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Cohen N, Kedem HI, Abu-Foul L, Paz M, Kaufman Y, Lavie O, Zilberlicht A. Does vaginal cleansing with iodine decreases infection rate in office hysteroscopy? Arch Gynecol Obstet 2023; 308:1791-1796. [PMID: 37653251 DOI: 10.1007/s00404-023-07199-y] [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: 07/05/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To determine whether preoperative vaginal cleansing with iodine-based solution prior to hysteroscopy, reduces postoperative infection rate compared to no vaginal cleansing. METHODS A retrospective study at a single tertiary, university affiliated hospital of all individuals who have had an office hysteroscopy. Study group consisted of patients who have had preoperative vaginal cleansing with iodine-based solution and were compared to those who have not. Any procedural related complaints at the 30 days following the hysteroscopy were recorded. RESULTS A total of 505 were available for analysis, 183 in the study group and 322 in the control group. The most common indications for operation were infertility evaluation (33.9% vs. 28.6%) and retained products of conception (33.3% vs. 29.2%), and most common procedures were diagnostic only (49.7% vs. 42.5%) followed by adhesiolysis (12% vs. 14.3%). No statistical differences were noted with regards to postoperative infections, as only one case of pelvic inflammatory disease was noted, in the iodine cleansing group (0.19% for postoperative infection). CONCLUSION Our comparative study may suggest that the use of preoperative iodine solution prior to office hysteroscopy does not decrease the postoperative infection rate up to 30 days, thus can be avoided.
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Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel.
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Hagit Itzhak Kedem
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Luna Abu-Foul
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Moran Paz
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yuval Kaufman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Okoshi C, Takahashi T, Fukatsu M, Suganuma R, Ikezoe T, Fujimori K. A case of delayed postoperative bleeding after excision of endometrial polyp using resectoscope in an infertile woman with von Willebrand disease:a case report and literature review. Fukushima J Med Sci 2023; 69:197-204. [PMID: 37853641 PMCID: PMC10694516 DOI: 10.5387/fms.2023-04] [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: 02/01/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
Von Willebrand disease (VWD) is a bleeding disorder caused by a congenital quantitative reduction, deficiency, or qualitative abnormality of the von Willebrand factor (VWF). Here, we report a case of delayed postoperative bleeding in an infertile woman with endometrial polyps complicated by VWD. The patient was a 39-year-old infertile woman with type 2A VWD. At 38 years of age, she was referred to our hospital for infertility and heavy menstrual bleeding. Hysteroscopy revealed a 15-mm polyp lesion in the uterus. The patient was scheduled for transcervical resection (TCR) of the endometrial polyp. Gonadotropin-releasing hormone agonists were preoperatively administered to prevent menstruation. The VWF-containing concentrate was administered for 3 days according to guidelines. The patient was discharged on postoperative day 3 after confirming the absence of uterine bleeding. Uterine bleeding began on postoperative day 6. The patient was readmitted on postoperative day 7 and treated with VWF-containing concentrate for 5 days, after which hemostasis was confirmed. TCR surgery for endometrial lesions is classified as a minor surgery, and guidelines recommend short-term VWF-containing concentrate replacement. However, it should be kept in mind that only short-term VWF-containing concentrate replacement may cause rebleeding postoperatively.
