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Published: 1 October 2000
Obstetrics & Gynecology, Volume 96, pp 517-520; https://doi.org/10.1016/s0029-7844(00)00958-3

The publisher has not yet granted permission to display this abstract.
Hua Duan, , Lanfen Li
Published: 1 November 2002
Zhonghua fu chan ke za zhi, Volume 37

Abstract:
To investigate the clinical characteristics, treatment and prevention methods of severe complications during hysteroscopic procedures.
S Kayatas, E Meseci, O Aydin Tosun, S Arzu Arinkan, L Uygur, M Api
Clinical and Experimental Obstetrics & Gynecology, Volume 41

Abstract:
To evaluate the indications, intraoperative diagnoses, and complication rates of both diagnostic and operative hysteroscopic procedures.
Martin L. Schwartz, Keith Isaacson, David L. Olive
The Journal of the American Association of Gynecologic Laparoscopists, Volume 6; https://doi.org/10.1016/s1074-3804(99)80082-6

Raz Bahar, Michal Shimonovitz, Avi Benshushan, Asher Shushan
Journal of Minimally Invasive Gynecology, Volume 20, pp 376-380; https://doi.org/10.1016/j.jmig.2012.12.012

Abstract:
To examine whether all hysteroscopic operations can be performed using bipolar technology and to compare the complication rates of hysteroscopic surgery performed using monopolar and bipolar technology.
A Chokri, M Chekib, Z Fethi, F Anis, M Sadok
Published: 24 February 2001
La Tunisie medicale, Volume 78

Abstract:
Uterine rupture during a pregnancy may occur following hysteroscopic metropasty. We report the case of a patient with a history of hysteroscopic resection complicated by of uterine rupture during pregnancy.
B Aydeniz, I.V Gruber, B Schauf, R Kurek, A Meyer, D Wallwiener
European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 104, pp 160-164; https://doi.org/10.1016/s0301-2115(02)00106-9

Abstract:
The following study analyses the hysteroscopic experience of multiple gynecologic centers throughout Germany in regard to the incidence of complications, the therapy of these complications and anesthesiological management during 21,676 hysteroscopic procedures. Under the supervision of the German Society of Gynecology Endoscopy, 92 hysteroscopic centers were evaluated and the following information was collected: hysteroscopic experience in years, number of surgical hysteroscopies per year, total number of operative hysteroscopies, types of hysteroscopic procedures, intra- and post-operative complications. The results of the study show that in most German centers, hysteroscopy is just being established. Nevertheless, the rate of complications such as perforation of the uterus, fluid-overload syndrome, infection and perioperative bleeding is small. This may be due to the high proportion of documented procedures performed by the more experienced centers.
J Zhang, W Shi
Journal of Minimally Invasive Gynecology, Volume 22; https://doi.org/10.1016/j.jmig.2015.08.360

The publisher has not yet granted permission to display this abstract.
Anja H Brügmann, Sven Erik Kristoffersen, Anne Kirkeby Hansen, Jan Bjørn Nielsen
Published: 4 June 2007
Ugeskrift for laeger, Volume 169

Abstract:
Gas embolism has been described as a complication of operative hysteroscopy. We present one of two non-fatal case stories where gas embolization was suspected due to symptoms observed by the anaesthesiologist and discuss how to prevent it.
Dale C. Birdsell, Fiona Mattatall, Albert M. Rosengarten, Sheila D. Watson
Journal of Obstetrics and Gynaecology Canada, Volume 32; https://doi.org/10.1016/s1701-2163(16)34702-8

Mueller, M Buttarelli, A Cromi, E Di Naro, M Franchi, F Ghezzi, L Raio
The Journal of the American Association of Gynecologic Laparoscopists, Volume 9; https://doi.org/10.1016/s1074-3804(02)80238-9

Yasushi Kotani, Eiji Koike, Masahiko Umemoto, , Ayako Miyazaki, Natsuki Ugajin, Koshiro Obata, Mitsuru Shiota, Hiroshi Hosiai
JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY, Volume 27, pp 473-477; https://doi.org/10.5180/jsgoe.27.473

