (1-2 μg/kg) with o2 4-5 lit/min via face mask. RESULTS There were no significant differences between groups on VAS score at 3 hours after operation (PB: 1.22 ± (1.31), IVS: 1.10 ± (1.68), GA: 1.29 ± (2.03), P = 0.671) and during recovery (PB: 0.85 ± (1.06), IVS: 0.68 ± (1.33), GA: 1.21 ± (2.04), P = 0.458). There was no difference between PB (3.33 ± (2.81)) and IVS (2.31 ± (2.63)) groups at hysteroscopy (P = 0.182). Patients undergoing IVS reported lower VAS score than PB group at dilation and curettage, although the difference was not statistically significant (PB: 2.59 ± (1.78), IVS: 1.72 ± (2.34), P = 0.051). Moreover, patients undergoing IVS obtained lower VAS score than PB group at polypectomy, while the difference was not statistically significant (PB: 1.81 ± (1.52), IVS: 1.10 ± (1.32), P = 0.073). CONCLUSION The finding of the present study revealed that IVS and PB showed the same effect in reducing pain during and after gynecological surgical procedures. The study was registered in Iranian Registry of Clinical Trial with the number IRCT2016031426855N3, on April 28, 2016.
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Affiliation(s)
- Zahra Asgari
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Razavi
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Hosseini
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Nataj
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahroo Rezaeinejad
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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20
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Scheiber MD, Chen SH. A Prospective Multicenter Registry of Patients Undergoing Hysteroscopic Morcellation of Uterine Polyps and Myomas. J Gynecol Surg 2016; 32:318-323. [PMID: 27965523 PMCID: PMC5144868 DOI: 10.1089/gyn.2016.0008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Hysteroscopic morcellation removes uterine pathology under direct visualization with continuous real-time tissue fragment removal. Objective: The aim of this study was to explore the feasibility of hysteroscopic morcellation across a diverse set of facilities, including both surgical and office-based settings. Design: This was a prospective, single-arm, multicenter registry development (Canadian Task Force classification II-3). Materials and Methods: Thirty-four U.S. obstetrics and gynecology facilities enrolled subjects into the registry. Inclusion criteria were women ages 18–65 with indications for hysteroscopic myomectomy and/or polypectomy who were treated with the MyoSure® Hysteroscopic Tissue Removal System (Hologic Inc., Marlborough, MA). Intrauterine lesion type/size and removal parameters, adverse events (AEs), and physician satisfaction ratings were recorded. Results: A total of 559 pathologies (187 fibroids; 372 polyps) were removed from 278 registered subjects (mean age: 43.9 ± 9.0 years), with 250 procedures (89.9%) performed in an ambulatory surgery center or hospital outpatient setting and 28 (10.1%) in a gynecologic office setting. Most patients (n = 206, 74.1%) were treated for abnormal uterine bleeding, and 42 (15.1%) were treated for infertility. Mean fibroid diameter was 2.2 ± 1.2 cm. Mean polyp diameter was 1.3 ± 1.0 cm. Overall mean percentage of pathology removed was 95.4% (polyps 99.3%, fibroids 86.8%). Five AEs included four incidents of blunt cervical trauma and a single postoperative case of pedal edema; all were considered mild and resolved spontaneously. Postprocedure surveys indicated that 95% of reporting physicians were “satisfied” or “highly satisfied” with device performance. Conclusions: Hysteroscopic morcellation of intrauterine pathology was accomplished safely with a high degree of physician satisfaction in 278 patients treated in diverse healthcare settings that are reflective of general community practice in the United States. (J GYNECOL SURG 32:318)
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Affiliation(s)
| | - Serena H Chen
- Institute for Reproductive Medicine and Science at Saint Barnabas Medical Center , Livingston, NJ
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Hua Y, Zhang W, Hu X, Yang A, Zhu X. The use of misoprostol for cervical priming prior to hysteroscopy: a systematic review and analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2789-2801. [PMID: 27660411 PMCID: PMC5019271 DOI: 10.2147/dddt.s111625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The effects of misoprostol use on cervical priming prior to hysteroscopy have been controversial. Therefore, a systematic literature review and meta-analysis of studies were conducted to assess the effect of misoprostol on cervical priming prior to hysteroscopy. All studies published before July 2014 with data related to the use of misoprostol for cervical priming compared with placebo or no medication prior to hysteroscopy, were identified. Twenty-five randomized controlled trials involving 2,203 females were systematically analyzed. The results showed that, compared with placebo or no medication, the use of misoprostol prior to hysteroscopy led to a significant relief of the need for cervical dilatation, resulted in a significantly greater cervical width, had fewer hysteroscopy complications, and mild and insignificant side effects. Subgroup analyses revealed that the regimen of 200 or 400 μg vaginal misoprostol may be a simple and effective method for cervical priming, especially prior to operative hysteroscopy.
