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Welykholowa K, Allaire C, Fisher S, Epp A, Lee CE. Safety and Efficiency Outcomes of Ambulatory Gynaecologic Procedures in Canadian Surgical Centres Adopting a Common Model. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102336. [PMID: 38159680 DOI: 10.1016/j.jogc.2023.102336] [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: 06/23/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The present study aims to compare the safety and efficiency outcomes of ambulatory gynaecologic procedures performed under conscious sedation and/or local anaesthetic at 2 Canadian institutions. METHODS A retrospective cohort study was completed over 1-year on patients presenting to the ambulatory care centres at 2 Canadian institutions that shared a common care model. Outcomes of interest were lead time (registration to discharge), procedural time, and intraoperative complications. Surgical data was derived from a retrospective chart review and outcomes were compared using the independent t test and one-way analysis of variance. RESULTS A total of 1495 and 1098 patients presented to the 2 sites. The average age of patients was 35.5 ± 12.3 years and 41.7 ± 10.2 years. The most commonly performed procedures were dilatation and curettages at the first centre and operative hysteroscopies at the second centre. Average lead times were similar: 170.3 ± 35.8 minutes and 171.6 ± 45.4 minutes (P = 0.45). There was a significant difference in mean procedural time being 9.8 ± 5.5 minutes and 17.0 ± 10.0 minutes (P < 0.001). The rate of minor intraoperative complications was 3.8% and 6.6% (P = 0.002); whereas the rate of major complications was 2.7% and 3.3% (P = 0.43). CONCLUSION In Canada, the majority of gynaecologic procedures are performed under general anesthesia. By comparing outcomes at 2 separate Canadian centres, we demonstrated the reproducibility of a common ambulatory model for minor gynaecologic procedures, supporting the implementation of similar care models across Canada.
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Affiliation(s)
- Kaylie Welykholowa
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie Fisher
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Annette Epp
- Department of Obstetrics and Gynaecology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Caroline E Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
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Khoiwal K, Zaman R, Bahurupi Y, Gaurav A, Chaturvedi J. Comparison of vaginoscopic hysteroscopy and traditional hysteroscopy: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 164:47-55. [PMID: 37306153 DOI: 10.1002/ijgo.14902] [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: 12/30/2022] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Outpatient hysteroscopy is a safe, feasible, and optimum procedure for the diagnosis and management of intrauterine pathologies. OBJECTIVE To determine the best approach of outpatient hysteroscopy (vaginoscopic vs traditional) in terms of pain, duration of procedure, feasibility, safety, and acceptability. SEARCH STRATEGY PubMed, Embase, Google Scholar, and Scopus were searched from January 2000 to October 2021. No filters or restrictions were applied. SELECTION CRITERIA Randomized controlled trials comparing vaginoscopic hysteroscopy with traditional hysteroscopy in an outpatient setting. DATA COLLECTION AND ANALYSIS Two authors independently performed a comprehensive literature search and collected and extracted data. The summary effect estimate was determined using both fixed effects and random-effects models. RESULTS Seven studies with 2723 patients (vaginoscopic [n = 1378] and traditional hysteroscopy [n = 1345]) were included. Vaginoscopic hysteroscopy was associated with a significant reduction in intraprocedural pain (standardized mean difference, -0.05 [95% confidence interval (CI), -0.33 to -0.23], I2 = 0%), procedural time (standardized mean difference, -0.45 [95% CI, -0.76 to -0.14], I2 = 82%), and fewer side effects (relative risk, 0.37 [95% CI, 0.15-0.91], I2 = 0%). The procedure failure rate was similar in both approaches (relative risk, 0.97 [95% CI, 0.71-1.32], I2 = 43%). Complications were mostly documented with traditional hysteroscopy. CONCLUSION Vaginoscopic hysteroscopy reduces the pain and duration compared with traditional hysteroscopy.
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Affiliation(s)
- Kavita Khoiwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Rabia Zaman
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Amrita Gaurav
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Jaya Chaturvedi
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
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Song X, Na R, Peng N, Cao W, Ke Y, Liu P, Chen C. Case report: The intrauterine suture surgery-an original method in the treatment of old uterine false passage. Front Surg 2023; 10:1193961. [PMID: 37576922 PMCID: PMC10416626 DOI: 10.3389/fsurg.2023.1193961] [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: 03/26/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To introduce an effective approach using the hysteroscopy system for patients with old uterine false passage after a failed conservative treatment. Materials and methods This study presents the case of a 34-year-old woman who was treated in the Department of Gynecology of Shenzhen Integrated Traditional Chinese and Western Medicine Hospital in 2018 with the complaint of "menstrual volumereduction for 2 years after abortion." A hysteroscopy was performed to make a clear diagnosis: (1) uterine cavity adhesion and (2) old uterine false passage. After the separation of adhesions, the patient was treated with estradiol and progesterone in sequence (estradiol valerate 3 mg, b.i.d., oral for 21 days; and dydrogesterone tablets 10 mg, b.i.d., oral for the second half of the cycle) for 3 months. After the review of the hysteroscopy results, it was found that there was no improvement in the old false passage; therefore, a suture and knotting surgery under hysteroscopy was performed to treat the old false passage in the uterus within 10 min, and the intraoperative blood loss was 2 ml. The patient was discharged 24 h postoperatively without any adverse perioperative complications. Results Two months after the operation, the review of the hysteroscopy results showed that the old false passage in the uterus disappeared. After the 6-month follow-up, the menstrual volume increased compared with the previous one, close to the normal menstrual volume, and the patient experienced no pain and menstrual discomfort. The patient was lost to follow-up and was contacted again in 2022. It was found out that in 2019, she was pregnant with a baby boy who is now 3 years old and healthy. Conclusion The intrauterine suture surgery presents a clear visual field to old uterine false passage after a failed conservative treatment. In patients with old uterine false passage suffering from reduced fertility, the intrauterine suture surgery can be a minimally invasive and effective alternative if the conservative treatment for old uterine false passage failed.