Shayista Nabi
European Journal of Medical and Health Sciences, Volume 4, pp 13-16; https://doi.org/10.24018/ejmed.2022.4.3.1312

Abstract:
Operative Hysteroscopy is a minimally invasive, safe and well tolerated procedure. Prevention of complications is crucial for patient care. The complication rate in diagnostic hysteroscopy is low 0.012%. Complications from operative hysteroscopy are more common and potentially more serious. These risks are highest with more complex hysteroscopic procedures like myomectomy and adhesiolysis. Complications of Operative Hysteroscopy can be early or late complications. Early include anesthetic complications, complications of distention media, cervical trauma, haemorrhage, perforation, and air embolism. Late ones are infections, adhesions. As Hysteroscopy continues to become popular, the importance of preventing, identifying, and managing complications is of utmost importance. Some problems are inherent in operative hysteroscopy, but large number of complications can be prevented by proper preoperative evaluation and surgical techniques. Appropriate training programmes and expertise are key to safe and successful hysteroscopy.
Morris Wortman, George A. Vilos, Angelos G. Vilos, Basim Abu-Rafea, Wendy Dwyer, Robert Spitz
JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons, Volume 21; https://doi.org/10.4293/jsls.2017.00011

Abstract:
Many women have undergone both resectoscopic and nonresectoscopic (or global) endometrial ablation (EA) during the past 20 years. These women are now approaching their sixth and seventh decades of life, a time frame in which endometrial carcinoma (EC) is most frequently diagnosed. In several reports, surgeons have expressed concern that endometrial ablation may leave a sequestered island of EC that may escape detection, possibly delaying its diagnosis or causing it to appear at an advanced stage. Others suggest that EA artifact does not hinder the evaluation and treatment planning in the presence of EC. Data bases used are from Medline and PubMed. We introduce 6 new cases of postablation endometrial carcinoma (PAEC), 4 of which occurred after the introduction of global endometrial ablation (GEA) techniques. In addition, we examine several key questions regarding the impact of EA on the subsequent development of EC, including the manner in which PAEC presents, the efficacy of traditional diagnostic modalities, the ablation-to-cancer interval, and the stage of PAEC at the time of diagnosis. Finally, we explore the use of reoperative hysteroscopic surgery (RHS) as a diagnostic modality and address the possible role ultrasound surveillance as a screening method for women at risk of EC.
, Marion Bertrand, Georges Bader, Jean-Philippe Lucot, ,
Published: 23 January 2018
JAMA, Volume 319, pp 375-387; https://doi.org/10.1001/jama.2017.21269