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Affiliation(s)
- Chihiro Okoshi
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University
| | - Masahiko Fukatsu
- Department of Haematology Fukushima Medical University School of Medicine
| | - Ryota Suganuma
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine
| | - Takayuki Ikezoe
- Department of Haematology Fukushima Medical University School of Medicine
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine
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Shiro R, Kotani Y, Ohta M, Sato H, Kashima Y, Murakami K, Kawasaki K, Nakai H, Matsumura N. Diagnostic Utility of Hysteroscopic Biopsy in Cases of Suspected Lobular Endocervical Glandular Hyperplasia and Comparison with Cervical Conization. Healthcare (Basel) 2023; 11:healthcare11111619. [PMID: 37297759 DOI: 10.3390/healthcare11111619] [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: 04/12/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Cervical cystic lesions encompass a range of benign and malignant pathologies. Magnetic resonance imaging or cytology alone cannot provide a definitive diagnosis, and conventional practice involves performing a cervical biopsy by conization to confirm the histology in cases exhibiting potential signs of lobular endocervical glandular hyperplasia (LEGH) or malignancy. However, as postoperative complications resulting from conization can impact future fertility and pregnancy, alternative diagnostic methods are needed for reproductive-age patients. This study aimed to establish the efficacy of a hysteroscopic biopsy for diagnosing cervical cystic lesions and compare it with conization. METHODS Thirteen patients with cervical cystic lesions suspected of LEGH or malignancy underwent a hysteroscopic biopsy, while 23 underwent conization. Patient background information, preoperative evaluation, histology, and postoperative outcomes were collected and compared retrospectively. RESULTS No significant differences were found between the hysteroscopy and conization groups in terms of mean patient age (45 vs. 48 years), operating time (23 vs. 35 min), blood loss (small amount vs. 43 mL), and postoperative hospitalization (1.1 vs. 1.6 days). CONCLUSION A hysteroscopic biopsy allows for targeted resection of the cervix while maintaining diagnostic accuracy. It may serve as an efficient method for diagnosing cervical cystic lesions.
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Affiliation(s)
- Reona Shiro
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Yasushi Kotani
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Mamiko Ohta
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Hanako Sato
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Yoko Kashima
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Kosuke Murakami
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Kaoru Kawasaki
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Hidekatsu Nakai
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
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Kumar K, Pajai S, Baidya GR, Majhi K. Utility of Saline Infusion Sonohysterography in Gynecology: A Review Article. Cureus 2023; 15:e35424. [PMID: 36987479 PMCID: PMC10040238 DOI: 10.7759/cureus.35424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/22/2023] [Indexed: 03/30/2023] Open
Abstract
This study aimed to describe the role played by saline infusion sonohysterosalpingography (SIS) in the evaluation of uterine lesions. Saline infusion sonohysterosalpingography provides three-dimensional (3D) images with high resolution, which, in turn, gives a good orientation to clinicians and radiologists, in most cases, about the underlying endometrial and tubal pathologies. Saline infusion sonohysterosalpingography is an underused imaging modality that has some advantages over other conventional imaging modalities. It can be used in the diagnosis of gynecological conditions. Saline infusion sonohysterosalpingography gets an edge over other modalities because of its ease of use, cost efficacy, and non-invasive nature while having comparable or even better accuracy than most imaging modalities used in gynecological conditions. Its cost efficacy and excellent pathological characterization make it an imaging modality beneficial for Indian healthcare setups as a whole, and rural healthcare setups in particular where patients cannot afford expensive investigations. This review covers indications and contraindications, imaging technique, drawbacks in imaging, use of SIS in various uterine pathologies, and, in the end, a comparison of SIS with other imaging modalities. Saline infusion sonohysterosalpingography is indicated in most of the prevalent gynecological diseases in India with the reported post-procedural complications being very few. There are a few contraindications as well which should be kept in mind and these are mentioned later. During the procedure, aseptic precautions should be taken. Comparison between imaging modalities will bring out the better modality for a particular case according to the need of the patient.
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Affiliation(s)
- Kingshuk Kumar
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Geeta R Baidya
- Obstetrics and Gynecology, Aashirwad Nursing Home, Ghatsila, IND
| | - Krishnendu Majhi
- Medicine, Employees' State Insurance Dispensary, Jugsalai, Jamshedpur, IND
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Han L, Shi G, Zheng A, Ruan J. Hysteroscopy for retained products of conception: a single-institution experience. BMC Womens Health 2023; 23:25. [PMID: 36653813 PMCID: PMC9847198 DOI: 10.1186/s12905-023-02170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Retained products of conception can occur with induced abortion during early-term pregnancy, induction of labor during mid-term pregnancy, drug-induced abortion, miscarriage, cesarean delivery, or full-term normal delivery. Compared with traditional dilation and curettage, hysteroscopy is a safer and more effective treatment method for retained products of conception. This study aimed to report the efficacy of hysteroscopy for treating retained products of conception and to share our new clinical perspectives. METHODS This retrospective, single-center study was conducted at a tertiary hospital in Chengdu, China. We included 36 patients with retained products of conception who underwent hysteroscopy at our hospital. RESULTS Our study reported a complete removal rate of 80.5% (29/36) with one procedure. The normal menstruation recovery rate during 1 year of follow-up was 91.6% (33/36). A low rate of postoperative intrauterine adhesions (2.8% [1/36]) was also reported. CONCLUSION Our retrospective study elucidated the use of hysteroscopy for retained products of conception. We also shared new perspectives regarding hysteroscopy and optimal surgical methods for treating retained products of conception as well as our experience treating residual products with hysteroscopy. To our knowledge, no other study has shared similar experiences.
