Monopolar versus bipolar device: safety, feasibility, limits and perioperative complications in performing hysteroscopic myomectomy

Litta, P.; Leggieri, Concetta; Conte, Lorena; Toffola, Angela Dalla; Multinu, Francesco; Angioni, Stefano

doi:10.12891/ceog19432014

Cited by 34 publications

(7 citation statements)

References 24 publications

(29 reference statements)

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“…In the process, uterine tissue secreted a large number of inflammatory factors, leading to the occurrence of endometrial fibrosis. [23] Electrical stimulation accelerated blood flow, maintained reduced blood flow resistance, increased blood supply, and promoted endometrial growth by controlling the contraction and relaxation of vascular smooth muscle, which might be the potential mechanism. Acupuncture and moxibustion had the effects of dredging meridians, adjusting viscera and immune function, and had a better promoting effect on embryo implantation.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of electrical stimulation combined with ultrasound acupuncture therapy on treatment in patients with intrauterine adhesions: Study protocol for a placebo-controlled, single-blind, single-center, randomized trial

Xie

Qin

et al. 2022

Medicine

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Background: Recurrence of postoperative adhesions is one of the most important factors for poor reproductive outcomes after hysteroscopic surgery, particularly in cases diagnosed with severe intrauterine adhesions (IUAs), where the recurrence rate is significantly higher. This study aims to explore the effectiveness of the electrical muscle stimulation combined with ultrasound acupuncture therapy in preventing the recurrence of IUAs and improving reproductive outcomes after operative hysteroscopy. Methods: This study is a single-center, randomized controlled trial. A total of 210 patients with IUAs will be randomly assigned into 2 groups according to the ratio of 1:1, as the treatment group and the control group. Participants will receive the electrical muscle stimulation combined with ultrasound acupuncture therapy and oral hormone supplementation or receive oral hormone supplementation only. The primary outcome was the clinical response rate. There were 3 menstrual cycles of treatment and 3 menstrual cycles of follow-up in this study. Ethics and Dissemination: This study protocol was approved by the Ethics Committee of the Reproductive Hospital of Guangxi Zhuang Autonomous Region (approval number: KY-LL-2022-06). This trial will be conducted in accordance with the principles of the Declaration of Helsinki as well as Good Clinical Practice. Study results will be disseminated at academic presentations and publications in peer-reviewed journals. Trial Registration: Registry name: Clinical value of electroultrasonic instrument in the treatment of IUAs and changes of related protein expression; Registry number: ChiCTR2200058901; registration date: April 19th, 2022; http://www.chictr.org.cn/showproj.aspx?proj=166155.

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Section: Discussionmentioning

confidence: 99%

“…In the process, uterine tissue secreted a large number of inflammatory factors, leading to the occurrence of endometrial fibrosis. [ 23 ]…”

Section: Discussionmentioning

confidence: 99%

Efficacy of electrical stimulation combined with ultrasound acupuncture therapy on treatment in patients with intrauterine adhesions: Study protocol for a placebo-controlled, single-blind, single-center, randomized trial

Xie

Qin

et al. 2022

Medicine

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“…The randomized controlled study of Darwish et al [24] showed that the application of bipolar energy system with electrolyte dilator can significantly reduce the dilator absorption and the reduction of blood sodium level compared with the use of nonelectrolyte dilator. In addition, compared with the unipolar energy system [25], the bipolar energy system has the advantages of rapid blood coagulation and reduced bleeding, and can provide a better field of vision for the hand surgeon. Further, it can shorten the operation time and reduce the suction of perfusion fluid.…”

Section: The Selection Of Bulge Mediummentioning

confidence: 99%

Complications When Infusing Massive Distending Medium in Hysteroscopic Surgery: A Review of Preventions and Cures for Operative Hysteroscopy Intravascular Absorption Syndrome (OHIA)

Cao¹,

Xu²

2022

Clin. Exp. Obstet. Gynecol.

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Objectives: Hysteroscopic surgery, as a minimally invasive gynecological diagnosis and treatment technique, has advantages including less trauma, quick recovery, and short hospital stay that are very common in clinical practice; however, certain problems remain. Using large amounts of distending medium can induce a series of body changes such as diluent hyponatremia, pulmonary edema and hypothermia. According to the 2021 Chinese Expert Consensus on anesthesia management for hysteroscopic diagnosis and treatment, the most common complication of hysteroscopic surgery was uterine perforation (0.12%), followed by operative hysteroscopy intravascular absorption syndrome (OHIA) (0.06%), intraoperative bleeding (0.03%), air embolism syndrome (0.03%), bladder or bowel injury (0.02%), and endometritis (0.01%). The incidence of uterine perforation and endovascular absorption syndrome was higher than others. With advances in both medical technology and devices, the incidence of uterine perforation has gradually decreased. Severe adhesions, multiple endometrial polyps, large uterine fibroids, etc., increase the difficulty of surgery, thus increasing operation time and the amount of fluid perfusion during surgery. OHIA has become the most important concern of clinicians during hysteroscopic surgery. At present, the prevention and treatment of OHIA remains to be further studied; accordingly, this article seeks to provide a review of current treatment modalities of OHIA during hysteroscopic surgery. Mechanism: Medline, Web of Science, and Ovid databases were searched using the following terms: distending medium, operative hysteroscopy, intravascular absorption syndrome; complications of hysteroscopic surgery. Findings in Brief: Shortening the operation time, reducing the volume of distending medium, decreasing infusion pressure, and using a bipolar scope can reduce the occurrence of OHIA during hysteroscopic surgery. Conclusions: Effective means of controlling and limiting OHIA during hysteroscopic surgery include: exploring the appropriate temperature of perfusion fluid; mastering the advanced monitoring methods; promoting the advanced surgical energy and perfusion system; and improving the surgical team's understanding, diagnosis and treatment level of hysteroscopic surgical complications for the safety of perioperative patients' vital signs.