Abstract:
Safety of hysteroscopic sterilization has been recently questioned following reports of general symptoms such as allergy, tiredness, and depression in addition to associated gynecological results such as pelvic pain, perforation of fallopian tubes or uterus, and unwanted pregnancy. To compare the risk of reported adverse events between hysteroscopic and laparoscopic sterilization. French nationwide cohort study using the national hospital discharge database linked to the health insurance claims database. Women aged 30 to 54 years receiving a first hysteroscopic or laparoscopic sterilization between 2010 and 2014 were included and were followed up through December 2015. Hysteroscopic sterilization vs laparoscopic sterilization. Risks of procedural complications (surgical and medical) and of gynecological (sterilization failure that includes salpingectomy, second sterilization procedure, or pregnancy; pregnancy; reoperation) and medical outcomes (all types of allergy; autoimmune diseases; thyroid disorder; use of analgesics, antimigraines, antidepressants, benzodiazepines; outpatient visits; sickness absence; suicide attempts; death) that occurred within 1 and 3 years after sterilization were compared using inverse probability of treatment-weighted Cox models. Of the 105 357 women included (95.5% of eligible participants; mean age, 41.3 years [SD, 3.7 years]), 71 303 (67.7% ) underwent hysteroscopic sterilization, and 34 054 (32.3%) underwent laparoscopic sterilization. During the hospitalization for sterilization, risk of surgical complications for hysteroscopic sterilization was lower: 0.13% for hysteroscopic sterilization vs 0.78% for laparoscopic sterilization (adjusted risk difference [RD], -0.64; 95% CI, -0.67 to -0.60) and was lower for medical complications: 0.06% vs 0.11% (adjusted RD, -0.05; 95% CI, -0.08 to -0.01). During the first year after sterilization, 4.83% of women who underwent hysteroscopic sterilization had a higher risk of sterilization failure than the 0.69% who underwent laparoscopic sterilization (adjusted hazard ratio [HR], 7.11; 95% CI, 5.92 to 8.54; adjusted RD, 4.23 per 100 person-years; 95% CI, 3.40 to 5.22). Additionally, 5.65% of women who underwent hysteroscopic sterilization required gynecological reoperation vs 1.76% of women who underwent laparoscopic sterilization (adjusted HR, 3.26; 95% CI, 2.90 to 3.67; adjusted RD, 4.63 per 100 person-years; 95% CI, 3.38 to 4.75); these differences persisted after 3 years, although attenuated. Hysteroscopic sterilization was associated with a lower risk of pregnancy within the first year of the procedure but was not significantly associated with a difference in risk of pregnancy by the third year (adjusted HR, 1.04; 95% CI, 0.83-1.30; adjusted RD, 0.01 per 100 person-years; 95% CI, -0.04 to 0.07). Risks of medical outcomes were not significantly increased with hysteroscopic sterilization compared with laparoscopic sterilization. Among women undergoing first...
Erin MacLean-Fraser, Deborah Penava, George A. Vilos
The Journal of the American Association of Gynecologic Laparoscopists, Volume 9, pp 175-177; https://doi.org/10.1016/s1074-3804(05)60127-2

Abstract:
To determine perioperative complication rates at primary and repeat endometrial ablations.
Gynecologic and Obstetric Investigation, Volume 82, pp 569-574; https://doi.org/10.1159/000455044

Abstract:
Venous air embolism (VAE) is a rare but potentially fatal complication of hysteroscopic myomectomy. The symptoms of VAE range from mild and clinically insignificant to complete cardiovascular collapse during surgery. Anesthesiologists and surgeons should be aware of the clinical characteristics and predisposing factors of this possible adverse event. This report analyzes 7 cases of VAE, which occurred at the University Hospitals Leuven, in patients undergoing hysteroscopic myomectomy from April 2009 to April 2011. Patient and myoma characteristics were compared to a control group of 27 patients who underwent uneventful hysteroscopic myomectomy during the same period of time. Analysis of baseline data including myoma size failed to identify predisposing factors. Clinical events in this series were classified according to their severity as minor (causing respiratory symptoms in 2 cases), moderate (accompanied by hemodynamic instability in 5 cases), or severe (requiring resuscitation in no cases). Case characteristics and therapeutic strategies in all cases were compared to reports from recent literature.
Huse Kamencic, Luke Thiel, Erwin Karreman, John Thiel
Journal of Minimally Invasive Gynecology, Volume 23, pp 1158-1162; https://doi.org/10.1016/j.jmig.2016.08.823

Abstract:
Essure sterilization can be associated with new-onset pain or a worsening of a pre-existing painful gynecologic condition, although both are very rare. A careful and complete consent before placement and a thorough examination if pain does occur usually show some etiology for the pain other than the Essure insert.
A G Gordon
Baillière's Clinical Obstetrics and Gynaecology, Volume 9

The publisher has not yet granted permission to display this abstract.
J Salat-Baroux, J Hamou, J M Antoine
Bulletin de l'Académie Nationale de Médecine, Volume 180

