Hysteroscopic Morcellator for Removal of Intrauterine Polyps and Myomas: A Randomized Controlled Pilot Study among Residents in Training

Dongen, Heleen van; Emanuel, Mark Hans; Wolterbeek, Ron; Trimbos, J. Baptist; Jansen, Frank Willem

doi:10.1016/j.jmig.2008.02.002

Cited by 150 publications

(130 citation statements)

References 9 publications

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“…It has several welldocumented advantages especially for the treatment of myomas up to 3 cm. First of all, any type of submucosal myoma, including G2 myomas, which had been excluded from similar studies about morcellators, has been included in this study [18]. In addition, one of the main advantages of the IBS® is that it enables the effective enucleation of myomas from their fovea and the removal of its intramural site of insertion (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the above-mentioned features, the Versapoint® resectoscopy has a long learning curve, explaining why, even today, only a few surgeons perform operative hysteroscopy [17,18]. By removing the tissue chips at the same time as their resection, the Integrated Bigatti Shaver (IBS®) has shown to improve on results of conventional resectoscopy, reducing the complications rate and improving the learning curve time [19].…”

Section: Introductionmentioning

confidence: 99%

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Hysteroscopic myomectomy with the IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscope: a retrospective comparative study

et al. 2014

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From June 2011 to June 2013, all hysteroscopic myoma resections at the Ospedale San Giuseppe of Milan were performed using either the IBS® or the Versapoint® bipolar resectoscope. Dilatation time of the cervical canal, resection time, fluid balance, and complete single-stage removal of the myoma have been studied. The outcome was stratified for groups of myomas larger and smaller than 3 cm. Seventy-six myomectomies were performed with the IBS® and 51 with the Versapoint®. Both groups had a similar distribution of difficult cases like G2 and larger than 3 cm myomas. The results show no difference in terms of cervical dilatation, resection time, and fluid deficit between the two groups, but, for myomas less than 3 cm and G2 myomas, the IBS® has been able to treat respectively 93.5 % (p=0.3753) and 62.5 % (p=0.5491) of cases in a single step procedure. The overall number of necessary second procedures has been statistically significantly less in the IBS® Group than in the Versapoint® Group (p=0.0067). Although no significative difference in terms of time of resection, the IBS® has proven to be able to approach all kind of submucosal myomas in a single-step procedure and in a very precise and easy way. The IBS® can be considered a valid alternative to the conventional resectoscope.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hysteroscopic myomectomy with the IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscope: a retrospective comparative study

et al. 2014

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show abstract

Section: Discussionmentioning

confidence: 99%

“…Studies using HM describe safe resection of type 0 or I myomas [2,3,5]. HM is easy to perform, demonstrates less fluidrelated complications and shows a shorter learning curve, compared to traditional resectoscopes [2,3,5]. Significant reduction in operation time may be due to simultaneous aspiration of tissue fragments rather than the removal of each individual fragment by using resectoscopy [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopic morcelation of large type II myoma

Abbink

Sendy²,

Gaafar

et al. 2015

Gynecol Surg

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“…Moreover, hysteroscopy systems have become miniaturised, such that they are increasingly portable and easy to insert into the uterine cavity without the need for wide cervical dilatation and blind uterine exploration. Alongside these developments, miniature ancillary instrumentation has been developed, allowing precise targeting of focal pathologies, such as uterine polyps, using a variety of mechanical and electrosurgical equipment 32,[85][86][87][88][96][97][98][99][100] (see Surgical management: polypectomy). These developments have facilitated the concept of 'see and treat' hysteroscopy in a convenient outpatient setting.…”

Section: Current Practice: Surgical Methods and Settingmentioning

confidence: 99%

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Clark

Middleton

Cooper

et al. 2015

Health Technol Assess

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BackgroundUterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited.ObjectivesTo test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined.DesignA multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study.SettingOutpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals.ParticipantsWomen with AUB – defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding – and hysteroscopically diagnosed uterine polyps.InterventionsWe randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia.Main outcome measuresThe primary outcome was successful treatment at 6 months, determined by the woman’s assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained.ResultsAt 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively.ConclusionsWhen treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower.Trial registrationCurrent Controlled Trials ISRCTN 65868569.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.

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Hysteroscopic Morcellator for Removal of Intrauterine Polyps and Myomas: A Randomized Controlled Pilot Study among Residents in Training

Cited by 150 publications

References 9 publications

Hysteroscopic myomectomy with the IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscope: a retrospective comparative study

Hysteroscopic myomectomy with the IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscope: a retrospective comparative study

Hysteroscopic morcelation of large type II myoma

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

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