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Affiliation(s)
- Ying Hua
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Wenwen Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiaoli Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ansu Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Therapeutic hysteroscopy in an outpatient office-based setting compared to conventional inpatient treatment: superior? a cohort study. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s10397-016-0974-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Capmas P, Pourcelot AG, Giral E, Fedida D, Fernandez H. Office hysteroscopy: A report of 2402 cases. ACTA ACUST UNITED AC 2016; 45:445-50. [DOI: 10.1016/j.jgyn.2016.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/08/2016] [Accepted: 02/24/2016] [Indexed: 11/15/2022]
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Mairos J, Di Martino P. Office Hysteroscopy. An operative gold standard technique and an important contribution to Patient Safety. ACTA ACUST UNITED AC 2016; 13:111-114. [PMID: 27226786 PMCID: PMC4854928 DOI: 10.1007/s10397-015-0926-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 12/14/2015] [Indexed: 12/02/2022]
Abstract
According to World Health Organization (WHO), about 1 out of 10 hospitalized patients suffers an adverse event, in developed countries, being an adverse event an injury related to medical management, in contrast to complications of disease. These events cause both unnecessary suffering and huge cost to health systems. This issue is so important that WHO has defined it as a global health problem and in 2004 launched the World Alliance for Patient Safety, with the aim to coordinate, disseminate and accelerate improvements in Patient Safety. Office Hysteroscopy (OH), as an independent technique of the hospital circuit, has the ideal conditions to be qualified as the gold standard technique for the surgical treatment of intracavitary uterine pathology. It does not require the use of an operating room, hospital admission and general or locoregional anaesthesia. The appropriate surgical techniques, allied to pain control, allow OH to resolve much more than 90 % of the surgical needs of the intracavitary uterine pathology, thus being an important contribution for Patient Safety.
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Affiliation(s)
- J. Mairos
- Department of Gynecology and Obstetrics, Hospital das Forças Armadas - Pólo de Lisboa, Azinhaga dos Ulmeiros, 1649-020 Lisbon, Portugal
| | - P. Di Martino
- Department of Gynecology and Obstetrics, Hospital das Forças Armadas - Pólo de Lisboa, Azinhaga dos Ulmeiros, 1649-020 Lisbon, Portugal
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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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Reith G, Schmitz-Greven V, Hensel KO, Schneider MM, Tinschmann T, Bouillon B, Probst C. Metal implant removal: benefits and drawbacks--a patient survey. BMC Surg 2015; 15:96. [PMID: 26250649 PMCID: PMC4528685 DOI: 10.1186/s12893-015-0081-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 08/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hardware removals are among the most commonly performed surgical procedures worldwide. Current literature offers little data concerning postoperative patient satisfaction. The purpose of our study was to evaluate the patients' point of view on implant removal. METHODS We surveyed patients of a German level one trauma center, who underwent hardware removal in 2009 and 2010, with regard to their personal experiences on implant removal. Exclusively, data obtained out of the survey were analyzed. RESULTS In 332 patients surveyed, most hardware removals were performed at the ankle joint (21%) followed by the wrist (15%). The most frequent indication was a doctor's recommendation (68%), followed by pain (31%) and impaired function (31%). Patient reported complication rate of implant removal was 10%. Importantly, after implant removal because of pain or impaired function patients reported an improvement in function (72%) as well as decreased pain (96%). 96% of all responding patients and 66% of the patients who suffered from subsequent complications would opt for surgical implant removal again. CONCLUSION In summary, despite the challenging and frequently troublesome nature of surgical hardware removal our data contradicts the widely held view that implant removal is often without a positive effect on the patients. These findings may influence the surgeons' attitude towards implant removal and their day-to-day routine in patient counseling.
