A systematic review and meta‐analysis of randomized controlled trials comparing hysteroscopic morcellation with resectoscopy for patients with endometrial lesions

Li, Chunbo; Dai, Zhiyuan; Gong, Yuping; Xie, Bin; Wang, Bei

doi:10.1002/ijgo.12012

Cited by 33 publications

(25 citation statements)

References 24 publications

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“…In an office setting, patient acceptability and procedural pain were linked to the duration of hysteroscopic surgery 21–23 . Therefore, the reduction in the total operative time is of a high clinical significance for patient acceptability 24 . Seven (14.6%) women out of 48 of the BE group reported moderate pain (VAS score between 5 and 7).…”

Section: Discussionmentioning

confidence: 99%

Comparison of endometrial polyp recurrence in fertile women after office hysteroscopic endometrial polypectomy using two widely spread techniques

Ceci

Franchini²,

Cardinale

et al. 2020

J of Obstet and Gynaecol

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Aim: To compare the recurrence of benign endometrial polyps after office hysteroscopic polypectomy performed with a bipolar electrode (BE) or a small diameter hysteroscopic tissue removal system (HTRs). Methods: From July 2018 to December 2019 we evaluated the charts of 114 asymptomatic fertile women who underwent office hysteroscopic polypectomy, 1 year before, for a single large benign endometrial polyp (size between 10 and 20 mm) using a 4 mm continuous flow hysteroscope with a BE or a 5 mm HTRs. Patients, divided into two groups according to surgical procedure, each performed exclusively by one expert gynecologist, were scheduled for a 12-month postoperative transvaginal sonography to evaluate the recurrence of endometrial polyps. Results: Forty-eight women of the BE group and 42 of the HTRs group were considered for the 1-year transvaginal sonography follow-up. Five polyps were identified in the BE group and three in the HTRs group (5/48 vs 3/42, P = n.s.). All polyps were removed hysteroscopically (in three out of five and in two out of three cases, respectively, in the same places of the previous polypectomy) and evaluated as 'benign' by the pathologist. Conclusion: Office hysteroscopic endometrial polypectomy with small HTRs compared to BE revealed at a 1-year follow-up no difference in terms of complete removal and recurrence of polyps. HTRs polypectomy resulted in less pain and significantly quicker time of procedure compared to BE. This data should be kept in mind for patient comfort any time hysteroscopic polypectomy is planned in an office setting.

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Section: Discussionmentioning

confidence: 99%

Comparison of endometrial polyp recurrence in fertile women after office hysteroscopic endometrial polypectomy using two widely spread techniques

Ceci

Franchini²,

Cardinale

et al. 2020

J of Obstet and Gynaecol

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“…Our results of the reduction in the operating time with hysteroscopic morcellation confirm the results of four previous RCTs and systematic reviews. [ 4 5 6 7 9 10 ] In hysteroscopic morcellation, the simultaneous cutting and aspiration of polyps may have reduced the number of the device's insertions and thus reduced the operating time.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative and postoperative clinical evaluation of the hysteroscopic morcellator system for endometrial polypectomy: A prospective, randomized, single-blind, parallel group comparison study

Tsuchiya

Komatsu

Matsuyama

et al. 2018

Gynecol Minim Invasive Ther

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Objective:To evaluate the TRUCLEAR™ system (Smith and Nephew Inc., London, UK), a hysteroscopic system that morcellates and aspirates masses, in terms of the operating time, surgeon's convenience, and effect on patients compared with conventional electrosurgical resection.Methods:Patients undergoing hysteroscopic resection of endometrial polyps were randomly allocated to undergo hysteroscopic morcellation or electrosurgical resection (UMIN-CTR identifier: UMIN000019649). The primary outcome was the operating time. Secondary outcomes were the removal success, fluid deficit, convenience with the technique, insertion time, number of insertions during the operation, visibility of the operative field, recurrence of the patient's chief complaint, and adverse events.Results:Sixty-seven women were randomly allocated to the morcellation arm (n = 34) or electrosurgical resection arm (n = 33) from November 2015 to November 2016. The polyps were completely removed, and no adverse events were observed in all 67 patients. The average operating time (8.3 min vs. 12.0 min, P = 0.014), insertion time (5.0 min vs. 9.0 min, P < 0.001), and number of insertions (1.0 vs. 8.2, P < 0.001) were significantly lower in the morcellation arm than in the electrosurgical resection arm. Surgeons' subjective evaluation measured on a 10-cm visual analog scale was higher in the morcellation arm than in the electrosurgical resection arm in terms of easiness of removal (8.4 vs. 6.5, P < 0.001) and visibility of the operative field (7.8 vs. 6.4, P < 0.001).Conclusion:Surgeons gave the hysteroscopic morcellator system a better evaluation compared than electrosurgical resection, and the system shortened the operating time.

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“…A previous study has shown that RFA of uterine myomas relieves the symptoms associated with myomas such as heavy bleeding and bulk-related symptoms [14]. However, to date there are no published studies that prospectively investigate patient follow-up after RFA treatment in terms of menstruation status and hysteroscopic results [15].…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopic outcomes after radiofrequency ablation of myomas: Two case reports and literature review

2020

Clinical and Experimental Obstetrics & Gynecology

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A systematic review and meta‐analysis of randomized controlled trials comparing hysteroscopic morcellation with resectoscopy for patients with endometrial lesions

Abstract: Hysteroscopic morcellation is associated with a higher operative success rate and a shorter operative time among patients with endometrial lesions than is resectoscopy. More high-quality trials are required to validate these results.

Cited by 33 publications

References 24 publications

Comparison of endometrial polyp recurrence in fertile women after office hysteroscopic endometrial polypectomy using two widely spread techniques

Comparison of endometrial polyp recurrence in fertile women after office hysteroscopic endometrial polypectomy using two widely spread techniques

Intraoperative and postoperative clinical evaluation of the hysteroscopic morcellator system for endometrial polypectomy: A prospective, randomized, single-blind, parallel group comparison study

Hysteroscopic outcomes after radiofrequency ablation of myomas: Two case reports and literature review

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