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Surgical Management of Retained Placental Tissue with the Hysteroscopic Morcellation Device.

ABSTRACT: Conventionally, surgical management of retained placental tissue is largely performed using blind dilatation and curettage. Hysteroscopic removal using diathermy loop has been shown to be successful while increasing complete removal rates and reducing risk of uterine perforation. Our two cases demonstrated that complete removal of placental tissues can be achieved with hysteroscopic morcellation device which is known to be associated with less operative time and less operative risk compared to diathermy loop. Preoperative transamin can reduce intraoperative bleeding, while careful preparation must be made for bleeding immediately after the procedure when the hysteroscope is withdrawn and distended uterus slowly contracts.

SUBMITTER: Lee MHM

PROVIDER: S-EPMC6367913 | biostudies-literature | 2019 Jan-Mar

REPOSITORIES: biostudies-literature

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Surgical Management of Retained Placental Tissue with the Hysteroscopic Morcellation Device.

Lee Man Hin Menelik MHM

Gynecology and minimally invasive therapy 20190123 1

Conventionally, surgical management of retained placental tissue is largely performed using blind dilatation and curettage. Hysteroscopic removal using diathermy loop has been shown to be successful while increasing complete removal rates and reducing risk of uterine perforation. Our two cases demonstrated that complete removal of placental tissues can be achieved with hysteroscopic morcellation device which is known to be associated with less operative time and less operative risk compared to d ...[more]

PMID: 30783587

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Project description:PurposeTo evaluate the quality of life in patients treated for submucosal leiomyomas after hysteroscopic myomectomy compared to medical therapy. This is the first prospective randomized analysis comparing outcomes of medical therapy versus hysteroscopic myomectomy using the TruClear™ hysteroscopic tissue removal system to treat heavy menstrual bleeding from submucosal leiomyoma(s).MethodsSetting: private practice and community-based hospital; subjects: female patients with symptomatic submucosal leiomyomas from 2014 to 2017. A total of 69 patients enrolled, with 47 completed.Statistical analysis usedrandomization, linear mixed-effects modeling, hypothesis testing, and intent-to-treat analysis. Each patient was randomized to oral contraceptive pills/progesterone releasing intrauterine device or hysteroscopic myomectomy. Each patient was to complete the Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire at baseline, one month, three months, and greater than or equal to six months after treatment.Main outcome measuredPrimary outcome was the health-related quality of life (HR-QOL), as reflected from UFS-QOL scores. Contrasts were constructed from a linear mixed-effects model to compare the two treatment groups for changes from baseline in UFS-QOL scores.ResultsUFS-QOL scores were similar at baseline between the two treatment groups. There was an overall improvement in all UFS-QOL scores within each group. Higher improvement scores were noted in the surgical group compared to the medical group for almost all UFS-QOL scores. At ≥ 6 months, in comparison to the medically managed patients, the most considerable score improvements for the surgical group were reported in HR-QOL concern, activities, self-consciousness and symptom severity scores having mean change scores (95% CIs) of 35.3, 28.9, 28.6, and 32.2, respectively.ConclusionAlthough there was no statistical difference in the change degree of improvement of overall quality of life among patients with symptomatic submucosal leiomyomas who received medical or surgical treatments in the study, there were greater differences in improvements in health-related quality of life scores over time after surgical treatment.

Project description:BackgroundFemale sterilization is the second most commonly used method of contraception in the United States. Female sterilization can now be performed through laparoscopic, abdominal, or hysteroscopic approaches. The hysteroscopic sterilization may be a safer option than sterilization through laparoscopy or laparotomy because it avoids invading the abdominal cavity and undergoing general anaesthesia. Hysteroscopic sterilization mainly includes chemical agents and mechanical devices. Common issues related to the toxicity of the chemical agents used have raised concerns regarding this kind of contraception. The difficulty of the transcervical insertion of such mechanical devices into the fallopian tubes has increased the high incidence of device displacement or dislodgment. At present, Essure® is the only commercially available hysteroscopic sterilization device being used clinically. The system is irreversible and is not effective immediately.Presentation of the hypothesisOur new hysteroscopic sterility system consists of nickel-titanium (NiTi) shape memory alloy and a waterproof membrane. The NiTi alloy is covered with two coatings to avoid toxic Ni release and to prevent stimulation of epithelial tissue growth around the oviducts. Because of the shape memory effect of the NiTi alloy, the device works like an umbrella: it stays collapsed at low temperature before placement and opens by the force of shape memory activated by the body temperature after it is inserted hysteroscopically into the interstitial tubal lumen. The rim of the open device will incise into interstitial myometrium during the process of unfolding. Once the device is fixed, it blocks the tube completely. When the patient no longer wishes for sterilization, the device can be closed by perfusing liquid with low temperature into the uterine cavity, followed by prospective hysteroscopic removal. After the device removal, the fallopian tube will revert to its physiological functions.Testing the hypothesisCurrently, experimental and clinical studies are needed to attest the safety, efficiency and reversibility of the novel sterilization device.Implications of the hypothesisIf our hypothesis is confirmed, appropriate and reversible contraceptive can be achieved with the device we have designed, which may have significant repercussions for numerous women worldwide.

Dataset Information

Surgical Management of Retained Placental Tissue with the Hysteroscopic Morcellation Device.

Publications

Surgical Management of Retained Placental Tissue with the Hysteroscopic Morcellation Device.

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