Innovations in hysteroscopic surgery: expanding the meaning of “in-office”

Vitale, Salvatore Giovanni; Haimovich, Sergio; Riemma, Gaetano; Ludwin, Artur; Zizolfi, Brunella; Angelis, Maria Chiara De; Carugno, Josè

doi:10.1080/13645706.2020.1715437

Cited by 44 publications

(25 citation statements)

References 32 publications

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“…Concerning Jimenez et al [31], the study was carried out between 2001 and 2008. In the subsequent decade, hysteroscopic instrumentation for in-office treatment has been meaningfully improved, with clearer visualization, greater equipment durability, and additional approaches to removal, including morcellation [44]. However, it is Fig.…”

Section: Discussionmentioning

confidence: 99%

Surgical and Reproductive Outcomes after Hysteroscopic Removal of Retained Products of Conception: A Systematic Review and Meta-analysis

Vitale

Parry

Carugno

et al. 2021

Journal of Minimally Invasive Gynecology

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Objective: To evaluate the impact of hysteroscopy for retained products of conception (RPOC) removal on surgical and reproductive outcomes. Data Sources: Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, SciELO, EMBASE, and the Cochrane Central Register of Controlled Trials at the Cochrane Library) were searched from inception to March 2020. Methods of Study Selection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Medical Subject Headings terms and text words such as "retained products of conception," "placental remnants," "placenta," and "hysteroscopy" were used for the identification of relevant studies. We included observational and randomized studies that analyzed surgical and/or reproductive outcomes of women who underwent hysteroscopic removal of RPOC. The primary outcome was the complete resection rate after 1 procedure. Tabulation, Integration, and Results: Twenty out of 245 studies were applicable, with data provided for 2112 women. The pooled complete resection rate was 91% (95% confidence interval [CI], 0.83−0.96). The incomplete resection rate evaluated was 7% (95% CI, 0.03−0.14), with a complication rate of 2% (95% CI, 0.00−0.04). Out of 1478 procedures, only 12 cases (0.8%) of postsurgical intrauterine adhesions were reported. Regarding post-therapy fecundity, women attempting postoperative conception had a clinical pregnancy rate of 87% (95% CI, 0.75−0.95), with a live birth rate of 71% (95% CI, 0.60 −0.81) and a pregnancy loss rate of 9% (95% CI, 0.06−0.12). Conclusion: Hysteroscopy has a high rate of completely removing RPOC in a single surgical step, with low complication rates. Subsequent fecundity seems reassuring, with appropriate clinical pregnancy and live birth rates. However, standardization of approach and comparative trials of different hysteroscopic approaches are needed.

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Section: Discussionmentioning

confidence: 99%

Surgical and Reproductive Outcomes after Hysteroscopic Removal of Retained Products of Conception: A Systematic Review and Meta-analysis

Vitale

Parry

Carugno

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Of course, we believe that the sampling of the tube is a more invasive procedure that cannot be performed as easily as a vaginal swab, even though an outpatient procedure with an in-office hysteroscope might be feasible and well tolerated by the woman. In literature, we found examples of brush cytology of the fallopian tube [ 42 , 43 , 44 ] using minimally invasive hysteroscopes [ 45 , 46 , 47 , 48 , 49 ], even though in the setting of prevention of ovarian cancer [ 43 , 45 ]. A previously reported study [ 20 ] investigated the contamination of follicular fluid by vaginal pathogens, hence, providing the rational for tubal microbiome sampling in infertile women.…”

