A Prospective Multicenter Registry of Patients Undergoing Hysteroscopic Morcellation of Uterine Polyps and Myomas

Abstract

Background: Hysteroscopic morcellation removes uterine pathology under direct visualization with continuous real-time tissue fragment removal. Objective: The aim of this study was to explore the feasibility of hysteroscopic morcellation across a diverse set of facilities, including both surgical and office-based settings. Design: This was a prospective, single-arm, multicenter registry development (Canadian Task Force classification II-3). Materials and Methods: Thirty-four U.S. obstetrics and gynecology facilities enrolled subjects into the registry. Inclusion criteria were women ages 18–65 with indications for hysteroscopic myomectomy and/or polypectomy who were treated with the MyoSure® Hysteroscopic Tissue Removal System (Hologic Inc., Marlborough, MA). Intrauterine lesion type/size and removal parameters, adverse events (AEs), and physician satisfaction ratings were recorded. Results: A total of 559 pathologies (187 fibroids; 372 polyps) were removed from 278 registered subjects (mean age: 43.9 ± 9.0 years), with 250 procedures (89.9%) performed in an ambulatory surgery center or hospital outpatient setting and 28 (10.1%) in a gynecologic office setting. Most patients (n = 206, 74.1%) were treated for abnormal uterine bleeding, and 42 (15.1%) were treated for infertility. Mean fibroid diameter was 2.2 ± 1.2 cm. Mean polyp diameter was 1.3 ± 1.0 cm. Overall mean percentage of pathology removed was 95.4% (polyps 99.3%, fibroids 86.8%). Five AEs included four incidents of blunt cervical trauma and a single postoperative case of pedal edema; all were considered mild and resolved spontaneously. Postprocedure surveys indicated that 95% of reporting physicians were “satisfied” or “highly satisfied” with device performance. Conclusions: Hysteroscopic morcellation of intrauterine pathology was accomplished safely with a high degree of physician satisfaction in 278 patients treated in diverse healthcare settings that are reflective of general community practice in the United States. (J GYNECOL SURG 32:318)

Audit of operative hysteroscopies among infertile women in a resource‐poor setting

“…In the present series, a day case theater setting was used because the hospitals have yet to acquire the capacity and required skills for outpatient operative hysteroscopy. Various tools are available for the resection of polyps, including a monopolar loop electrode, scissors and graspers, bipolar systems, laser systems, a mechanical energy system, morcellators, and tissue‐assimilation systems . In the present series, a combination of scissors, graspers, and monopolar resectoscope was used.…”

Minimally Invasive Approaches to the Surgical Management of Fibroids

“…82 Similarly, a prospective multicenter study reported high physician satisfaction with HML systems across diverse health care settings. 75 It is important to note, however, that studies have reported lower rates of complete resection (48%) for fibroids > 4 cm and a higher chance of conversion to electrosurgical technique for fibroids with a significant intramural component. 76,80 One of the newest HSC systems available in the United States is the Symphion System (Boston Scientific).…”

“…1b). 13,[74][75][76] Conventional loop resection requires repeated manual extraction of shaved fragments so as not to obscure the operative field, and has a long learning curve. 17,77 HML systems, consisting of a sheathed cutting blade without electrosurgical energy and vacuum suction for simultaneous tissue resection and removal, aim to circumvent the earlier-mentioned difficulties.…”

“…17,77 HML systems, consisting of a sheathed cutting blade without electrosurgical energy and vacuum suction for simultaneous tissue resection and removal, aim to circumvent the earlier-mentioned difficulties. 13,74,75 HML has been shown to have high rates of complete resection of intrauterine lesions with low complication rates (< 1%). [78][79][80] Both retrospective studies and RCTs have reported significantly faster removal of intrauterine pathology with HML when compared with conventional resectoscopy.…”

New Hysteroscopic Approaches to Uterine Fibroids

“…The sectional mechanical effect is done, similar to laparoscopic morcellator, by rotation of an inner tube into an outer tube at high speed. The advantages of the technique, as mentioned in a large multicentric study coordinated by Scheiber et al [18], are:…”