Search

Objective: To compare and analyze the clinical efficacy and reproductive outcomes of the hysteroscopic tissue removal system (MyoSure) and hysteroscopic electroresection in the treatment of benign intrauterine lesions in women of reproductive age., Methods: This is a retrospective study of patients with benign intrauterine lesions treated with MyoSure or hysteroscopic electroresection. The primary outcomes were operative time and resection completeness, and reproductive outcomes were followed up and compared. Secondary outcomes included perioperative adverse events and postoperative adhesions seen during second-look hysteroscopy. Data analysis was performed using χ 2 and Fisher tests for qualitative variables and Student t-test for quantitative variables., Results: The operative times of patients with type 0 or I myoma, endometrial polyps, or retained products of conception in the MyoSure group were shorter than those in the electroresection group but were not significantly different for patients with type II myomas. The complete resection rate was lower in the MyoSure group than in the electroresection group. The degree of decrease in the American Fertility Society score of intrauterine adhesion in the MyoSure group was significantly higher (2.90 ± 1.29 points vs 1.31 ± 0.89 points, P = 0.025). The time to pregnancy and the pregnancy rate were higher in the MyoSure group (13.14 ± 7.85 months vs 16.26 ± 8.22 months, P = 0.040; 65.12% vs 54.55%, P = 0.045), but there was no significant difference in the term live birth rate, premature birth rate, or abortion rate between the two groups., Conclusion: MyoSure has advantages of a shortened operative time and improvement in reproductive outcomes such as pregnancy rate. However, for type II myomas, MyoSure has limitations, and a comprehensive evaluation before the procedure is required., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Background: To investigate the clinical efficacy of the MyoSure hysteroscopic tissue removal system in the treatment of endometrial and cervical polyps in women with an intact hymen., Methods: Retrospective analysis was performed on the clinical data of 32 patients treated with the MyoSure hysteroscopic tissue removal system for endometrial and cervical polyps., Results: All the patients successfully completed the procedure. No intraoperative complications, such as cervical trauma, uterine perforation or TURP syndrome, were reported. The surgical time ranged from 5 to 35 min, with an average time of 19.3 min, and the intraoperative blood loss ranged from 2 to 50 ml with an average blood loss of 10.8 ml. After surgery, all patients were shown to have intact hymens. No residual polyp tissues were observed under the microscope, and abnormal uterine bleeding was relieved., Conclusions: The MyoSure hysteroscopic tissue removal system can be a safe and effective treatment for endometrial and cervical polyps in women with an intact hymen.

Study Objective: To identify factors that affect reproductive outcomes after hysteroscopic adhesiolysis in patients with severe intrauterine adhesions (IUAs, scored between 9 and 12 according to the American Fertility Society classification) and amenorrhea., Design: A retrospective cohort study., Setting: A university-affiliated hospital., Patients: One hundred fifty-one patients with severe IUAs and amenorrhea., Intervention: Patients were diagnosed via hysteroscopy and underwent at least 1 hysteroscopic adhesiolysis between May 2012 and January 2016., Measurements and Main Results: Of 151 patients, 12 were lost to follow-up, and 139 were included in the study with a follow-up period ranging from 2 to 6 years. Of the 139 evaluable patients, 107 (77%) recovered with a normal uterine cavity (free of IUAs), 28 (20.1%) had improved uterine cavity (fewer IUAs), and 4 (2.9%) showed no improvement. Moreover, 79 patients (56.8%) recovered with normal menstruation, 54 (38.9%) showed increased frequency of menstruation, and 6 (4.3%) had persistent amenorrhea. Seventy-seven (55.4%) became pregnant, of whom 13 had a spontaneous miscarriage, 11 birthed prematurely (at 31-36 gestational weeks), 44 experienced term delivery, and 9 were still pregnant at the end of the study. Age >32 years (p = .002, odds ratio [OR] = 3.442), >2 surgeries (p = .027, OR = 2.969), cervical canal adhesions (p = .047, OR = 2.112), and disease course >6 months (p = .037, OR = 2.335) were risk factors for infertility in patients with severe IUAs and amenorrhea., Conclusion: Younger age, earlier treatment within the disease course, fewer cervical canal adhesions, and fewer surgical procedures improve the reproductive outcome in patients with severe IUAs and amenorrhea., (Copyright © 2019. Published by Elsevier Inc.)

