Hysteroscopic myomectomy: The guidelines of the International Society for Gynecologic Endoscopy (ISGE)

Loddo, Alessandro; Djokovic, Dusan; Drizi, Amal; Vree, Bart Paul De; Sedrati, Adel; Herendael, Bruno J. van

doi:10.1016/j.ejogrb.2021.11.434

Cited by 38 publications

(26 citation statements)

References 58 publications

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“…In fact, with the development of minimally invasive gynecological surgery, conventional resectoscopy of endometrial polyps has become the criterion standard for treatment, and its surgical success rate was also relatively high. For intrauterine tissue pulverization and suction technology, although the TRUCLEAN system overcame the problems of the electric cutting method, such as steam bubbles generated by electric heating of uterine dilatation fluid or excised tissue, and incomplete excision, which can lead to surgical failure, it has also created new problems that reduce the success rate of surgery, such as inability to enter the uterine cavity [ 14 ] and inability to use hysteroscopic morcellation for hard fibroids [ 2 ]. In terms of complications, life-threatening complications such as fluid overload, uterine perforation, and bleeding cannot be completely eliminated regardless of the surgical option, although these are uncommon with the use of hysteroscopic morcellation [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, although the use of the new technology has shortened the operation time to a certain extent, the shortened time may not cause statistical differences in the absorption of uterine distention fluid between patients with different surgical methods. Last but not least, there are many factors that affect the absorption of body fluids, not only the operation time [ 17 ], but also the intrauterine pressure, mean arterial pressure, the depth of myometrial penetration, and the size of the uterine cavity, which affect the absorption of body fluids [ 14 ]. However, these reasons have little to do with the choice of the 2 surgical methods.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Hysteroscopic Morcellation Versus Resectoscopy in Treatment of Patients with Endometrial Lesions: A Meta-Analysis

Ren¹,

Huang

Wang

et al. 2022

Med Sci Monit

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Background Hysteroscopic surgery has been widely used in clinical practice for more than 30 years due to its advantages of less trauma, less bleeding, and direct vision. The aim of this study was to compare hysteroscopic morcellation versus conventional resectoscopy for removal of endometrial lesions. Material/Methods For the database search, we used the keywords “morcellator,” “morcellators,” “morcellate,” “morcellation,” and “morcellated” combined with “hysteroscopy,” “uteroscope,” and “transcervical”. The last search was conducted on February 1, 2022. Randomized controlled trials (RCTs) were included in the meta-analysis. Results According to our retrieval scheme and the inclusion and exclusion criteria, we found 6 studies including 565 patients. For enumeration data, we calculated the effect size as relative risk (RR) and 95% confidence interval (95% CI), while for quantitative data we used the weighted mean difference (WMD) and 95% confidence interval (95% CI). There was no significant difference between success rate of hysteroscopic morcellation and conventional resectoscopy (relative risk and 95% confidence interval 1.05(0.97,1.13); P =0.232). Procedure time was also shorter with hysteroscopic morcellation, the procedure time of the hysteroscopic morcellation group was 3.43 min shorter compared with the conventional resectoscopy group, and the operating time in the hysteroscopic morcellation group was 2.81 min shorter. In terms of fluid deficit, there was no statistically significant difference in fluid loss between the 2 groups ( P =0.209). Conclusions Hysteroscopic morcellation is associated with a shorter procedure time and operative time among patients with endometrial lesions compared with resectoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Hysteroscopic Morcellation Versus Resectoscopy in Treatment of Patients with Endometrial Lesions: A Meta-Analysis

Ren¹,

Huang

Wang

et al. 2022

Med Sci Monit

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“…Surgical treatment can rapidly relieve the clinical symptoms produced by fibroids and is the main choice for the treatment of uterine submucosal fibroids. 10…”

Section: Discussionmentioning

confidence: 99%

Optimal treatment options for uterine submucosal fibroids: Percutaneous microwave ablation versus transcervical resection of myoma