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Affiliation(s)
- Georg Reith
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany.
| | - Vera Schmitz-Greven
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Kai O Hensel
- Helios Medical Center Wuppertal, ZBAF, Center for Biomedical Education and Research, Witten/Herdecke University, Witten, Germany
| | - Marco M Schneider
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Tibor Tinschmann
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Christian Probst
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
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Rovira Pampalona J, Degollada Bastos M, Mancebo Moreno G, Ratia Garcia E, Buron Pust A, Mateu Pruñonosa JC, Guerra Garcia A, Carreras Collado R, Bresco Torras P. Outpatient Hysteroscopic Polypectomy: Bipolar Energy System (Versapoint®) versus Mechanical Energy System (TRUCLEAR System®) - Preliminary Results. Gynecol Obstet Invest 2015; 80:3-9. [DOI: 10.1159/000377700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022]
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30
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Pampalona JR, Bastos MD, Moreno GM, Pust AB, Montesdeoca GE, Guerra Garcia A, Pruñonosa JCM, Collado RC, Torras PB. A Comparison of Hysteroscopic Mechanical Tissue Removal With Bipolar Electrical Resection for the Management of Endometrial Polyps in an Ambulatory Care Setting: Preliminary Results. J Minim Invasive Gynecol 2015; 22:439-45. [DOI: 10.1016/j.jmig.2014.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/27/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
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31
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Centini G, Calonaci A, Lazzeri L, Tosti C, Palomba C, Puzzutiello R, Luisi S, Petraglia F, Zupi E. Parenterally Administered Moderate Sedation and Paracervical Block Versus General Anesthesia for Hysteroscopic Polypectomy: A Pilot Study Comparing Postoperative Outcomes. J Minim Invasive Gynecol 2015; 22:193-8. [DOI: 10.1016/j.jmig.2014.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/05/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
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32
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Rubino RJ, Lukes AS. Twelve-Month Outcomes for Patients Undergoing Hysteroscopic Morcellation of Uterine Polyps and Myomas in an Office or Ambulatory Surgical Center. J Minim Invasive Gynecol 2015; 22:285-90. [DOI: 10.1016/j.jmig.2014.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/17/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
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Abstract
Hysteroscopic surgery is pivotal in management of many gynecological pathologies. The skills required for performing advanced hysteroscopic surgery (AHS), eg, transcervical hysteroscopic endometrial resection (TCRE), hysteroscopic polypectomy and myomectomy in the management of menorrhagia, hysteroscopic septulysis in fertility-related gynecological problems and hysteroscopic removal of chronically retained products of conception and excision of intramural ectopic pregnancy ought to be practiced by contemporary gynecological surgeons in their day-to-day clinical practice. AHS is a minimally invasive procedure that preserves the uterus in most cases. Whilst the outcome is of paramount importance, proper training should be adopted and followed through so that doctors, nurses, and institutions may deliver the highest standard of patient care.