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“…Структура органозбеорігаючого ендохірургічного втручання в обсязі міомектомії у обстеженного контингенту представлена наступним чином: гістероскопія -118 (59%), комбінація лапароскопії та гістероскопії -50 (25%), у 28 (14%) була здійснена конверсія з комбінація лапароскопії та гістероскопії на лапароскопічний-вагінальний доступ, а у 2,0% була здійснена конверсія лапароскопії на лапаротомію; відповідно до груп дослідження -в основній групі (n=120 (100%)), де в передопераційному обстеженні було застосовано УЗД в якості єдиного виду візуальної діагностики, вирогідно виначалася вища питомна вага конверсій гістероскопії на лапароскопіюу 36 (30%), з комбінації лапароскопії та гістероскопії на лапароскопічно-вагінальний доступ -24 (20%) та з лапароскопії лапаротомію -12 (10%). [8,9,10,11]…”

Section: результати дослідження та їх обговоренняunclassified

Analysis of the informativeness of perioperative visual diagnostics of uterine fibroids

Khabrat

Lytvak

2022

Clin. and prev. med.

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The aim. To analyze the methods of visual diagnosis used in reproductive age women with uterine fibroids. Materials and Methods. Retrospective analisys, information–analytical methods were used in the work. Sources of information were data from the scientific literature on the topic of the study, modern gadleins, a review of randomized controlled trials. Results. Depending on the types of visual diagnostics used in the preoperative examination were formed groups: I group (n=120) – patients were examined only by the sonographic method; II group (n=80) – patients were examined by MRI and ultrasound. Comparative analysis of the MRI and sonographic studies results determined the number of myomatous nodes inpatients of the II group (n=80 (100%): by ultrasound – solitary nodes in 52 (65%), multiple in 28 (35%), and by MRI – a solitary nodule in 37 women (according to FIGO classification – type SM0 – 16 women, SMI in 8 patients, SMII in 8 patients, O3–6 typein 5 women), two nodules in 27 people and three myomatous nodules in 16 women (among multiple myomas n=43 (100%) according to the FIGO classification, , were diagnosed: SM0/О3–4 type– 20 (47%), SM1/О3–4 type –13 (30%), SM2/ O3–4 type –10 (23%), and according to MP type: MP1 – 16 (37%), MP2 –11 (26%), MP3 –16 (37%), and among solitary nodes n=37 (100% ): MP1 – 27 (71%), MP2 –10 (29%). The frequency of cases of inconsistency the clinical situation with ultrasound data interms of the number and localization of myomatous nodes in multinodular UF, especially in SM0–2/О3–4 type combinations, was 39, 0%, and when was using MRI – 8.0% (p<0.05). The structure of organ–preserving surgical intervention in the scope of myomectomy is presented as follows: hysteroscopy – 118 (59%), a combination of laparoscopy and hysteroscopy – 50 (25%), in 28 (14%) a combination of laparoscopy and hysteroscopy was converted to laparoscopic–vaginal access and 2.0% were converted to laparoscopic laparotomy. In the 1st group (n=120(100%)) where only preoperative ultrasound was used, a higher specific weight of conversions from hysteroscopy to laparoscopy – 36 cases (30%), from a combination of laparoscopy and hysteroscopy to laparoscopic–vaginalaccess – 24 (20%) and from laparoscopy laparotomy – 12 (10%). Conclusions. Ultrasound in the perioperative period is unable to fully determine clear navigation for the operation, especially for multinodular UF and hard–to–reach UF localization for hysteroscopic myomectomy. This clinical problem can be solved by using MRI in the perioperative diagnostic and intraoperative sonography.

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Monopolar versus bipolar device: safety, feasibility, limits and perioperative complications in performing hysteroscopic myomectomy

Cited by 34 publications

References 24 publications

Efficacy of electrical stimulation combined with ultrasound acupuncture therapy on treatment in patients with intrauterine adhesions: Study protocol for a placebo-controlled, single-blind, single-center, randomized trial

Efficacy of electrical stimulation combined with ultrasound acupuncture therapy on treatment in patients with intrauterine adhesions: Study protocol for a placebo-controlled, single-blind, single-center, randomized trial

Complications When Infusing Massive Distending Medium in Hysteroscopic Surgery: A Review of Preventions and Cures for Operative Hysteroscopy Intravascular Absorption Syndrome (OHIA)

Analysis of the informativeness of perioperative visual diagnostics of uterine fibroids

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