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Affiliation(s)
- Ling Han
- grid.13291.380000 0001 0807 1581Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Renmin South Road, Chengdu, Sichuan China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Gang Shi
- grid.13291.380000 0001 0807 1581Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Renmin South Road, Chengdu, Sichuan China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Ai Zheng
- grid.13291.380000 0001 0807 1581Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Renmin South Road, Chengdu, Sichuan China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jiaying Ruan
- grid.13291.380000 0001 0807 1581Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Renmin South Road, Chengdu, Sichuan China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Céspedes Martínez MA, Rovira Pampalona J, Degollada Bastos M, Izquierdo Argelich R, Bou Tapias J, Flores Laura MD, Brescó Torras P, Carugno Jose MD. Effectiveness and patient satisfaction with office hysteroscopic polypectomy in patients with symptomatic endometrial polyps. Facts Views Vis Obgyn 2022; 14:325-329. [PMID: 36724424 PMCID: PMC10364329 DOI: 10.52054/fvvo.14.4.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Endometrial polyps are a common cause of abnormal uterine bleeding. In-office hysteroscopic management is frequently performed to treat this frequently encountered pathology. Objectives To evaluate the long-term outcome and patients' satisfaction with office hysteroscopic polypectomy in patients with symptomatic endometrial polyps. Materials and Methods Retrospective longitudinal observational study of all hysteroscopic polypectomies performed at d'Igualada University Hospital (Barcelona, Spain) between May 2016 and December 2018. The medical records were reviewed, and a telephone interview was conducted with all the patients diagnosed with symptomatic endometrial polyps who underwent outpatient hysteroscopic polypectomy, with the purpose of evaluating the post-procedure symptomatology and satisfaction with the procedure. Main outcomes and results A total of 848 outpatient hysteroscopies were performed, 379 of which were polypectomies. Of those, 163 procedures were performed in symptomatic patients and were included in the final analysis. The most common symptom among premenopausal patients was abnormal uterine bleeding (84.85%) and in postmenopausal women, postmenopausal bleeding (95.3%). After the procedure, the symptoms resolved or decreased considerably in 66.7% of premenopausal and 93.7% of postmenopausal patients. Additionally, 87.1% of the patients were very satisfied with the procedure. Conclusion Office hysteroscopic polypectomy is an effective treatment for endometrial polyps with high patient satisfaction reported following the procedure.
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Current update on status of saline infusion sonohysterosalpingography. Abdom Radiol (NY) 2022; 47:1435-1447. [PMID: 35112137 DOI: 10.1007/s00261-022-03427-2] [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: 11/09/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/01/2022]
Abstract
The purpose of this article is to elucidate the current role of saline infusion sonohysterosalpingography (SIS) in evaluation of various uterine pathologies. SIS improves visualization of the endometrium and pathologies related to endometrial cavity, as well as it can simultaneously assess tubal patency. SIS provides high-resolution images, and three-dimensional (3D) reformatted images provide excellent orientation for radiologists as well as the clinicians about the underlying pathologies. This article will discuss imaging technique, indications, pearls, and pitfalls in imaging, diverse disease pathologies, and ultimately compare performance of SIS among other different imaging modalities. SIS as an adjunct imaging modality results in a greater diagnostic yield for diverse uterine pathologies.
