Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions: A Systematic Review and Meta-analysis

Shazly, Sherif; Laughlin-Tommaso, Shannon K.; Breitkopf, Daniel M.; Hopkins, Matthew R.; Burnett, Tatnai L.; Green, Isabel C.; Farrell, Ann; Murad, M. Hassan; Famuyide, Abimbola O.

doi:10.1016/j.jmig.2016.04.013

Cited by 35 publications

(24 citation statements)

References 29 publications

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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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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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“…Meta-analysis revealed that compared with a bipolar resectoscope, hysteroscopic morcellation systems were associated with a shorter procedural time, smaller fluid deficit and lower odds of incomplete removal. 9 In this case, the patient required treatment for severe anemia that was induced by heavy menstrual bleeding. Several therapeutic options were available, including myomectomy, hysterectomy and hormone therapy.…”

Section: Discussionmentioning

confidence: 97%

“…These devices combine mechanical cutting with continuous aspiration of the resected pathology using saline as the distension medium. Meta‐analysis revealed that compared with a bipolar resectoscope, hysteroscopic morcellation systems were associated with a shorter procedural time, smaller fluid deficit and lower odds of incomplete removal 9 …”

Section: Discussionmentioning

confidence: 99%

Successful management of a submucosal fibroid using a hysteroscopic morcellator system in a patient with a history of total proctocolectomy: A case report

Ota

Takahashi

Kamo

et al. 2020

J of Obstet and Gynaecol

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Transcervical resection is widely used in the management of submucosal fibroids. However, uterine perforation and thermal bowel injuries are known complications associated with the procedure. This is a case report of a 44-year-old woman who presented with heavy menstrual bleeding and anemia. Magnetic resonance imaging and hysteroscopy revealed multiple fibroids, including a submucosal type 1 fibroid. She had previously undergone a total proctocolectomy with intestinal pouch-anal anastomosis for ulcerative colitis. Because there was a high risk of permanent colostomy in the event of a bowel injury, an electrode-free, operative hysteroscopy using the Intrauterine Bigatti Shaver (IBS), a hysteroscopic morcellator system, was employed to prevent thermal bowel injury. The fibroid was completely removed using the IBS system with no complications. Therefore, we recommend the electrode-free use of a hysteroscopic morcellator system in patients with a history of extensive pelvic surgery.

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“…Modified technique in which the base was excised followed by ring forceps extraction after misopristol priming [27]. Morcellators, with no doubt shorten the operative time and fluid deficit [28], but they can't yet concurrence the hysteroscopic resectoscopes for the treatment of large submucous myomas or those with a large intramyometrial involvement [29]. In more detailed very recent analysis of hysteroscopic morcellator in submucous myomas, it was stated that complete resection was achieved in 90% of leiomyomas < 20 mm, in 89% of those 20 to 29 mm, in 83% of those 30 to 39 mm, and in 48% of those >40 mm.…”

Section: Discussionmentioning

confidence: 99%

Slice and Excise Technique in Hysterscopic Myomectomy for Large G0 Submucous Myoma

El-Tawab¹

2017

OGIJ

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Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions: A Systematic Review and Meta-analysis

Cited by 35 publications

References 29 publications

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

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

Successful management of a submucosal fibroid using a hysteroscopic morcellator system in a patient with a history of total proctocolectomy: A case report

Slice and Excise Technique in Hysterscopic Myomectomy for Large G0 Submucous Myoma

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