Jin

Chen

et al. 2023

J of Clinical Ultrasound

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Objectives To compare the efficacy and safety of percutaneous microwave ablation (PMWA) and transcervical resection of myoma (TCRM) for submucosal fibroids. Methods From January 2019 to January 2021, we conducted a randomized controlled study involving patients with symptomatic uterine submucosal fibroids. Questionnaires were also used to measure the uterine fibroid symptom (UFS) scores and quality of life (QoL) scores before and after treatment at 3, 6, and 12 months. Outcomes, adverse events, hemoglobin recovery, and submucosal fibroid volume of both groups were also compared. Operation time, amount of bleeding, hospital stay time, and occurrence of complications were compared in groups with fibroids of different lengths. Results Follow‐up after surgery showed that UFS scores at 3, 6, and 12 months were significantly lower in each group, while QoL scores increased significantly. For fibroids less than 3 cm, surgical time was 34.2 ± 9.9 min, incidence of perioperative complications was 4.2%, and both decreased significantly, compared to the surgical time of the PMWA group (40.0 ± 8.1 min) and incidence of perioperative complications (24%; p < .05 for both). For uterine submucosal fibroids >5 cm, the operation time in the PMWA group was 92.7 ± 16.0 min, intraoperative bleeding volume was 22.7 ± 6.4 mL, and hospital stay was 2.7 ± 1.1 days, which were significantly less than the procedural time (107 ± 11.9 min), intraoperative bleeding loss (45.9 ± 12.8 mL), and length of hospital stay (5.0 ± 1.1 days) in the TCRM group. The differences were statistically significant (p < .05). Conclusions PMWA and TCRM were both effective treatments for uterine submucosal fibroids. For fibroids shorter than 3 cm in length, especially pedicled submucosal fibroids, TCRM has absolute advantages; however, for uterine submucosal fibroids >5 cm, PMWA avoids perioperative complications, such as uterine perforation, water poisoning syndrome, and the need for repeat surgery, and is considered the preferred mode of treatment. Therefore, personalized treatment should be used for different patients with uterine submucosal fibroids.

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“…Hysteroscopy surgery has been widely used in the examination, diagnosis and treatment of gynaecological diseases and promoted the development of minimally invasive reproductive technology. [1][2][3] Although the time for hysteroscopy operation is short, the pain stimulation is still intense, especially when pulling and dilating the orifice of uterus. 4,5 Inhalation anaesthetics are commonly used in hysteroscopy surgery due to their rapid onset and offset.…”

Section: Introductionmentioning

confidence: 99%

Minimal alveolar concentration of sevoflurane in combination with dexmedetomidine in patients with hysteroscopy: An up‐down sequential allocation study

Guo

Luo

Jiang

et al. 2022

Basic Clin Pharma Tox

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Background: Dexmedetomidine is commonly used in hysteroscopy surgery due to its analgesia and sedation without respiratory depression. Many studies have shown that dexmedetomidine can reduce the consumption of sevoflurane. However, the optimal end-tidal concentration of sevoflurane when it is co-administered with dexmedetomidine has not been established. The primary purpose of this study was to investigate the minimal alveolar concentration (MAC) of sevoflurane for cervical dilatation combined with different doses of dexmedetomidine in patients with hysteroscopy surgery.Methods: One-hundred patients undergoing hysteroscopy surgery were enrolled in this clinical trial. All the patients were randomly assigned into four groups (C, D 1 , D 2 , D 3 ) and received a loading dose of dexmedetomidine (0, 0.6, 0.8 and 1.0 μg/kg) over 10 min before anaesthesia induction, respectively. Anaesthesia was induced in each patient with 5% sevoflurane in 100% oxygen via a facemask. A laryngeal mask (LMA) was inserted when the patient had lost consciousness and the BIS value decreased below 40. The response to cervical dilatation stimulus (movement vs non-movement) by the insert of hysteroscope was recorded. The MAC of sevoflurane was measured by up and down sequential method of Dixon and Mood and centred isotonic regression analysis. Results: The calculated MAC of sevoflurane using up-and-down method of Dixon and Mood in patients with hysteroscopy surgery was (1.90 AE 0.13)%, (1.23 AE 0.16)%, (1.03 AE 0.10)% and (0.93 AE 0.08)% in groups C, D 1 , D 2 and D 3 , respectively. Conclusions:The administration of dexmedetomidine can significantly decrease the MAC of sevoflurane for hysteroscopy surgery. However, a ceiling effect of the reduction was observed when the dose of dexmedetomidine was higher than 0.8 μg/kg.Yan-Xia Guo and Kai Luo contributed equally to this article and share co-first authorship.

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Hysteroscopic myomectomy: The guidelines of the International Society for Gynecologic Endoscopy (ISGE)

Cited by 38 publications

References 58 publications

Comparison of Hysteroscopic Morcellation Versus Resectoscopy in Treatment of Patients with Endometrial Lesions: A Meta-Analysis

Comparison of Hysteroscopic Morcellation Versus Resectoscopy in Treatment of Patients with Endometrial Lesions: A Meta-Analysis

Optimal treatment options for uterine submucosal fibroids: Percutaneous microwave ablation versus transcervical resection of myoma

Minimal alveolar concentration of sevoflurane in combination with dexmedetomidine in patients with hysteroscopy: An up‐down sequential allocation study

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