Balloon Catheter for Cervical Priming before Operative Hysteroscopy in Young Women: A Pilot Study

Analgesia efficacy of lidocaine transfused by a novel disposable injectable cervical dilator during intrauterine device removal procedure: A randomized clinical trial

OBJECTIVE

The majority of intrauterine devices (IUDs) inserted in China are tailless, requiring intrauterine manipulations for removal and causing pain. This study aimed to investigate the analgesic efficacy of lidocaine injection into a novel disposable injectable cervical dilator for IUD removal procedures.

STUDY DESIGN

A double-blinded, placebo-controlled, randomized clinical trial was conducted with women aged 18-65 years old requesting outpatient IUD removal. The study randomly assigned participants to either lidocaine (injecting 5 ml of 2% lidocaine into the injectable cervical dilator) or placebo (injecting 5 ml of normal saline into the device) group. All participants received a standardized paracervical block. The primary outcome was pain reported during IUD removal on a 100 mm Visual Analog Scale (VAS). Intention-to-treat were conducted to evaluate the analgesic effectiveness of injecting lidocaine into the injectable cervical dilators.

RESULTS

We enrolled seventy-four eligible participants (37 in lidocaine group and 37 in placebo group). The results showed that the median intraoperative VAS score in the lidocaine group was lower than the placebo group (30.0 mm [IQR 20.0-46.0, n = 37] vs 46.0 mm [IQR 30.0-55.0, n = 37], p = 0.01. In subgroup analyses, among participants with IUD removal and without uterine manipulation and additional procedures, there was no statistically significant disparity observed in intraoperative VAS scores between the lidocaine and placebo group (15.0 mm [IQR 10.0-27.5, n = 8] vs 20.0 mm [IQR 20.0-40.0, n = 6]), p = 0.28). Among participants with an IUD removal necessitating intrauterine manipulations and without additional procedures, showing lower intraoperative VAS scores in lidocaine group (25.0 mm [IQR 15.0-40.5, n = 17]) compared to placebo group (46.0 mm [IQR 38.5-50.0, n = 23]), p < 0.01. Among participants with additional procedures in addition to IUD removal, there was no statistically significant disparity observed in intraoperative VAS scores between the lidocaine and placebo group (41.0 mm [IQR 32.5-57.5, n = 12] vs 45.0 mm [IQR 22.5-69.0, n = 8]), p = 0.97).

CONCLUSIONS

Injecting lidocaine into the novel disposable injectable cervical dilator for cervix dilation can significantly reduce pain during an IUD removal, particularly in patients necessitating intrauterine manipulations during IUD removal.

IMPLICATIONS

When we have to perform intrauterine manipulations to remove an IUD, surgical pain and narrow cervical canal undoubtedly affect the implementation of the procedure. Injecting lidocaine into the injectable cervical dilator can achieve local anesthesia while dilating the cervix, and might reduce the choice of general anesthesia for IUD removal.

A lariat-based dilatation device for hysteroscopy: an in vitro study

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.