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ObjectiveTo compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect. DesignMulticentre randomised controlled trial. SettingEleven hospitals collaborating in a consortium for women's health research in the Netherlands. PopulationWomen reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of 3 mm, measured during sonohysterography. MethodsWomen were randomly allocated to hysteroscopic niche resection or expectant management for 6 months. Main outcome measuresThe primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of life, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation. ResultsWe randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2-7 days) in the intervention group and 7 days (IQR 3-10 days) in the control group (P = 0.04); on a scale of 0-10, discomfort as a result of spotting had a median score of 2 (IQR 0-7) in the intervention group, compared with 7 (IQR 0-8) in the control group (P = 0.02). ConclusionsIn women with a niche with a residual myometrium of 3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting-related discomfort. Tweetable abstractA hysteroscopic niche resection is an effective treatment to reduce niche-related spotting. Tweetable abstract A hysteroscopic niche resection is an effective treatment to reduce niche-related spotting.

Study Objective To determine if the extent of fibroid ablation, as reflected in a decrease in perfused fibroid volume three months after treatment, correlates with a reduction in total fibroid volume at 12 months. Design Prospective, longitudinal, multicenter, single-arm trial. Setting Academic and community hospitals in the United Kingdom, The Netherlands and Mexico. Patients 27 women with heavy menstrual bleeding secondary to fibroids. Intervention Radiofrequency ablation guided by built-in intrauterine sonography (the Sonata™ System). Measurements and Main Results The 27 patients had a total of 42 fibroids that were ablated. Contrast-enhanced MRI was used to determine the perfused and total fibroid volumes at baseline, at 3 months post-treatment and again at 12 months post-treatment. All MRI measurements were performed at a single core laboratory (MedQIA, Los Angeles, USA). Using a least squares method for linear regression, the change in total fibroid volume at 12 months as a function of the change in perfused fibroid volume at 3 months was found to have a correlation coefficient (R2) of 0.7518. The linear equation describing this relationship was y = 0.9919x + 0.0052. Conclusion There is a positive correlation between the reduction in perfused fibroid volume noted on contrast-enhanced MRI at 3 months after transcervical radiofrequency ablation and the reduction in total fibroid volume at 12 months. Thus, as larger portions of a fibroid are ablated, there will tend to be a greater reduction in total fibroid volume at 1 year.

Please cite this paper as: Janssen P, Brolmann H, van Kesteren P, Bongers M, Thurkow A, Heymans M, Huirne J. Perioperative outcomes using LigaSure compared with conventional bipolar instruments in laparoscopic hysterectomy: a randomised controlled trial. BJOG 2011;118:1568–1575. Objective To compare the effects of LigaSure versus the conventional bipolar technique on operating time and blood loss during laparoscopic hysterectomy. Design A randomised controlled trial. Setting Three teaching hospitals. Population Women undergoing a laparoscopic hysterectomy for benign indications. Methods 140 women undergoing a laparoscopic hysterectomy were randomised for LigaSure or conventional bipolar instruments. Main outcome measures Primary outcome was operating time from initial skin incision till detachment of the uterus. Secondary outcome measures were total operating time (from initial skin incision till final skin closure), time to dissect the adnexal ligaments, intra-operative blood loss and subjective evaluation by the surgeon of the instrument used. Results No differences in operating time (from initial skin incision till uterine detachment and initial skin incision till final skin closure) using LigaSure versus conventional bipolar instruments: 97.6 versus 91.8 minutes (P = 0.39, 95% CI – 7.6 to 19.2), and 148.1 versus 142.1 minutes (P = 0.46, 95% CI – 10.1 to 22.3), respectively. The mean blood loss using LigaSure versus conventional bipolar was 234.1 versus 273.1 ml (P = 0.46, 95% CI -39.1 to 52.7). Various subjective efficacy and instrument handling parameters were significantly different between the two instruments and between the different participating centres. Conclusions There were no significant differences in operating time and blood loss between the use of LigaSure and the use of conventional bipolar instruments during laparoscopic hysterectomy, even after correction for potential confounders. User satisfaction parameters were assessed as significantly different by surgeons of the participating centres.