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Vilà Famada A, Cos Plans R, Costa Canals L, Rojas Torrijos M, Rodríguez Vicente A, Bainac Albadalejo A. Outcomes of surgical hysteroscopy: 25 years of observational study. J OBSTET GYNAECOL 2021; 42:1365-1369. [PMID: 34913810 DOI: 10.1080/01443615.2021.1971176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this prospective study was to analyse the complications of operative hysteroscopy over the last 25 years and determine whether such complications were related to patient characteristics, surgery type, surgical time or distension-medium balance. Three thousand and sixty-three operative hysteroscopies were performed; 52.7% were polypectomies and 31.5% were myomectomies. Myectomies had the highest incidence of complications, at 14%, followed by septolysis, at 6.9%. The most common complications were mechanical (52%). Myomectomies had seven times higher risk than polypectomies of distension-medium complications (RR 7.5, p<.001) but three times lower risk of mechanical complications (RR 0.32, p<.001). The highest incidence of complications occurred in type I myomas and those larger than 3 cm. If we define fluid-balance complications as only those patients who absorbed more than 1.5 L and developed related symptoms, our overall complication rate, including all mechanical complications, was 5.6%.Impact StatementWhat is already known on this subject? In recent years, the importance of properly preventing and managing hysteroscopic complications has risen in line with the number of diagnostic and operative hysteroscopies performed. Complications in operative hysteroscopy differ between surgery types, patient characteristics and the distending media used.What do the results of this study add? This study provides data from a high number of patients compared to previously published studies on the complications of operative hysteroscopies, and includes a study of the relationship between type of surgery and type of complication.What are the implications of these findings for clinical practice and/or further research? Our study shows the importance of a good preoperative assessment, since the complications of hysteroscopy differ greatly depending on the indication. Thus, within myomectomies, knowing the exact type, size and location of the myoma will allow the surgeon to carefully plan the procedure to avoid complications.
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Affiliation(s)
- Anna Vilà Famada
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Ramon Cos Plans
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Costa Canals
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Rojas Torrijos
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Agueda Rodríguez Vicente
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
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Loddo A, Djokovic D, Drizi A, De Vree BP, Sedrati A, van Herendael BJ. Hysteroscopic myomectomy: The guidelines of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 2021; 268:121-128. [PMID: 34902749 DOI: 10.1016/j.ejogrb.2021.11.434] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE With this publication, the International Society for Gynecologic Endoscopy (ISGE) aims to provide the clinicians with the recommendations arising from the best evidence currently available on hysteroscopic myomectomy (HM). STUDY DESIGN The ISGE Task Force for HM defined key clinical questions, which led the search of Medline/PubMed and the Cochrane Database. We selected and analyzed relevant English-language articles, published from January 2005 to June 2021, including original works, reviews and the guidelines previously published by the European Society for Gynecological Endoscopy (ESGE) and the American Association of Gynecologic Laparoscopists (AAGL), in which bibliographies were also checked in order to identify additional references, using the medical subject heading (MeSH) term "Uterine Myomectomy" (MeSH Unique ID: D063186) in combination with ''Myoma" (MeSH Unique ID: D009214) and ''Hysteroscopy" (MeSH Unique ID: D015907). We developed the recommendations through multiple cycles of literature analysis and expert discussion. RESULTS The ISGE Task Force did develop 10 grade 1A-C and 4 grade 2A-C recommendations. For planning HM, evaluation of the uterus with saline infusion sonohysterography (SIS) or combined assessment by transvaginal ultrasound (TVUS) and diagnostic hysteroscopy is recommended (Grade 1A). The use of STEPW (Size, Topography, Extension of the base, Penetration and lateral Wall position) classification system of submucosal leiomyoma (LM) is recommended to predict the complex surgeries, incomplete removal of the LM, long operative time, fluid overload and other major complications (grade 1B). For type 0 LMs, in addition to resectoscopy (slicing technique), morcellation is recommended, being faster and having a shorter learning curve with respect to resectoscopy (grade 1C). For type 1-2 LMs, slicing technique is currently recommended (grade 1C). A fluid deficit of 1000 mL also in case of bipolar myomectomy with saline solution, in healthy women of reproductive age, contains low risk for major complications. Lower thresholds (750 mL) for fluid deficit should be considered in the elderly and in women with cardiovascular, renal or other co-morbidities (Grade 1B). CONCLUSION HM is the most effective conservative minimally invasive gynecologic intervention for submucous LM. The set of 14 ISGE recommendations can significantly contribute to the success of HM and the safety of patients for whom the choice of appropriate surgical technique, as well as the surgeon's awareness and measures to prevent complications are of the utmost importance.
