Mechanical hysteroscopic tissue removal or hysteroscopic morcellator: understanding the past to predict the future. A narrative review

Abstract

Background: In recent years, the available evidence revealed that mechanical hysteroscopic tissue removal (mHTR) systems represent a safe and effective alternative to conventional operative resectoscopic hysteroscopy to treat a diverse spectrum of intrauterine pathology including endometrial polyps, uterine myomas, removal of placental remnants and to perform targeted endometrial biopsy under direct visualisation. This innovative technology simultaneously cuts and removes the tissue, allowing one to perform the procedure in a safer, faster and more effective way compared to conventional resectoscopic surgery. Objective: To review currently available scientific evidence concerning the use of mechanical hysteroscopic morcellators and highlight relevant aspects of the technology. Material and Methods: A narrative review was conducted analysing the available literature regarding hysteroscopic tissue removal systems. Main outcome measures: Characteristics of available mHTR systems, procedures they are used for, their performance including safety aspects and their comparison. Results: A total of 7 hysteroscopic morcellators were identified. The diameter of the external sheet ranged from 5.25 to 9.0 mm, optics ranged from 0.8 to 6.3 mm with 0o angle. The cutter device diameter ranged from 2.9 to 4.5 mm most of them with rotation and reciprocation. Conclusion: We conclude that the adoption of mHTR has shown to reduce operating time, simultaneously cutting and suctioning tissue fragments avoiding the need for multiple removal and reinsertions of the device into the uterine cavity as well as reducing the volume of distension media required to complete the procedure compared to using the hysteroscopic resectoscope.

Hysteroembryoscopy and hysteroscopic uterine evacuation of early pregnancy loss: A feasible procedure in selected cases

“…TRD has shown to reduce operating time, by simultaneously cutting and suctioning tissue fragments, avoiding the need for multiple removal and reinsertions of the device into the uterine cavity as well as reducing the volume of distension media required to complete the procedure compared to using standard resectoscope (Franchini et al, 2021). In cases of RPOC, TRD is a faster alternative than loop resection (Hamerlynck et al, 2016).…”

Optimizing Operative Hysteroscopy in the Office Setting: Updated Techniques and Technology

“…Although mHTRs are becoming the preferred approach to treating intrauterine pathology, the resectoscope continues to be an important tool, particularly in the setting of type 2 submucosal myomas. 31 The prevalence of complications is low for mHTR, reported at 0.02% for inhospital procedures and 1.6% when used in the office setting. 32 When compared with the resectoscope, the mHTR system is associated with fewer complications such as uterine perforation, bleeding, and fluid overload, which can be life threatening.…”

We should stop calling hysteroscopic tissue removal systems ‘morcellators’

“…However, hysteroscopic fibroid resection procedures require a high degree of surgical expertise for safe and complete removal of submucosal fibroids. As highlighted by Franchini et al ( 2021 ) comparative trials showed hysteroscopic morcellation technologies are easier to learn and are faster. In addition, mHTR systems eliminate the risk of diathermy damage in cases of uterine perfora- tion and avoid the need for wider cervical dilatation as they are thinner than the standard resectoscopes.…”

“…In contrast, a narrative review published in this issue of Facts, Views and Vision by Franchini et al ( 2021 ) provides a comprehensive review of the available data on mechanical tissue removal systems (mHTR systems) and their performance against traditional hysteroscopic resection systems, and concludes that ‘gynaecologists should be encouraged to choose mHTR systems when available’.…”

“…mHTR systems do not ‘morcellate’ the tissue. As Franchini et al ( 2021 ) brings to our attention, the term originates from the French word ‘morcellement’ which means ‘to subdivide’. mHTRs do not subdivide the tissue but ‘shave’ and ‘aspirate’ it.…”