Abstract:
A study carried out on 342 cases of endometrial resection, with a follow up of 3 to 36 months, has allowed us to precise: 1. The indications of this technique: patients more than 40 years, suffering of abnormal uterine bleeding. 2. The endometrial ablation was performed by electrosurgery through an operating channel of the hysteroscopic sheet (9 mm) and with a glycocol distended media (1.5%). The mean time to complete the operation was 35 +/- 10 minutes, the mean length of the hospital stay was 1 day. We had no serious complications. 3. And the rate of success (amenorrhea or hypomenorrhea) was 95% at 3 months but decreased at 90% at 36 months. The rate of secondary hysterectomy was 10%, due to the associated lesions: myoma with adenomyosis in 50% of the cases. There was some evidence of superior health related quality of life among hysterectomy patients. It's the reason why it is necessary to make a serious selection of the patients who are to be treated by this method in order to avoid complications and secondary hysterectomy.
Current Opinion in Obstetrics & Gynecology, Volume 13, pp 407-410; https://doi.org/10.1097/00001703-200108000-00006

Abstract:
The treatment of menorrhagia in the twentieth century changed after 1960 with the introduction of hormonal therapy as well as an array of laboratory, imaging and minimal access tests for more accurate diagnosis. Since 1981, hysteroscopy has been used for diagnosis as well as the control of thermoablative treatments of bleeding non-malignant endometrium, including laser, electrocoagulation and electroresection. The success rates, complications, intermediate range outcome and cost comparisons with hysterectomy favor hysteroscopic methods. But the long term data on both hysteroscopic ablation and hysterectomy are not yet complete. In an effort to simplify techniques, reduce costs, and reduce complications, a variety of non-hysteroscopic methods and devices have appeared. Only two balloon devices have satisfactory success data as well as sufficient field experience to provide some degree of reliability regarding complications, which appear to be very low. Most of the devices have had clinical trials, which suggest equivalence to hysteroscopic endometrial ablation, but the determination of clinical safety requires at least several thousand cases. However, the levels of effectiveness for most of these devices make them candidates for commercial use. Hysterectomy may move from a primary surgical treatment of menorrhagia to a second-line treatment after ablation, particularly if some of the non-hysteroscopic methods become well accepted. If they are found to be safe, the costs and ease of use for the gynecologist and patient will make them attractive as a first-line surgical option. Hysterectomy, whether abdominal, vaginal, or laparoscopic will then be applied to ablation failures or non-candidates. This has the potential to change gynecological training and practice significantly in the future.
Minako Koizumi, Hisahiko Hiroi,
Nihon rinsho. Japanese journal of clinical medicine, Volume 68

Abstract:
Hysteroscopic surgery is considered to be a minimally-invasive procedure. This technique is associated with a shorter hospital stay and a rapid recovery time. At present, with the development of operative technique and instrumention, hysteroscopic surgery is widely performed to disease of endometrial cavity, tubal ostia, or endocervical canal. This procedure needs highly trained technique and can lead to number of associated complications, including uterine perforation and hyponatremia. Falloscpoic tuboplasty (FT) is regarded as a useful and less invasive method for the treatment of tubal occlusion, whereas the operator should have prior experience to avoid the complications such as tubal perforation and damage of instruments. Selective hydrotubation (SHT) with flexible hysterofiberscope is an also effective method for evaluating and managing tubal obstruction. SHT has the advantage of being an easy procedure and can be carried out safely in an outpatient setting.
S Sugaya, T Yahata, N Nishikawa, Y Arinami, T Maruhashi, K Takakuwa, K Tanaka
Clinical and Experimental Obstetrics & Gynecology, Volume 39