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Affiliation(s)
- Alessandro Loddo
- Clinica Ostetrica e Ginecologica Azienda Ospedaliero-Universitaria di Cagliari, Policlinico Duilio Casula, Monserrato, CA, Italy
| | - Dusan Djokovic
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; Department of Obstetrics and Gynecology, NOVA Medical School - Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon, Portugal; Department of Obstetrics and Gynecology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Amal Drizi
- Independent Consultant in Obstetrics and Gynecology, Algiers, Algeria
| | - Bart Paul De Vree
- Department of Obstetrics & Gynecology, Ziekenhuis Netwerk Antwerpen (ZNA), Campus Middelheim, Antwerp, Belgium; Department of Obstetrics & Gynecology, Universitair Ziekenhuis Antwerpen (UZA), Edegem, Belgium
| | - Adel Sedrati
- Independent Consultant in Gynecology Obstetrics and Gynecology, Constantine, Algeria
| | - Bruno J van Herendael
- Endoscopic Training Center Antwerp (ETCA), Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium; Università degli Studi dell'Insubria, Varese, Italy
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10
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Maior MDCFS, Souza ASR, Souza GFDA, da Costa AAR. Comparison between 200 μg and 800 μg of vaginal misoprostol for cervical ripening before operative hysteroscopy: A randomized controlled trial. Int J Gynaecol Obstet 2021; 158:205-212. [PMID: 34695232 DOI: 10.1002/ijgo.13984] [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: 07/22/2021] [Revised: 08/17/2021] [Accepted: 10/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare between 200 and 800 μg of vaginal misoprostol for cervical ripening before operative hysteroscopy. METHODS Quadruple-blind randomized clinical trial conducted between November 2019 and September 2020 involving 76 patients undergoing cervical dilatation before surgical hysteroscopy at teaching hospitals in Pernambuco, Brazil. Women received the vaginal misoprostol dosage of 200 or 800 μg,10-12 h before operative hysteroscopy. The cervical width was the primary outcome, and secondary outcomes were patient satisfaction, adverse effects, surgical complications, and duration of cervical dilatation. Chi-square tests of association, Fisher's exact and Mann-Whitney U tests were used with an α error of <5%. RESULTS There was no statistical difference between the groups in the mean of the cervical width (800 μg: 6.5 ± 1.6 mm vs 200 μg: 5.8 ± 1.8 mm, P = 0.055), patient satisfaction, and surgical findings, but the duration of cervical dilatation was lower in the 800-μg group (28.16 ± 28.5 s vs 41.97 ± 31.0 s, P = 0.035). Among the adverse effects, diarrhea was more frequent in the 800-μg group with statistical difference (100% vs 0%; P = 0.01). CONCLUSION For cervical ripening, 200 μg misoprostol is equally effective with fewer adverse effects than 800 μg before operative hysteroscopy. ClinicalTrials.gov: NCT04152317. https://clinicaltrials.gov/ct2/show/NCT04152317.
