A prospective randomized comparative clinical trial of hysteroscopic septal resection using conventional resectoscope versus mini-resectoscope

Abstract

Context: Hysteroscopic metroplasty (HM) is the gold standard treatment for women with septate uterus with recurrent pregnancy loss. Miniresectoscope requires less cervical dilatation as compared to conventional resectoscope. Very few studies are available in the literature on use of miniresectoscope for operative purpose. Aim of the Study: This study aimed to compare operative and postoperative outcome parameters using conventional versus mini resectoscope (MR) for hysteroscopic septal resection (HSR). Study Settings and Design: This was a prospective randomized controlled trial conducted in the Department of Obstetrics and Gynaecology from July 2017 to May 2019. Materials and Methods: Forty patients fulfilling the inclusion criteria were recruited and randomized into two groups. In Group A (20 patients), HSR was done using conventional resectoscope (CR) and in Group B (20 patients), MR was used. The various parameters recorded were cervical dilatation time, operating time, intraoperative complications, postoperative pain, and hospital stay and reproductive outcome post surgery in both groups. Results: Data analysis was carried out using SPSS IBM software version 20.0. The mean operating time was comparable but cervical dilatation time was significantly more in Group A. The duration of hospital stay was significantly less in Group B. There were no differences in adequacy of vision in both the groups but area of field was less in MR group. Four out of nine patients with infertility conceived after surgery. 65% in Group A and 70% in Group B conceived during follow up. Conclusion: Our study showed that hysteroscopic metroplasty with MR, has comparable efficacy to CR in terms of good vision and septal resectability with added advantages of shorter cervical dilatation time, ease of entry of resectoscope, shorter operative time and significantly reduced postoperative morbidity in terms of less pain. However, the field of vision is less and resection time is more, hence more expertise is required. Further larger randomized trials are required.

Use of Diode Laser in Hysteroscopy for the Management of Intrauterine Pathology: A Systematic Review

“…Finally, although not supported by solid literature, another minimally invasive method that is increasingly moving hysteroscopic surgery from the operating room to the outpatient setting is the mini-resectoscope. The mini-resectoscope is a widely used instrument in the hysteroscopic treatment of intrauterine pathology, and its miniaturization would seem to bring with it all the advantages of the conventional resectoscope, together with a procedure that is quicker and well tolerated by the patient and thus conducted without the aid of anesthesia in most cases [83][84][85][86][87][88][89]. Given the increasing use of laser and mini-resectoscope technology in "see and treat" hysteroscopy, future studies should be conducted with the aim of verifying the superiority of one technology over the other in terms of efficacy and safety.…”

Efficacy, safety, and feasibility of the treatment of intrauterine pathologies with the mini‐resectoscope: A systematic review

“…The main characteristics of the included studies are summarized in Table 1. All studies were prospective, including three randomized controlled trials (RCTs), 8,15,17 one prospective controlled study, 16 one multicenter prospective cohort study, 14 and two prospective cohort studies. 7,13 Of these, four studies come from Italy, 7,8,13,14 two from India, 15,17 and one from the United Kingdom.…”

“…Septate uterus One randomized controlled trial 17 and safe alternative to the 9-mm resectoscope for the treatment of IS under general anesthesia.…”

“…Study selection is displayed in the Figure 1. After the evaluation of full texts, a total of seven papers, 7,8,[13][14][15][16][17] which met the abovementioned inclusion criteria, were included in the present systematic review.…”

Pregnancy Rates after Hysteroscopic Endometrial Polypectomy versus Endometrial Curettage Polypectomy: A Retrospective Study

“…Next, the polyp was removed by squeezing the loop after hooking it at its base and moving the wire back and forth while passing water from the side of the wire. A resectoscope uses a 9 mm rigid speculum to remove lesions in the uterus by moving a loop-or ball-shaped instrument back and forth using a hand-held control [29]. Additionally, the instrument is connected to an electrode and energized to perform incision and coagulation.…”