Section: Discussionmentioning

confidence: 99%

The Role of Genital Tract Microbiome in Fertility: A Systematic Review

Vitale

Ferrari

Ciebiera

et al. 2021

IJMS

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The human microbiome plays a crucial role in determining the health status of every human being, and the microbiome of the genital tract can affect the fertility potential before and during assisted reproductive treatments (ARTs). This review aims to identify and appraise studies investigating the correlation of genital microbiome to infertility. Publications up to February 2021 were identified by searching the electronic databases PubMed/MEDLINE, Scopus and Embase and bibliographies. Only full-text original research articles written in English were considered eligible for analysis, whereas reviews, editorials, opinions or letters, case studies, conference papers, and abstracts were excluded. Twenty-six articles were identified. The oldest studies adopted the exclusive culture-based technique, while in recent years PCR and RNA sequencing based on 16S rRNA were the most used technique. Regardless of the anatomical site under investigation, the Lactobacillus-dominated flora seems to play a pivotal role in determining fertility, and in particular Lactobacillus crispatus showed a central role. Nonetheless, the presence of pathogens in the genital tract, such as Chlamydia trachomatis, Gardnerella vaginalis, Ureaplasma species, and Gram-negative stains microorganism, affected fertility also in case of asymptomatic bacterial vaginosis (BV). We failed to identify descriptive or comparative studies regarding tubal microbiome. The microbiome of the genital tract plays a pivotal role in fertility, also in case of ARTs. The standardization of the sampling methods and investigations approaches is warranted to stratify the fertility potential and its subsequent treatment. Prospective tubal microbiome studies are warranted.

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“…A reliable irrigation system is crucial to maintain a clear view into the uterine cavity during the procedure (Vitale et al, 2020 is placed in close contact with the lesions to be removed, this new technology simultaneously cuts and aspirates the tissue improving visibility and reducing the need for multiple removal and insertions of the device from the uterine cavity (Noventa et al, 2015). The speed of tissue removal depends on the contact time of the cutting window with the pathology, the consistency of the tissue and the speed with which the blade cuts and aspirates the tissue.…”

Section: Clinical Practicementioning

confidence: 99%

“…Mechanical hysteroscopic tissue removal or hysteroscopic morcellator: understanding the past to predict the future. A narrative review Facts Views Vis Obgyn, 2021, 13 (3): 193-201 Review article M. Franchini 1 , O. ceci 2 , P. casadiO 3 , J. carugnO 4 , g. giarrè 5 , g. gubbini 6 , u. catena 7 , M. chiara de angelis 8 , a. di sPieziO sardO 9 Mechanical hysteroscopic morcellator (mHM) systems are an innovative minimally invasive surgical technology available to treat a large number of intrauterine pathologies both in the operative room as well as in the office setting (Vitale et al, 2020). Since April 2014, mHMs have been commonly known as mechanical hysteroscopic tissue removal (mHTR) systems to avoid potential terminology misunderstanding with laparoscopic power morcellator after the US Food and Drug Administration (FDA) issued a black box warning for laparoscopic electromechanical morcellators.…”

Section: Introductionmentioning

confidence: 99%

“…Mechanical hysteroscopic morcellator (mHM) systems are an innovative minimally invasive surgical technology available to treat a large number of intrauterine pathologies both in the operative room as well as in the office setting ( Vitale et al, 2020 ). Since April 2014, mHMs have been commonly known as mechanical hysteroscopic tissue removal (mHTR) systems to avoid potential terminology misunderstanding with laparoscopic power morcellator after the US Food and Drug Administration (FDA) issued a black box warning for laparoscopic electromechanical morcellators.…”

Section: Introductionmentioning

confidence: 99%

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

Franchini¹,

Ceci²,

Casadio³

et al. 2021

Facts Views Vis ObGyn

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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.

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Innovations in hysteroscopic surgery: expanding the meaning of “in-office”

Cited by 44 publications

References 32 publications

Surgical and Reproductive Outcomes after Hysteroscopic Removal of Retained Products of Conception: A Systematic Review and Meta-analysis

Surgical and Reproductive Outcomes after Hysteroscopic Removal of Retained Products of Conception: A Systematic Review and Meta-analysis

The Role of Genital Tract Microbiome in Fertility: A Systematic Review

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

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