Abstract:
Although severe Asherman's syndrome is a disease that may cause infertility, pregnancy and childbirth are possible by performing hysteroscopic surgery. However, the obstetrical outcome is not always satisfactory. We report a case where severe Asherman's syndrome occurred following a cesarean section. Hysteroscopic surgery was performed due to secondary infertility, and pregnancy was achieved through a subsequent intracytoplasmic sperm injection. At 23 weeks of gestation, the patient was hospitalized due to the threat of premature labor, and a cesarean section was performed at 29 weeks of gestation after pregnancy-induced hypertension occurred. It was determined to be abnormal adherent placentation such as placenta increta through intraoperative findings, and a cesarean hysterectomy was performed. The pathological diagnosis of the uterus was placenta increta. Due to the risk of complications from placenta increta in pregnancies following hysteroscopic surgery in patients with severe Asherman's syndrome, it is important to realize the high risk involved in such cases during the pregnancy course, and careful perinatal management should be required.
Reproductive Surgery in Assisted Conception pp 197-207; https://doi.org/10.1007/978-1-4471-4953-8_19

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Ivan Mazzon, , Mario Grasso, Stefano Horvath, ,
Journal of Minimally Invasive Gynecology, Volume 22, pp 792-798; https://doi.org/10.1016/j.jmig.2015.03.004

Abstract:
To assess the safety and efficacy of cold loop hysteroscopic myomectomy in a large series of cases.Retrospective study (Canadian Task Force Classification III).Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy.A total of 1215 patients with 1 or more G1-G2 submucous myomas.Cold loop hysteroscopic myomectomy.A total of 1690 myomas were removed. A minimum of 1 to a maximum of 5 fibroids for each surgical procedure were totally removed. Out of 1215 patients, 1017 (83.7%) were treated with a single surgical procedure. Twelve intraoperative complications occurred (0.84%). No cases of uterine perforation with the thermal loop or clinical intravasation syndrome were reported.Cold loop hysteroscopic myomectomy seems to represent a safe and effective procedure for the removal of submucous myomas with intramural development, while at the same time respecting the anatomic and functional integrity of the myometrium. The use of a cold loop in resectoscopic myomectomy is associated with a low rate of minor intraoperative complications and an absence of major complications. This could be of primary relevance with a view to fertility and future pregnancies.
A. Hamidouche, M. Vincienne, T. Thubert, C. Trichot, G. Demoulin, A.L. Rivain,
Gynécologie Obstétrique & Fertilité, Volume 43, pp 104-108; https://doi.org/10.1016/j.gyobfe.2014.12.012

The publisher has not yet granted permission to display this abstract.
Samuel Smith
Practical Manual of Operative Laparoscopy and Hysteroscopy pp 199-215; https://doi.org/10.1007/978-1-4684-0430-2_21

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B Povedano, J E Arjona, E Velasco, J A Monserrat, J Lorente,
BJOG: An International Journal of Obstetrics & Gynaecology, Volume 119, pp 795-799; https://doi.org/10.1111/j.1471-0528.2012.03292.x

The publisher has not yet granted permission to display this abstract.
Mark Hans Emanuel, Kees Wamsteker
Journal of Minimally Invasive Gynecology, Volume 12, pp 62-66; https://doi.org/10.1016/j.jmig.2004.12.011

Abstract:
Conclusion This new technique is faster, and it appears to be easier to perform. Therefore, it can be expected to result in fewer fluid-related complications and to lead to a shorter learning curve when compared with conventional resectoscopy.
Chris Sutton
Best Practice & Research Clinical Obstetrics & Gynaecology, Volume 20, pp 105-137; https://doi.org/10.1016/j.bpobgyn.2005.10.002

Abstract:
Hysteroscopy and visually directed endometrial sampling have replaced blind curettage for the diagnosis of endometrial disease. Hysteroscopy can be used to detect endometrial cancer and various premalignant lesions, as well as to diagnose intrauterine polyps and submucous fibroids. It can also be used to locate lost intrauterine devices, assess the shape and size of the endometrial cavity during an infertility work-up and to visualise intrauterine septae and adhesions. If the hysteroscopist possesses special skills and training, it can be used to perform intrauterine sterilisation by occluding the tubal ostia. The ability to perform endometrial ablation as an alternative to hysterectomy in patients with menorrhagia has led to reduction in the number of hysterectomies performed. Long-term follow-up has confirmed the success of this procedure, but it is not without complications. The inherent dangers and complications of endometrial ablation and the considerable skill and training it requires has led to the development of numerous second-generation devices, which can involve balloons that are heated with circulating fluid, impedance-controlled endometrial ablation or surface electrodes, heated fluid running through the hysteroscope under direct vision or the use of microwaves or cryotherapy. This chapter reviews the techniques, potential complications and evidence for the effectiveness of the common diagnostic and therapeutic hysteroscopic procedures.
Luke Thiel, Darrien Rattray, John Thiel
Journal of Minimally Invasive Gynecology, Volume 24; https://doi.org/10.1016/j.jmig.2016.07.004

