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Wagenaar LP, van Vliet HA, Radder CM, Peters LW, Weyers S, Schoot BC, Hamerlynck TW. Operative hysteroscopy versus ultrasound-guided electric vacuum aspiration for removal of retained products of conception: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100230. [PMID: 37701632 PMCID: PMC10493502 DOI: 10.1016/j.eurox.2023.100230] [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: 04/10/2023] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives To compare intrauterine adhesion (IUA) formation after hysteroscopic removal (HR) of retained products of conception (RPOC) with IUA formation after ultrasound-guided electric vacuum aspiration (EVA) and externally validate the outcomes of an RCT. Study design This prospective cohort study was conducted from April 2015 until June 2022 in 2 Dutch teaching hospitals and one Belgian university hospital. Women opting for EVA underwent the procedure as soon as possible. In the HR group, the therapeutic hysteroscopy was performed at least eight weeks after the end of pregnancy. Postoperatively, an office second-look hysteroscopy was offered to all patients. Women were included if they had been diagnosed with RPOC ranging from 1 to 4 cm on ultrasound and did not want to participate in the RCT. EVA was performed using a Karman cannula. Operative hysteroscopy consisted either of hysteroscopic morcellation with the TruClear™ System or the Intrauterine BIGATTI Shaver or cold loop resection with a bipolar resectoscope. Results Of 178 included women, 124 were treated with HR and 28 with EVA. Outcomes of HR and EVA did not differ significantly in terms of complications (5.6 % vs 3.6 %; p = 1.00). Second-look hysteroscopy showed IUAs in 14 of 91 women (15.4 %) after HR and in 1 of 16 (6.3 %) after EVA (p = .461). Completeness of removal was significantly higher (90.1 %) after HR than after EVA (68.8 %) (p = .035). Additional operative hysteroscopy was required in 14.3 % of the HR group versus 37.5 % in the EVA group (p = .036). Conclusion In our cohort study, no significant differences in IUAs or complications were found. RPOC removal with HR was more often complete than removal with EVA, and additional therapeutic hysteroscopy was less frequently required after HR. These findings need to be correlated with those of RCTs. Clinical trial registration The study was registered in de Dutch Trial Register (NTR4923). Date of registration 23-11-2014. Date of first enrollment 01-01-2015. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923.
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Affiliation(s)
- Liselot P. Wagenaar
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Hubertus A. van Vliet
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Celine M. Radder
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Louisette W. Peters
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Steven Weyers
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Women’s Clinic, Ghent University Hospital, Ghent, Belgium
| | - Benedictus C. Schoot
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Tjalina W. Hamerlynck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Women’s Clinic, Ghent University Hospital, Ghent, Belgium
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Zhang S, Di W, Wang Y, Shi J, Yin X, Zhang Y, Zhao A, Campo R, Bigatti G. Hysteroscopic myomectomy with the IBS® Intrauterine Bigatti Shaver: A Retrospective Comparative Analysis of the impact of rotational speed and aspiration flow rate. Facts Views Vis Obgyn 2023; 15:53-59. [PMID: 37010335 PMCID: PMC10392109 DOI: 10.52054/fvvo.15.1.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: Myoma removal remains a challenge hysteroscopically including for the “IBS®” Intrauterine Bigatti Shaver technique.
Objective: To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology.
Materials and methods: This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size:<3 cm and 3-5 cm. Both Groups A and B were similar in terms of patient age, parity, symptoms, myoma type and size. Submucous myomas were classified according to the European Society for Gynaecological Endoscopy classification. All patients underwent a myomectomy with the IBS® under general anaesthesia. The conventional 22 Fr. Bipolar Resectoscope was used in cases requiring conversion to the resection technique. All surgeries were planned, performed and followed by the same surgeon in both institutions.
Main outcome measures: Complete resection rates, total operation time, resection time and used fluid volume.
Results: Complete resection with the IBS® Shaver was seen in 93/107 (86.91%) in Group A versus 83/84 (98.8 %) in Group B (P=0.0021). Five patients (5.8%) in Subgroup A1 (<3 cm) and nine patients (42.9%) in Subgroup A2 (3cm~5cm) could not be finished with the IBS (P<0.001, RR=2.439), while in Group B only one case (8.3%) in Subgroup B2 (3cm~5cm) underwent a conversion to bipolar resectoscope (Group A: 14/107=13.08% vs. Group B: 1/84=1.19%, P=0.0024). For <3cm myomas (subgroup A1 versus B1) there was a statistically significant difference in terms of resection time (7.75±6.363 vs. 17.28±12.19, P<0.001), operation time (17.81 ± 8.18 vs. 28.19 ±17.614, P<0.001) and total amount of fluid used (3365.63 ± 2212.319 ml vs. 5800.00 ± 8422.878 ml, P<0.05) in favour of Subgroup B1. For larger myomas, a statistical difference was only observed for the total operative time (51.00±14.298 min vs. 30.50±12.122 min, P=0.003).