Study Objective: The majority of the current published literature describes hysteroscopic adhesiolysis (HA) for patients with intrauterine adhesions (IUA) using electrical instruments which may cause thermal injury to the endometrium. This video shows the procedure for HA using the "ploughing" technique with cold scissors., Design: Step-by-step explanation of the technique using videos and pictures (educative video) (Canadian Task Force Classification III)., Setting: Third Xiangya Hospital of Central South University, Changsha, China., Patient: A 39-year-old woman diagnosed with IUA., Intervention: HA using the ploughing technique with cold scissors, followed by adjunct postoperative treatment with a follow up hysteroscopy 2 months later., Measurement and Main Results: The uterine cavity was successfully reopened, and the scars covering the inner uterine walls were ploughed longitudinally to release the contraction imposed by the scars, as well as to provide a fresh and rich blood-supplied surface for endometrium to grow and cover after the surgery. There were no complications. The follow-up hysteroscopy 2 months later revealed a normal uterine cavity and much improved endometrium, along with restoration of almost normal menses., Conclusion: HA using the ploughing technique with cold scissors is effective for rebuilding the uterine cavity even for patients with severe IUA. Its advantages merit further study., (Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the efficacy and safety of auto-crosslinked hyaluronic acid (HA) gel for preventing intrauterine adhesion (IUA) after hysteroscopic adhesiolysis., Methods: A prospective, randomized, double blinded and controlled clinical trial (level I) was performed. According to American Fertility Society (AFS) scoring system, 120 patients (treatment group: 60 cases, control group: 60 cases) with moderate to severe IUA were enrolled. Upon completion of adhesiolysis, a Foley balloon catheter was first introduced into the uterine cavity and then 3 ml of auto-crosslinked HA gel for patients in the treatment group; patients in the control group, however, only received Foley balloon catheter. Second-look hysteroscopic examination was performed to all patients at 3 months postoperatively for evaluation of IUA. Primary endpoint was the reduction rate of IUA at 3 months after surgery. The secondary endpoints include total AFS score, score of each individual AFS category., Results: At 3 months after surgery, auto-crosslinked HA gel resulted in significantly higher effective rate for reduction of adhesion, the effective rate were 76% (42/55) and 48% (27/56) respectively (P = 0.000 9); the total AFS score of treatment group was 2.1 ± 1.1, and significantly lower than that of control group (3.7 ± 2.5, P = 0.000 8). Application of auto-crosslinked HA gel after surgery significantly enhanced the improvement for each individual patient with regard to their adhesive type and menstrual pattern (P = 0.037 8, P = 0.000 4). The treatment group had significantly lower proportion of patients with moderate to severe adhesive stages than that of control group [13% (7/55) versus 38% (21/56), P = 0.000 6]. No adverse events and complications were observed., Conclusions: Auto-crosslinked HA gel coule be able to reduce IUA, decrease adhesion severity, and improve menopause postoperatively. This absorbable auto-crosslinked HA gel is proposed as a barrier for preventing IUA after intrauterine procedures.

Objective: To analyze data from the hysteroscopic adhesiolysis of moderate-to-severe intrauterine adhesions (IUAs), and to review the disease etiology, changes in menstruation, uterine recovery, and reproductive prognosis of women after comprehensive therapy., Methods: In a retrospective descriptive analysis, clinical data were assessed from 683 patients with moderate-to-severe IUAs who were treated by hysteroscopic adhesiolysis at Third Xiangya Hospital, Changsha, China, between January 2007 and December 2011. Patients underwent comprehensive treatment. After hysteroscopic adhesiolysis, a persistent balloon urinary catheter was inserted, together with an intrauterine device (IUD). Intrauterine sodium hyaluronate gel was injected to prevent adhesion reformation, and oral estrogen was administered to promote endometrial regeneration. The outcomes were menstrual changes and uterine recovery under hysteroscopy, and the reproductive prognosis of patients with fertility intentions., Results: At the 3-month follow-up, the postoperative recovery of uterine shape was better than the recovery of menstruation among patients with moderate-to-severe IUAs. Among the 475 patients with fertility intentions, the pregnancy and live birth rates were 66.1% (314/475) and 64.0% (201/314), respectively., Conclusion: Comprehensive treatment prevented the recurrence of IUAs to a certain extent, but some severe endometrial injuries were found to be irreparable, reducing the rate of subsequent pregnancy and live birth., (Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)