Abstract:
The authors present a laparoscopic technique for complete removal of Essure microinserts (including nitinol coil and positron emission tomography fibers). Step-wise instruction using video. The study was granted a Research Ethics Board exemption because the Regina Qu'Appelle Health Region Research Ethics Board does not require ethics board approval for single case submissions. Tertiary care hospital. Patient requesting removal of Essure inserts because of post-placement discomfort. Recent concern regarding adverse outcomes (persistent pelvic pain, device malposition, nickel allergy) after Essure placement has led to a small percentage of women requesting removal of the coils. Laparoscopic salpingectomy and salpingostomy have been successfully used for removal. Hysteroscopic removal has been achieved up to 6 weeks after placement; however, because of the fibrosis-inducing mechanism of the inserts, there is theoretical concern regarding fragmentation or incomplete removal with a cut and pull approach. The authors used a laparoscopic surgical approach for removal of the Essure microinserts "en bloc" by performing a salpingectomy and mini-resection of the uterine cornua to the level of the endometrium. This approach ensures complete extraction of the Essure microinserts. The surgery was completed in a tertiary care hospital operating theatre with standard laparoscopic and electrosurgical instruments using a 10-mm infraumbilical port and two 5-mm ports in the left lower quadrant. En bloc resection of the fallopian tubes, uterine cornua, and Essure microinserts is a feasible laparoscopic approach to ensure complete removal of Essure microinserts. This approach is technically straightforward and can be achieved with minimal blood loss.
G Bacskó, T Major, P Csiszár, A Borsos
Published: 1 January 1997
Acta chirurgica Hungarica, Volume 36

Abstract:
Diagnostic hysteroscopy is a valuable method for evaluation of intrauterine disorders. After diagnosing, the endoscopic treatment of these pathologies is the major question of past decade. Possibility of solving cause of infertility or abnormal uterine bleeding without laparotomy or hysterotomy/hysterectomy is the great advantage of operative hysteroscopic methods. In Department of Obstetrics and Gynaecology of University Medical School of Debrecen more than 1400 hysteroscopic interventions were performed from 1 September 1989 to 31 December 1996. In treatment of intractable uterine bleeding 347 operative hysteroscopy (targeted biopsy, polypectomy, transcervical endometrial ablation, fibroid resection etc.) were performed. The rate of complications was low, only 2% (4 perforations and 2 bleedings). The high success rate and low rate of complications offers a modern, safe, minimally invasive method for treatment of menorrhagia.
M. König, A. Meyer, B. Aydeniz, R. Kurek, D. Wallwiener
Published: 1 January 2000
Female Stress Incontinence, Volume 20, pp 161-170; https://doi.org/10.1159/000060275

Abstract:
During the last few years, diagnostic hysteroscopy has become a standard procedure in the diagnosis of abnormal uterine bleeding, sonographically suspicious endometrial reflex and fertility disorders. At the same time the hysteroscopic treatment of intrauterine pathology is becoming more common. Today, hysteroscopic resection of uterine myomas, dissection of uterine septa, and endometrial ablation are standard procedures. Using monopolar cutting devices and saline-free distension media, hysteroscopic surgery bears specific risks. The knowledge of these risks is important to avoid typical complications of operative hysteroscopy. This article gives an overview about the most common procedures of operative hysteroscopy and the combined risks. Criteria for a safe procedure are defined in order to increase the quality management of operative hysteroscopy.
C Rajakumar, K Lortie
Journal of Minimally Invasive Gynecology, Volume 22; https://doi.org/10.1016/j.jmig.2015.08.027