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Affiliation(s)
- Maria da Conceição Farias Souto Maior
- Postgraduate Program in Integral Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Biological Sciences and Health Center, Catholic University Pernambuco (UNICAP), Recife, Pernambuco, Brazil.,Department of Health Science, University Center Maurício de Nassau (UNINASSAU), Recife, Pernambuco, Brazil.,Department of Gynecology, Hospital Agamenon Magalhães (HAM), Recife, Pernambuco, Brazil
| | - Alex Sandro Rolland Souza
- Postgraduate Program in Integral Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Biological Sciences and Health Center, Catholic University Pernambuco (UNICAP), Recife, Pernambuco, Brazil.,Department of Maternal and Child Healthcare, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Aurélio Antônio Ribeiro da Costa
- Postgraduate Program in Integral Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Department of Maternal and Child Healthcare, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
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11
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Ryan N, Snowsill T, McKenzie E, Monahan KJ, Nebgen D. Should women with Lynch syndrome be offered gynaecological cancer surveillance? BMJ 2021; 374:n2020. [PMID: 34475027 DOI: 10.1136/bmj.n2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Naj Ryan
- The Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol, UK
| | - T Snowsill
- Health Economics Group, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | | | - K J Monahan
- The Lynch Syndrome and Family Cancer Clinic, St Mark's Hospital and Academic Institute, Harrow, London, UK Imperial College London, London, UK
| | - D Nebgen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Yang L, Wang L, Chen Y, Guo X, Miao C, Zhao Y, Li L, Zhang Q. Cold scissors versus electrosurgery for hysteroscopic adhesiolysis: A meta-analysis. Medicine (Baltimore) 2021; 100:e25676. [PMID: 33907137 PMCID: PMC8084071 DOI: 10.1097/md.0000000000025676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/07/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Intrauterine adhesion seriously affects reproductive health in women. Hysteroscopic adhesiolysis using cold scissors or electrosurgery is the main treatment, although there is no consensus on the preferable method. This review aimed to compare the efficacy and safety of these methods for treating moderate to severe intrauterine adhesion. METHODS PubMed, EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure were searched on April 30, 2020. Randomized controlled trials and observational studies that were published in all languages (must contain English abstracts) and compared hysteroscopic cold scissors with electrosurgery for the treatment of intrauterine adhesion were included. Mean differences, odds ratios, and 95% confidence intervals (CIs) were reported. Bias was evaluated using the Cochrane Risk of Bias assessment tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Data were analyzed using RevMan software (Review Manager version 5.3, The Cochrane Collaboration, 2014). Two researchers independently extracted data and assessed the quality of the included studies. If a consensus was not reached, a third researcher was consulted. RESULTS Nine studies (n = 761; 6 randomized controlled trials and 3 retrospective studies) were included. The intrauterine adhesion recurrence rate with second look hysteroscopy was significantly lower (odds ratio = 0.30, 95% CI = 0.16-0.56; P = .0002) with hysteroscopic cold scissors than with electrosurgery. The total operation time was significantly shorter (mean difference = -7.78, 95% confidence interval = -8.50 to -7.07; P < .00001), intraoperative blood loss was significantly lower (mean difference = -9.88, 95% CI = -11.25 to -8.51; P < .00001), and the menstrual flow rate was significantly higher (odds ratio = 4.36, 95% confidence interval = 2.56-7.43; P < .00001) with hysteroscopic cold scissors than with electrosurgery. There were no significant differences in the pregnancy rate. One complication (1 perforation case, hysteroscopic cold scissors group) was reported. CONCLUSIONS Hysteroscopic cold scissors is more efficient in preventing intrauterine adhesion recurrence, increasing the menstrual flow, reducing intraoperative blood loss, and shortening the operation time.
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Affiliation(s)
- Liuqing Yang
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Ling Wang
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
- The First Clinical College of Zhejiang Chinese Medical University
| | - Yun Chen
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Xiaoshi Guo
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Chenyun Miao
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Ying Zhao
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Lu Li
- College of Pharmaceutical Sciences, Zhejiang University, Xihu District, Hangzhou, Zhejiang, PR China
| | - Qin Zhang
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
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Abstract
Hysteroscopy and hysteroscopic myomectomy in general have low complication rates. Two patients underwent hysteroscopic myomectomy for prolapsing submucous myomas after UAE. The onset of prolapsing myoma occurred at varying times between completion of UAE and myomectomy, resulting in bacteremia for both patients. In Case 1, the patient recovered with intravenous antibiotic treatment. However, the patient in Case 2 had status improvement after undergoing an abdominal myomectomy, explorative laparotomy for removal of a necrotic myoma. Our two patient cases serve as a caution to clinicians regarding the rare incidence of septicemia occurring in patients undergoing hysteroscopic myomectomy with prior UAE treatment for prolapsing myomas.