Conclusion: For hysteroscopic myomectomy using the IBS®, 1,500rpm rotational speed and 500ml/min aspiration flow rate are recommended as these settings result in more complete resections compared to the conventional settings. In addition, these settings are associated with a reduction in total operating time.
What is new? Reducing the rotational speed rate from 2500 rpm to 1500 rpm and increasing the aspiration flow rate from 250 ml/min to 500 ml/min improve complete resection rates and reduce operating times.
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Shi J, Zhang Y, Zhang S, Yin X, An D, Zhang J, Cheng J, Wang Y, Zhao A, Di W, Campo R, Bigatti G. Intrauterine Bigatti Shaver (IBS ® ) successful placental remnants removal, after caesarean section for a cervical pregnancy with placenta accreta. Facts Views Vis Obgyn 2022; 14:95-98. [PMID: 35373555 PMCID: PMC9612859 DOI: 10.52054/fvvo.14.1.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Placenta accreta located in a caesarean section scar is difficult to remove. The Intrauterine Bigatti Shaver (IBS®) has already been proven to be effective in placental remnant removal. Our case report highlights that the IBS® is also a safe method to remove placental remnants attached to a previous caesarean section scar performed for a cervical pregnancy and associated with placenta accreta.
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Ota K, Takahashi T, Kamo N, Endo Y, Furukawa S, Soeda S. Successful management of a submucosal fibroid using a hysteroscopic morcellator system in a patient with a history of total proctocolectomy: A case report. J Obstet Gynaecol Res 2020; 46:2450-2453. [PMID: 32914517 DOI: 10.1111/jog.14481] [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: 04/18/2020] [Revised: 07/21/2020] [Accepted: 08/29/2020] [Indexed: 11/28/2022]
Abstract
Transcervical resection is widely used in the management of submucosal fibroids. However, uterine perforation and thermal bowel injuries are known complications associated with the procedure. This is a case report of a 44-year-old woman who presented with heavy menstrual bleeding and anemia. Magnetic resonance imaging and hysteroscopy revealed multiple fibroids, including a submucosal type 1 fibroid. She had previously undergone a total proctocolectomy with intestinal pouch-anal anastomosis for ulcerative colitis. Because there was a high risk of permanent colostomy in the event of a bowel injury, an electrode-free, operative hysteroscopy using the Intrauterine Bigatti Shaver (IBS), a hysteroscopic morcellator system, was employed to prevent thermal bowel injury. The fibroid was completely removed using the IBS system with no complications. Therefore, we recommend the electrode-free use of a hysteroscopic morcellator system in patients with a history of extensive pelvic surgery.
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Affiliation(s)
- Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Norihito Kamo
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuta Endo
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shigenori Furukawa
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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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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Tanos V, Berry KE, Seikkula J, Abi Raad E, Stavroulis A, Sleiman Z, Campo R, Gordts S. The management of polyps in female reproductive organs. Int J Surg 2017; 43:7-16. [DOI: 10.1016/j.ijsu.2017.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
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Hysteroscopic myomectomy with the IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscope: a retrospective comparative study. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s10397-013-0827-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Bigatti G, Ferrario C, Rosales M, Baglioni A, Bianchi S. A 4-cm G2 cervical submucosal myoma removed with the IBS® Integrated Bigatti Shaver. GYNECOLOGICAL SURGERY 2012; 9:453-456. [PMID: 23144643 PMCID: PMC3491200 DOI: 10.1007/s10397-012-0737-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 02/08/2012] [Indexed: 11/25/2022]
Affiliation(s)
- G. Bigatti
- U.O. di Ostetricia e Ginecologia, Ospedale Classificato San Giuseppe Via San Vittore, 12-20123 Milan, Italy
| | - C. Ferrario
- U.O. di Ostetricia e Ginecologia, Ospedale Classificato San Giuseppe Via San Vittore, 12-20123 Milan, Italy
| | - M. Rosales
- U.O. di Ostetricia e Ginecologia, Ospedale Classificato San Giuseppe Via San Vittore, 12-20123 Milan, Italy
| | - A. Baglioni
- U.O. di Ostetricia e Ginecologia, Ospedale Classificato San Giuseppe Via San Vittore, 12-20123 Milan, Italy
| | - S. Bianchi
- Università degli Studi di Milano, Direttore dell’ Unità Opertiva di Ostetricia e Ginecologia, Ospedale Classificato San Giuseppe, Via San Vittore, 12-20123 Milan, Italy
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