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Affiliation(s)
- Mark M Erian
- Teaching and Research Department, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Glenda R McLaren
- University of Queensland and Mater Mothers Hospital, Brisbane, Australia
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A Randomized, Single Blind, Placebo-Controlled Trial for the Pain Reduction During the Outpatient Hysteroscopy After Ketoprofen or Intravaginal Misoprostol. J Minim Invasive Gynecol 2014; 21:921-7. [DOI: 10.1016/j.jmig.2014.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
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Kamel MA, El-Tawab SS, El-Ashkar OS, Hassan MIA. Mini-Scissor Versus Bipolar Twizzle in Ambulatory Hysteroscopic Metroplasty: A Prospective Randomized Study. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mostafa A.M. Kamel
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shatby Maternity University Hospital, Alexandria University, Shatby, Alexandria, Egypt
| | - Sally S. El-Tawab
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shatby Maternity University Hospital, Alexandria University, Shatby, Alexandria, Egypt
| | - Osama S. El-Ashkar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shatby Maternity University Hospital, Alexandria University, Shatby, Alexandria, Egypt
| | - Mona I. Abdo Hassan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shatby Maternity University Hospital, Alexandria University, Shatby, Alexandria, Egypt
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Hysteroscopy: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol 2014; 178:114-22. [PMID: 24835861 DOI: 10.1016/j.ejogrb.2014.04.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 01/02/2023]
Abstract
The objective of this study was to provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning hysteroscopy. Vaginoscopy should be the standard technique for diagnostic hysteroscopy (Grade A) using a miniature (≤3.5mm sheath) (Grade A) rigid hysteroscope (Grade C), using normal saline solution distension medium (Grade C), without any anaesthesia (conscious sedation should not be routinely used), without cervical preparation (Grade B), without vaginal disinfection and without antibiotic prophylaxy (Grade B). Misoprostol (Grade A), vaginal oestrogens (Grade C), or GnRH agonist routine administration is not recommended before operative hysteroscopy. Before performing hysteroscopy, it is important to purge the air out of the system (Grade A). The uterine cavity distention pressure should be maintained below the mean arterial pressure and below 120mm Hg. The maximum fluid deficit of 2000ml is suggested when using normal saline solution and 1000ml is suggested when using hypotonic solution. When uterine perforation is recognized during operative hysteroscopy using monopolar or bipolar loop, the procedure should be stopped and a laparoscopy should be performed in order to eliminate a bowel injury. Diagnostic or operative hysteroscopy is allowed when an endometrial cancer is suspected (Grade B). Implementation of this guideline should decrease the prevalence of complications related to hysteroscopy.
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Kim JY, Chae M, Lee J. Operative hysteroscopy intravascular absorption syndrome caused by massive absorption of 0.9% saline as the distention/irrigation medium. Korean J Anesthesiol 2014; 65:S44-6. [PMID: 24478868 PMCID: PMC3903856 DOI: 10.4097/kjae.2013.65.6s.s44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ji-Yong Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Minsuk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaemin Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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[Prevention of the complications related to hysteroscopy: guidelines for clinical practice]. ACTA ACUST UNITED AC 2013; 42:1032-49. [PMID: 24210234 DOI: 10.1016/j.jgyn.2013.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To provide clinical practice guidelines (CPGs) from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning the adverse events related to hysteroscopy. MATERIALS AND METHODS Review of literature using following Keywords: hysteroscopy; vaginoscopy; infection; perforation; intrauterine adhesions RESULTS Vaginoscopy should be the standard technique for outpatient hysteroscopy (grade A) using a miniature (≤ 3.5mm sheath) (grade A) rigid hysteroscope (grade C), using normal saline solution distension medium (grade C), without any anesthesia (conscious sedation should not be routinely used), without cervical preparation (grade B), without vaginal disinfection and without antibiotic prophylaxy (grade B). Misoprostol (grade A), vaginal estrogens (grade C), or GnRH agonist routine administration is not recommended before operative hysteroscopy. Before performing hysteroscopy, it is important to purge the air out of the system (grade A). The uterine cavity distention pressure should be maintained below the mean arterial pressure and below 120 mmHg. The maximum fluid deficit of 2000 mL is suggested when using normal saline solution and 1000 mL is suggested when using hypotonic solution. When uterine perforation is recognized during operative hysteroscopy using monopolar or bipolar loop, the procedure should be stopped and a laparoscopy should be performed in order to eliminate a bowel injury. Diagnostic or operative hysteroscopy is allowed when an endometrial cancer is suspected (grade B). CONCLUSION Implementation of this guideline should decrease the prevalence of complications related to office and operative hysteroscopy.
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