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Affiliation(s)
- Katherine J C Chua
- Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Bruce McLucas
- Department of Obstetrics and Gynecology, University of Los Angeles - California, Los Angeles, CA, USA
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Lima MPJDS, Costa-Paiva L, Brito LGO, Baccaro LF. Factors Associated with the Complications of Hysteroscopic Myomectomy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:476-485. [PMID: 32898912 PMCID: PMC10309217 DOI: 10.1055/s-0040-1713915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate the factors associated with complete myomectomy in a single surgical procedure and the aspects related to the early complications. METHODS A cross-sectional study with women with submucous myomas. The dependent variables were the complete myomectomy performed in a single hysteroscopic procedure, and the presence of early complications related to the procedure. RESULTS We identified 338 women who underwent hysteroscopic myomectomy. In 89.05% of the cases, there was a single fibroid to be treated. According to the classification of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French), most fibroids were of grade 0 (66.96%), followed by grade 1 (20.54%), and grade 2 (12.50%). The myomectomies were complete in 63.31% of the cases, and the factors independently associated with complete myomectomy were the diameter of the largest fibroid (prevalence ratio [PR]: 0.97; 95% confidence interval [95%CI]: 0.96-0.98) and the classification 0 of the fibroid according to the FIGO (PR: 2.04; 95%CI: 1.18-3.52). We observed early complications in 13.01% of the hysteroscopic procedures (4.44% presented excessive bleeding during the procedure, 4.14%, uterine perforation, 2.66%, false route, 1.78%, fluid overload, 0.59%, exploratory laparotomy, and 0.3%, postoperative infection). The only independent factor associated with the occurrence of early complications was incomplete myomectomy (PR: 2.77; 95%CI: 1.43-5.38). CONCLUSIONS Our results show that hysteroscopic myomectomy may result in up to 13% of complications, and the chance of complete resection is greater in small and completely intracavitary fibroids; women with larger fibroids and with a high degree of myometrial penetration have a greater chance of developing complications from hysteroscopic myomectomy.
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Affiliation(s)
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Luiz Francisco Baccaro
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Is every patient eligible to have an office hysteroscopy? A retrospective analysis of 1301 procedures. Wideochir Inne Tech Maloinwazyjne 2020; 15:337-345. [PMID: 32489495 PMCID: PMC7233160 DOI: 10.5114/wiitm.2019.89609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Hysteroscopy is the gold standard for diagnosis and treatment of uterine pathologies. The office setting seems to be safe, reducing the anesthesia risks and also decreasing the overall costs of the procedure. Recent literature suggests that hysteroscopy performed without anesthesia may not be as painless as it was previously considered. Moreover, not every patient can be referred for a hysteroscopy in an office setting. Aim To analyze the factors correlated with a successful hysteroscopy in an office setting. Material and methods We analyzed the documentation of 1301 patients who underwent hysteroscopy at our department in the period 2013-2016. The impact of the type of the procedure and the various demographic factors on the need for general anesthesia was assessed. Results Almost 80% of all hysteroscopies were performed without analgesia in an office setting. The remaining patients underwent a hysteroscopy in general anesthesia. The key aspect for successful office hysteroscopy is the scope of the performed surgery. Over 91% of diagnostic hysteroscopies have been done without analgesia, but only about 30% of extensive endometrial scratching procedures were performed in an office setting. A previous vaginal delivery increases the chances for a successful office hysteroscopy by about 21%, and in the case of diagnostic procedures, multiparous patients were at an about 79% lower risk of analgesia necessity. Conclusions It is possible to perform nearly all diagnostic hysteroscopies in an office setting. In the case of operative hysteroscopy, the most crucial factor is the scope of the procedure.
