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Ren F, Huang G, Wang X, Li X, Cai J. Comparison of Hysteroscopic Morcellation Versus Resectoscopy in Treatment of Patients with Endometrial Lesions: A Meta-Analysis. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e936771. [PMID: 35844074 PMCID: PMC9306303 DOI: 10.12659/msm.936771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hysteroscopic surgery has been widely used in clinical practice for more than 30 years due to its advantages of less trauma, less bleeding, and direct vision. The aim of this study was to compare hysteroscopic morcellation versus conventional resectoscopy for removal of endometrial lesions. MATERIAL AND METHODS For the database search, we used the keywords "morcellator," "morcellators," "morcellate," "morcellation," and "morcellated" combined with "hysteroscopy," "hysteroscopy," "uteroscope," and "transcervical". The last search was conducted on February 1, 2022. Randomized controlled trials (RCTs) were included in the meta-analysis. RESULTS According to our retrieval scheme and the inclusion and exclusion criteria, we found 6 studies including 565 patients. For enumeration data, we calculated the effect size as relative risk (RR) and 95% confidence interval (95% CI), while for quantitative data we used the weighted mean difference (WMD) and 95% confidence interval (95% CI). There was no significant difference between success rate of hysteroscopic morcellation and conventional resectoscopy (relative risk and 95% confidence interval 1.05(0.97,1.13); P=0.232). Procedure time was also shorter with hysteroscopic morcellation, the procedure time of the hysteroscopic morcellation group was 3.43 min shorter compared with the conventional resectoscopy group, and the operating time in the hysteroscopic morcellation group was 2.81 min shorter. In terms of fluid deficit, there was no statistically significant difference in fluid loss between the 2 groups (P=0.209). CONCLUSIONS Hysteroscopic morcellation is associated with a shorter procedure time and operative time among patients with endometrial lesions compared with resectoscopy.
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Affiliation(s)
- Fangying Ren
- Department of Gynecology, Hebei Linxi People's Hospital, Xingtai, Hebei, China (mainland)
| | - Guannan Huang
- Department of Ultrasound, The Second hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Xue Wang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Xuehui Li
- Department of Gynecology, The First hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jianning Cai
- Department of Epidemic Treatment and Prevention, Center for Disease Prevention and Control of Shijiazhuang City, Shijiazhuang, Hebei, China (mainland)
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Stoll F, Lecointre L, Meyer N, Faller E, Host A, Hummel M, Boisrame T, Akladios C, Garbin O. Randomized Study Comparing a Reusable Morcellator with a Resectoscope in the Hysteroscopic Treatment of Uterine Polyps: The RESMO Study. J Minim Invasive Gynecol 2020; 28:801-810. [PMID: 32681995 DOI: 10.1016/j.jmig.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To compare a reusable hysteroscopic morcellator and standard resectoscopes in the hysteroscopic management of uterine polyps. DESIGN Single-center randomized prospective single-blind trial (resectoscope-morcellator study). SETTING Centre Médico-chirurgical Obstétrique teaching hospital, Strasbourg University Hospitals, France. PATIENTS All patients presenting with a single endometrial polyp of size 1 cm or larger. INTERVENTIONS After consent, the patients were randomized into 2 groups: hysteroscopic morcellation (HM) group or standard resection (SR) group. Office-based review hysteroscopy was performed 6 weeks to 8 weeks after surgery. Primary end point: time of morcellation or resection. SECONDARY OUTCOMES total operating time (minutes), volume of fluid used (mL), fluid deficit (mL), number of morcellator or resectoscope insertions, operator comfort (visual analog scale: 0 to 10) and quality of vision (0 to 5), perioperative complications, completeness of resection, need to convert to another technique, pain assessment (visual analog scale), and length of hospitalization. At review hysteroscopy, we noted whether the resection or morcellation had been effective and if synechiae were present or absent. Statistical analyses followed Bayesian methods. MEASUREMENTS AND MAIN RESULTS Ninety patients were randomized: 45 in the HM group and 45 in the SR group. The average size of polyps at hysteroscopy was 13.3 mm. Morcellation time was lower than resection time (6.1 minutes vs 9 minutes; p [HM < SR] = .996). This also applied to total operating time (12.7 minutes vs 15.6 minutes; p [HM < SR] = .985), number of device insertions (1.50 vs 6; p [HM < SR] > .999), volume of fluid used (766.9 mL vs 1118.9 mL; p [HM < SR] = .994), and fluid deficit (60.2 mL vs 169.8 mL; p [HM < SR] = .989). Operator comfort was better in the HM group (8.4 vs 7.4; p [HM > SR] = .999) as was visualization (4 vs 3.7; p [HM > SR] = .911, highly probable). Operative complications were higher in the SR group (5 vs 0; p [HM < SR] = .989]. One patient in the SR group died after surgery owing to an anesthetic complication (anaphylactic shock complicated by pulmonary embolism). No differences were noted between the groups for pain assessment, length of hospitalization, and outcome on review hysteroscopy. CONCLUSION The reusable morcellator is quicker, uses less fluid with less deficit and fewer introductory maneuvers, and offers better comfort and visualization than the resectoscope while being as effective for the hysteroscopic treatment of uterine polyps.
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Affiliation(s)
- François Stoll
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Lise Lecointre
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aline Host
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Michel Hummel
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisrame
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Cherif Akladios
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Garbin
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Di Spiezio Sardo A, Spinelli M, Zizolfi B, Nappi C. Ambulatory management of heavy menstrual bleeding. ACTA ACUST UNITED AC 2015; 12:35-43. [PMID: 26696502 DOI: 10.2217/whe.15.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Heavy menstrual bleeding (HMB) has significant adverse effects on the quality of life of many women, placing an economic burden on both health services and society at large. Thus, it is essential that all women with HMB have easy access to the proper diagnostic and therapeutic work-up in an outpatient fashion, avoiding the more time-consuming inpatient management. This new outpatient approach for HMB is one of the latest development of gynecological practice and can offer both diagnostic and therapeutic procedures. This manuscript aims to show the current possibilities of the modern management of HMB, which can be safely and effectively accomplished in the outpatient setting: global and directed endometrial biopsy, levonorgestrel intrauterine system insertion as well as minimally invasive surgical procedures (encompassing a variety of operative hysteroscopic procedures and second-generation endometrial ablation) are described below.
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Affiliation(s)
- Attilio Di Spiezio Sardo
- Department of Neurosciences & Reproductive Sciences, University of Naples Federico II, Naples, Italy
| | - Marialuigia Spinelli
- Department of Neurosciences & Reproductive Sciences, University of Naples Federico II, Naples, Italy
| | - Brunella Zizolfi
- Department of Neurosciences & Reproductive Sciences, University of Naples Federico II, Naples, Italy
| | - Carmine Nappi
- Department of Neurosciences & Reproductive Sciences, University of Naples Federico II, Naples, Italy
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