Whereas resectoscopy is more commonly used, morcellation is less described in the management of retained products of conception.
concluded that hysteroscopic morcellation was associated with a higher operative success (odds ratio 4.5) rate and a shorter operative time among patients with endometrial lesions compared to resectoscopy .
Wang, "A systematic review and meta-analysis of randomized controlled trials comparing hysteroscopic morcellation with resectoscopy for patients with endometrial lesions," International Journal of Gynecology and Obstetrics, vol.
All these devices work with physiologic saline solution as distension and irrigation media, instead of the electrolyte-free solutions used for monopolar high-frequency resectoscopy.
In this regard, usually a maximum fluid deficit of 1000 mL is recommended, but with the advent of bipolar electrosurgical systems in traditional resectoscopy and in HTRs a deficit of 2500 mL of isotonic solution is well tolerated by healthy women .
Despite the introduction of HTRs in the clinical practice several years ago, published data about their use for the management of SMs are so far extremely limited, especially because this technique was not so attractive for surgeons, probably due to the large consent gained through the time by traditional resectoscopy. The available studies differ significantly regarding methodology and inclusion and exclusion criteria, and these elements clearly affect the comparison of intra- and postoperative outcomes among them.
The Truclear system also is associated with a significantly shorter operative time, compared with resectoscopy, which may be advantageous for residents, fellows, and other physicians learning the procedure (FIGURE 3, page 30).
(1) When the mechanical approach is used, rather than resectoscopy, continuous flow coupled with suctioning of the chips during the procedure keeps the image clear.
Lasmar and colleagues devised a new system for preoperative assessment of submucosal myomas, hoping to estimate more precisely the likelihood of successful removal via resectoscopy
. They call their system the New Classification (NC).
Hysteroscopic morcellators offer advantages over traditional resectoscopy
, making hysteroscopic myomectomy of Type 0 and Type I myomas safer and more feasible for gynecologic surgeons.