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Enderle I, Dion L, Bauville E, Moquet PY, Leveque J, Lavoue V, Lous ML, Nyangoh-Timoh K. Surgical management of isthmocele symptom relief and fertility. Eur J Obstet Gynecol Reprod Biol 2020; 247:232-237. [DOI: 10.1016/j.ejogrb.2020.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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Indraccolo U, Bini V, Favilli A. Likelihood of Accomplishing an In-Patient Hysteroscopic Myomectomy in a One-Step Procedure: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4208497. [PMID: 32090092 PMCID: PMC7015183 DOI: 10.1155/2020/4208497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the feasibility rate of one-step hysteroscopic myomectomy according to the technique adopted. METHODS In July 2016, PubMed, ClinicalTrials.gov, SCOPUS, Scielo, and AJOL databases were used for searching references. Series of in-patient hysteroscopic myomectomies reporting success rate in only one-step procedure, categorization of submucous fibroids, explanation of the surgical technique, and description of patients were considered eligible for meta-analysis (retrospective, prospective randomized studies). Two authors extracted the data. Rate of myomectomies accomplished in only a surgical step and rate of intraoperative complications were extracted per protocol. A modified GRADE score was used for quality assessment. Random-effect models were already assumed. Mean rates were compared among subgroups. RESULTS One thousand two hundred and fifty-seven studies were screened and 241 of these were read for eligibility. Seventy-eight series were included in qualitative synthesis and 24 series were included in quantitative synthesis. Wide heterogeneity was found. In series with <50% of G2 myomas treated, the slicing technique feasibility rate was 86.5% while techniques for enucleating the deep portion of the myomas showed a feasibility rate of 92.3% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (. CONCLUSION In case of submucous myomas with intramural development, the slicing technique was correlated with a lower rate of in-patient hysteroscopic myomectomies accomplished in a one-step procedure and a higher complications rate.
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Affiliation(s)
- Ugo Indraccolo
- Department of Obstetrics and Gynaecology, USL Umbria 1, Alta Valle del Tevere Hospital, Città di Castello (PG), Umbria, Italy
| | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessandro Favilli
- Department of Obstetrics and Gynaecology, USL Umbria 1, Alta Valle del Tevere Hospital, Città di Castello (PG), Umbria, Italy
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Garofalo A, Desgro M. WITHDRAWN: Hysteroscopic removal of placental remnants using the Bigatti Shaver®: A mininvasive surgical approach. Eur J Obstet Gynecol Reprod Biol 2019:S0301-2115(19)30420-8. [PMID: 31551168 DOI: 10.1016/j.ejogrb.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Anna Garofalo
- Department of Gynecology and Obstetrics, San Giuseppe Hospital, University of Milan, Via San Vittore 12, Milano, Italy.
| | - Marcello Desgro
- Department of Gynecology and Obstetrics, San Giuseppe Hospital, University of Milan, Via San Vittore 12, Milano, Italy
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Vitale SG, Caruso S, Vitagliano A, Vilos G, Di Gregorio LM, Zizolfi B, Tesarik J, Cianci A. The value of virtual reality simulators in hysteroscopy and training capacity: a systematic review. MINIM INVASIV THER 2019; 29:185-193. [DOI: 10.1080/13645706.2019.1625404] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Caruso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | - George Vilos
- Department of Obstetrics and Gynaecology, University of Western Ontario, London, ON, Canada
| | - Luisa Maria Di Gregorio
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Brunella Zizolfi
- Department of Public Health, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | | | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Dubuisson J. The current place of mini-invasive surgery in uterine leiomyoma management. J Gynecol Obstet Hum Reprod 2019; 48:77-81. [DOI: 10.1016/j.jogoh.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/09/2018] [Indexed: 12/15/2022]
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Ono S, Kuwabara Y, Matsuda S, Yonezawa M, Watanabe K, Akira S, Takeshita T. Is hysteroscopic metroplasty using the incision method for septate uterus a risk factor for adverse obstetric outcomes? J Obstet Gynaecol Res 2019; 45:634-639. [DOI: 10.1111/jog.13884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Shuichi Ono
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Yoshimitsu Kuwabara
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Shigeru Matsuda
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Mirei Yonezawa
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Kenichiro Watanabe
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Shigeo Akira
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
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Ono S, Watanabe K, Yonezawa M, Ichikawa T, Kuwabara Y, Akira S, Takeshita T. Efficacy of Dienogest in Thinning the Endometrium Before Hysteroscopic Metroplasty and Analysis of Postoperative Reproductive Outcomes. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shuichi Ono
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Kenichiro Watanabe
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Mirei Yonezawa
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Tomoko Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yoshimitsu Kuwabara
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Shigeo Akira
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
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Optimal Dose of Vaginal Misoprostol for Cervical Ripening before Hysteroscopy: A Randomized Double-Blind Study. J Minim Invasive Gynecol 2018; 25:1031-1034. [DOI: 10.1016/j.jmig.2018.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/20/2022]
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