Chunbo Li1, Zhiyuan Dai1, Yuping Gong2, Bingying Xie3, Bei Wang4. 1. Department of Obstetrics and Gynaecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China. 2. Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai, China. 3. Department of Gynaecology and Obstetrics, Gynaecology and Obstetrics Hospital of Fudan University, Shanghai, China. 4. Department of Anesthesia, Zhongshan Hospital of Fudan University, Shanghai, China.
Abstract
BACKGROUND: Results on the efficacy of hysteroscopic morcellation for patients with endometrial lesions remain conflicting. OBJECTIVES: To compare hysteroscopic morcellation with conventional resectoscopy for removal of endometrial lesions. SEARCH STRATEGY: Electronic databases were searched for reports published up to February 1, 2016, using terms such as "morcellator," "morcellators," "morcellate," "morcellation," "morcellated," "hysteroscopy," "hysteroscopy," "uteroscope," and "transcervical." SELECTION CRITERIA: Randomized controlled trials were included if they assessed success rate, procedure speed, complications, tolerability, and/or learning curve. DATA COLLECTION AND ANALYSIS: Data were extracted by two independent reviewers and a meta-analysis was performed. MAIN RESULTS: Four trials including 392 patients were analyzed. Successful removal of all endometrial lesions was more frequent with hysteroscopic morcellation than conventional resectoscopy (odds ratio 4.49, 95% confidence interval [CI] 1.94-10.41; P<0.001). Total operative time was also shorter with hysteroscopic morcellation (mean difference -4.94 minutes, 95% CI -7.20 to -2.68; P<0.001). No significant differences in complications were found. Meta-analyses were not possible for tolerability and learning curve. In one study, hysteroscopic morcellation was acceptable to more patients (P=0.009). CONCLUSIONS: Hysteroscopic morcellation is associated with a higher operative success rate and a shorter operative time among patients with endometrial lesions than is resectoscopy. More high-quality trials are required to validate these results.
BACKGROUND: Results on the efficacy of hysteroscopic morcellation for patients with endometrial lesions remain conflicting. OBJECTIVES: To compare hysteroscopic morcellation with conventional resectoscopy for removal of endometrial lesions. SEARCH STRATEGY: Electronic databases were searched for reports published up to February 1, 2016, using terms such as "morcellator," "morcellators," "morcellate," "morcellation," "morcellated," "hysteroscopy," "hysteroscopy," "uteroscope," and "transcervical." SELECTION CRITERIA: Randomized controlled trials were included if they assessed success rate, procedure speed, complications, tolerability, and/or learning curve. DATA COLLECTION AND ANALYSIS: Data were extracted by two independent reviewers and a meta-analysis was performed. MAIN RESULTS: Four trials including 392 patients were analyzed. Successful removal of all endometrial lesions was more frequent with hysteroscopic morcellation than conventional resectoscopy (odds ratio 4.49, 95% confidence interval [CI] 1.94-10.41; P<0.001). Total operative time was also shorter with hysteroscopic morcellation (mean difference -4.94 minutes, 95% CI -7.20 to -2.68; P<0.001). No significant differences in complications were found. Meta-analyses were not possible for tolerability and learning curve. In one study, hysteroscopic morcellation was acceptable to more patients (P=0.009). CONCLUSIONS: Hysteroscopic morcellation is associated with a higher operative success rate and a shorter operative time among patients with endometrial lesions than is resectoscopy. More high-quality trials are required to validate these results.
Authors: M Franchini; O Ceci; P Casadio; J Carugno; G Giarrè; G Gubbini; U Catena; M Chiara de Angelis; A Di Spiezio Sardo Journal: Facts Views Vis Obgyn Date: 2021-06-10