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, Thoralf Schollmeyer, , , Ibrahim Alkatout
Obstetrics and Gynecology International, Volume 2012, pp 1-8; https://doi.org/10.1155/2012/791248

Abstract:
A critical analysis of the surgical treatment of fibroids compares all available techniques of myomectomy. Different statistical analyses reveal the advantages of the laparoscopic and hysteroscopic approach. Complications can arise from the location of the fibroids. They range from intermittent bleedings to continuous bleedings over several weeks, from single pain episodes to severe pain, from dysuria and constipation to chronic bladder and bowel spasms. Very seldom does peritonitis occur. Infertility may result from continuous metro and menorrhagia. The difficulty of the laparoscopic and hysteroscopic myomectomy lies in achieving satisfactory haemostasis using the appropriate sutures. The hysteroscopic myomectomy requires an operative hysteroscope and a well-experienced gynaecologic surgeon.
, Suketu M. Mansuria, Beatrice A. Chen, Ted T. Lee
Journal of Minimally Invasive Gynecology, Volume 15, pp 362-365; https://doi.org/10.1016/j.jmig.2007.10.008

Abstract:
Hysteroscopic Essure sterilizations offer women and physicians another option for contraception. Overall, the procedure is simple to perform and highly efficacious, and as a result, has gained popularity among practicing gynecologists. Unfortunately, complications occur with any type of surgery. We report 3 cases of hysteroscopic Essure sterilization complications where the Essure microinsert was noted to be misplaced or where patients had persistent postprocedure pain in the setting of appropriately placed microinserts. In all 3 cases, the microinserts were successfully removed laparoscopically.
Waixing Li, Bingsi Gao, Zhenkun Guan, Xingping Zhao, Huan Huang, Aiqian Zhang, Grace Johnson, Jeffrey Woo, Chunxia Cheng, XiaoMing Guan, et al.
Published: 24 July 2021
Fertility and Sterility, Volume 116, pp 1423-1425; https://doi.org/10.1016/j.fertnstert.2021.06.017

Abstract:
Objective To demonstrate an easier surgical strategy by using the marking technique for hysteroscopic incision of the uterine septum using 5-French cold scissors. Design A step-by-step surgical video demonstration. Setting Gynecologic department of the affiliated hospital. Patient(s) A 33-year-old woman presented with a 4-year history of primary infertility. She previously had undergone transcervical resection of (uterine) septum owing to the presence of a complete uterine septum and double cervices. Postoperative 3-dimensional ultrasound revealed a 1.2-cm residual uterine septum, and the outline of the uterine fundus was flat. A second surgery for resection of the residual septum was recommended before in vitro fertilization and embryo transfer. We used the Campo hysteroscope (4.4-mm outer sheath) and 5-French scissors with our modified marking strategy to incise the incomplete uterine septum. Intervention(s) There were several critical strategies for this approach. After fully exposing 2 fallopian tube ostia, a 3–5-mm mark was made on each side of the uterine fundus where the septum ended, and the marks were parallel to the fallopian tubal ostia. The septum then was incised along the line between the two previously marked points that served as the endpoints. Care was taken to avoid incising myometrial blood vessels during incision, and the 5-French bipolar electrode was used for coagulation when necessary. At the end of the surgery, the distension pressure was gradually decreased to 80 mm Hg to confirm hemostasis of the wound before withdrawing the hysteroscope. Main Outcome Measure(s) Description of a modified hysteroscopic technique. Result(s) The overall operation time was 10 minutes, and the estimated blood loss was 5 mL. The residual septum was resected successfully while maintaining optimal hysteroscopic visualization. There were no short-term complications, such as uterine perforation or fluid overload. Hysteroscopic evaluation performed 3 months after surgery revealed that the uterine cavity was nearly normal, with no intrauterine adhesion appreciated. There are several advantages to this innovative and practical hysteroscopic surgical approach. Marking the lateral limits of the uterine septum means that a shorter reference line is obtained to incise the septum effectively rather than using the bilateral ostia as reference points. At the same time, marking the bilateral endpoint of the uterine septum incision at the beginning of the surgery might be helpful when bilateral tubal ostia are invisible because of quick absorption of the distension media, which causes insufficient distention pressure at the end of the surgery. Use of the narrow 5-French scissors allowed for instrumentation without prior cervical dilation. Moreover, with this "see and treat" strategy, a clear visualization of the surgical field was maintained without inserting and withdrawing the hysteroscope. The endometrium sustained minimal damage because of the "cold scissors" technique. Conclusion(s) Our hysteroscopic marking strategy allows the surgeon's intraoperative judgment to be efficient and safe during incision of the uterine septum and ensures that the incision is adequate. It is an improved and valid surgical strategy for hysteroscopic incision of the uterine septum.
Xiaodan Li, Tianzhu Liu,
Published: 20 June 2021
Radiology Case Reports, Volume 16, pp 2319-2324; https://doi.org/10.1016/j.radcr.2021.05.055