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Affiliation(s)
- Xiaolei Song
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Re Na
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Nianghai Peng
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Wenming Cao
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Yan Ke
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Ping Liu
- Department of Gynecology, Southern Hospital of Southern Medical University, Guangdong, China
| | - Chunlin Chen
- Department of Gynecology, Southern Hospital of Southern Medical University, Guangdong, China
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Molnár S, Farkas Z, Jakab A, Lampé R, Török P. Effectiveness of different methods for polypectomy in the menopause: a retrospective study. Climacteric 2021; 23:325-329. [PMID: 32648828 DOI: 10.1080/13697137.2020.1732915] [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: 10/23/2022]
Abstract
Introduction: Most endometrial polyps represent focal hyperplasia of the endometrium. Endometrial polyps can be diagnosed by ultrasound, hysterocontrast sonography, hysterosalpingography, endometrial biopsy, and uterine curettage, but diagnostic hysteroscopy is considered the gold-standard method, with the greatest sensitivity and specificity and also with the opportunity for treatment at the same time.Study design: A retrospective study was conducted on 424 patients between 2006 and 2018. The polyps were verified during diagnostic hysteroscopy and were removed by resectoscopy or curettage. All samples underwent histological examination. The effectivity of the type of resection and the recurrence rate were evaluated.Results: The average age of the patients was 60.2 ± 9.3 years. Polyps were excised in 62.97% by resectoscopic polypectomy and in 37.03% by curettage. Malignancy was confirmed in 4.24% of cases. Histological verification of polyps was 79.4% in the resectoscopy group and 69.04% in the curettage group; the difference was significant (p < 0.01). The recurrence rate was 20.47% after resectoscopy and 27.12% following curettage.Conclusion: Hysteroscopy remains the best option and the gold-standard method among diagnostic procedures of endometrial pathology. In this study, there was a significant difference in matching hysteroscopic and histological findings in the two methods of polypectomy. The recurrence rate is also lower following resectoscopy.
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Affiliation(s)
- S Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Z Farkas
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - R Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - P Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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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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Bennett A, Lepage C, Thavorn K, Fergusson D, Murnaghan O, Coyle D, Singh SS. Effectiveness of Outpatient Versus Operating Room Hysteroscopy for the Diagnosis and Treatment of Uterine Conditions: A Systematic Review and Meta-Analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:930-941. [DOI: 10.1016/j.jogc.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/21/2018] [Indexed: 10/27/2022]
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The effect of localization and histological verification of endometrial polyps on infertility. Arch Gynecol Obstet 2019; 300:217-221. [PMID: 30976969 PMCID: PMC6560005 DOI: 10.1007/s00404-019-05155-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 04/06/2019] [Indexed: 11/17/2022]
Abstract
Aim Our purpose is to investigate if transcervical resection of endometrial polyps improves the fertility in ovulatory infertile women, and whether polyp histology, intrauterine location, and the technique of polypectomy have any influence on the pregnancy rates. Methods In this retrospective study, clinical data of 87 ovulatory infertile women who underwent hysteroscopy and polypectomy, and their 12-month follow-up have been analyzed. Subgroups according to the method of polyp removal (resectoscope or curettage), the polyp localization (utero-tubal, anterior, posterior, lateral, multiple) and the histological result were interpreted. Results Mean age of patients was 33.99 ± 4.24 years. There were no differences in the BMI and basal FSH levels between the subgroups. Pregnancy was recorded in 30 (34.5%) within the next 12 months without any difference between the subgroups of polypectomy method applied. Posterior wall polyp resection increased the pregnancy chance (OR 5.02), but no other differences were observed in 1-year pregnancy rates to other localizations. Removal of polyps which had normal endometrial histology had lower pregnancy rates as compared to that of polyps with hyperplasia or endometrial polyp histology results (OR 0.25). Conclusions Polypectomy improved the conception rate in the subsequent year regardless of the intrauterine localization and the method of its surgical removal. Therefore, we can conclude that polypectomy should be considered in infertile women.
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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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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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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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Song D, Xia E, Xiao Y, Li TC, Huang X, Liu Y. Management of false passage created during hysteroscopic adhesiolysis for Asherman’s syndrome. J OBSTET GYNAECOL 2015. [DOI: 10.3109/01443615.2015.1030601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Munro MG. Reply: To PMID 25596171. J Minim Invasive Gynecol 2015; 22:1117-8. [PMID: 26134149 DOI: 10.1016/j.jmig.2015.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 11/27/2022]
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Hamidouche A, Vincienne M, Thubert T, Trichot C, Demoulin G, Rivain A, Deffieux X. Morcellement hystéroscopique versus résection à l’anse bipolaire pour les polypes endométriaux. ACTA ACUST UNITED AC 2015; 43:104-8. [DOI: 10.1016/j.gyobfe.2014.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
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