See‐and‐treat in‐office hysteroscopy versus operative hysteroscopy for the treatment of retained products of conception: A retrospective study

Abstract

Aim To compare the efficacy and safety of in‐office hysteroscopy with a see‐and‐treat approach with that of operative hysteroscopy for the treatment of retained products of conception (RPOC). Methods We retrospectively identified all consecutive patients who underwent hysteroscopic treatment of RPOC between 2015 and 2019. We excluded patients with RPOC larger than 2 cm at preoperative transvaginal ultrasounds. Between 2015 and 2017, all hysteroscopic removals of RPOC were performed by operative hysteroscopy. Between 2018 and 2019, all cases of RPOC less than 2 cm in size were hysteroscopically removed by the see‐and‐treat approach in the office setting. Sociodemographic, clinical, and procedure characteristics along with complications were retrieved from medical records. Results Between 2015 and 2019, 119 women underwent hysteroscopic removal of RPOC equal to or smaller than 2 cm: 53 patients by in‐office hysteroscopy, and 66 by operative hysteroscopy. The two groups were similar in preoperative characteristics. Although the time required to complete the RPOC removal was similar, the total procedure and assistant time were significantly higher in the operative hysteroscopy group (p < 0.001). Moreover, operative hysteroscopy was associated with a higher proportion of cases complicated by excessive bleeding, cervical tear, or uterine perforation (p = 0.016). Failure to complete the procedure was similarly reported in the two groups (p = 0.58). Conclusions In‐office hysteroscopy with the see‐and‐treat approach for RPOC equal to or smaller than 2 cm appears as effective as operative hysteroscopy, but safer. In‐office hysteroscopy may be considered the first choice for treating RPOC equal to or smaller than 2 cm.

Hysteroscopy for retained products of conception: a single-institution experience

“…Nappi et alreported that the office hysteroscope had the advantages of avoiding general anesthesia, decreasing the costs and a good compliance of patients, which also successfully used in Cesarean Scar Pregnancy combined with uterine artery embolization [ 11 ].In addition, Raz et al compared in-office hysteroscopy with operative hysteroscopy for treating RPOC ≤ 2 cm. Operative hysteroscopy was reported to be associated with significantly more surgical complications and longer procedure and assistant times [ 12 ].

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Hysteroscopic management of molar pregnancy: A series of 36 cases

“…We used the last two techniques for this indication in our series. The recent work of Raz et al 21 shows that office hysteroscopy should be preferred in case of RPOC smaller than 2 cm as being safer (less perforation, hemorrhage, cervical tear) and quicker than operative hysteroscopy.…”

Hysteroscopic removal of retained products of conception in the outpatient setting

“…All these instruments have the advantages provided by hysteroscopy, namely a focused and non-traumatic procedure in the cavity, and all appear to have low rates of complications and IUAs and high rates of subsequent fertility, as opposed to curettage. The resusable mechanical instruments have the advantage of low cost, require minimal or no cervical dilation, and can be used in the see and treat setting without anaesthesia (Raz et al, 2022;Mohr-Sasson et al, 2022). However, they are mostly used for small and non-vascular RPOC, and require surgical expertise and relativey longer learning curve.…”

“…Mechanical instruments can be introduced through the working channel of the small diameter (4-5 mm) hysteroscope using a vaginoscopic approach without cervical dilation or anaesthesia (Raz et al, 2022). The grasper and/or scissors are used to separate the RPOC from the uterine wall, and the subsequent grasping and removal of the RPOC mass.…”