The publisher has not yet granted permission to display this abstract.
Published: 29 February 2020
Atlas of Hysteroscopy pp 225-230; https://doi.org/10.1007/978-3-030-29466-3_23

The publisher has not yet granted permission to display this abstract.
N. K. Alizade
Obstetrics, Gynecology and Reproduction, Volume 13; https://doi.org/10.17749/2313-7347.2019.13.2.095-102

Abstract:
Aim: to assess the incidence of complications after laparoscopic and hysteroscopic myomectomy.Materials and methods. The results of 378 laparoscopic and 292 hysteroscopic surgeries for uterine fibroids (myomas) have been retrospectively analyzed. All patients were examined for their history of gynecological and concomitant non-gynecological diseases, past surgeries, and the menstrual, sexual and reproductive functions. The patients underwent clinical blood analysis, urinalysis, electrocardiography and chest X-ray test, blood group and rhesus factor determination, hemostasis assay, blood analysis for RV, HIV and tumor markers, as well as transabdominal and transvaginal ultrasound using SSD-1200 and SSD-2000 devices (Aloka Ltd, Japan). We characterized the patients by the type of surgical intervention (laparoscopic or hysteroscopic), and also by age, indications for surgery, the number of fibroids and their locations, size of the uterus, presence of extragenital and genital disorders, and also by the surgery techniques. The post-surgery complication incidence rate was calculated and expressed as percentage (%), arithmetic mean (M), and standard error of the mean (m).Results. The overall incidence of severe postoperative complications did not differ between laparoscopic (2.7 ± 0.8 %) and hysteroscopic (2.1 ± 0.8 %) operations for uterine myomas (p > 0.05). The incidence of complications was significantly higher in women operated by laparoscopy if they underwent simultaneous operations (12.3 ± 4.0 % vs. 0.6 ± 0.4 % for non-simultaneous operations), if the number of fibroids was > 4 (3.9 ± 1.4 % vs. 1.1 ± 0.8 % in those with < 4 fibroids), in the presence of anemia (8.2 ± 2.9 % vs. 1.0 ± 0.6 % in cases with no anemia), and in patients with menstruation disorders (4.9 ± 1.8 % vs. 1.3 ± 0.7 % with normal menstruation). The operated patients significantly differed by the number of uterine fibroids: the average number of fibroids was larger in those operated laparoscopically (2.9 ± 0.05 vs. 2.3 ± 0.04; p < 0.01); the proportion of patients with 4 or more fibroids was also significantly higher in those patients (53.7 ± 2.6 % vs. 30.1 ± 2.7 %; p < 0.001). The compared groups also differed in the location of their myomas.Conclusion. The risk of postoperative complications after laparoscopic surgery is relatively high if simultaneous operations take place, if the number of fibroids is ³ 4, and in the presence of anemia or menstruation disorder.
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