Hysteroscopic Endometrial Resection

Abstract

Endometrial resection (TRCE) is a well-examined alternative therapy to hysterectomy in the treatment of menorrhagia that preserves the uterus at long term in at least 70% of patients. The technique and safety considerations are described and an overview of the existing evidence is given. Complication rates (2.5%) and performance of the personal series of 465 operative hysteroscopies including 244 endometrial resections with a follow-up of at least 18 months are shown. 3.3% of patients with endometrial resection needed a hysterectomy up to now (follow-up 18-90 months). The combination of endometrial resection and the insertion of the levonorgestrel hormone-releasing intrauterine device (LNG-IUD) is described. Especially in patients with adenomyosis, the combination of LNG-IUD with endometrial resection augments the success rate. 96 of 99 patients with the combined therapy (TRCE and LNG-IUD) and a follow-up of 18-48 months still have their uterus.

Surgical Outcomes in Human Immunodeficiency Virus–Infected Patients in the Era of Highly Active Antiretroviral Therapy

“…We had initially predicted a lower overall complication rate in the HIV-noninfected patients, but our results are consistent with the literature for HIVnoninfected patients undergoing similar surgical procedures. [27][28][29][30][31][32][33] While the HIV-infected patients had a higher prevalence of bacterial infection at surgery, this did not predict a higher postoperative infection rate (19 [5.7%] of 332; P=.32), nor did these patients have a higher surgical site infection rate up to 12 months (P = .60). Patients who were HIV positive did not have a greater need for further surgical interventions to manage first surgery complications.…”

The combined use of endometrial ablation or resection and levonorgestrel‐releasing intrauterine system in women with heavy menstrual bleeding: A systematic review

“…One difficult removal of LNG-IUD was described due to synechiae, but no hysteroscopic intervention was necessary. 17 All removals went without any complications. 8,15,16 Two women were reported who spontaneously expelled the LNG-IUS within 1 week after insertion.…”

“…8,12,14,15 The four studies examining hysteroscopic endometrial resection plus LNG-IUS showed hysterectomy rates of 0%-11%. [12][13][14]17 The remaining four studies investigating non-hysteroscopic EA + LNG-IUS showed 0%-1% hysterectomy rates. 8,15,16 In two retrospective studies without a control group, a total of two out of 123 women required a hysterectomy after treatment with EA/resection and LNG-IUS, because of ongoing vaginal bleeding.…”

“…13,16 In the case series of Bratschi three out of 99 women (3%) required a hysterectomy after the combined treatment, all as the result of (precursors of) cancer. 17 Four studies (222 women) reported re-intervention rates, including hysterectomy and repeat hysteroscopic intervention (transcervical resection of intrauterine adhesions or re-ablation) (Table 2).…”

“…Among the seven included studies were four retrospective cohort studies with a control group, two retrospective studies without a control group and one case series. 8,[12][13][14][15][16][17] All the studies included women with HMB, disregarding one study, which specifically evaluated women with HMB and adenomyosis. 14 A total of 747 women were included with a follow-up duration between 6 and 55.2 months.…”