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Purpose To compare different endoscopic techniques, such as hysteroscopy with morcellator and traditional resectoscopy, and different surgical settings, such as operating room setting and outpatient setting, for patients with abnormal uterine bleeding (AUB) and suspected endometrial polyps. Metho In this prospective study, 180 women diagnosed with endometrial polyps on ultrasound were enrolled. Patients were divided into three groups: 1) resectoscopy under anesthesia in an operating room setting; 2) morcellation with anesthesia in an operating room setting; and 3) outpatient morcellation without anesthesia. The main outcomes included procedure completion rates, operative time, patient satisfaction, and pain intensity using the Visual Analog Scale (VAS). Additionally, histological analysis was conducted for all cases. Results Among the 180 patients, all procedures were completed in Groups 1 and 2, while Group 3 had a 96.7% completion rate. Procedure duration was the shortest in Group 3 (average 6.5 min), significantly less than in Group 1 ( p value < 0.05; CI 95%). Pain was manageable in all groups, with VAS scores < 4 for most patients in the outpatient setting. Histology confirmed benign polyps in most cases, and malignant or premalignant conditions were around 3% of procedure. Conclusion Outpatient “see-and-treat” hysteroscopy with morcellator, performed without anesthesia, proved feasible, safe, and cost-effective, with minimal discomfort and comparable diagnostic accuracy to traditional methods. This technique offers a practical approach for the management of AUB, enabling efficient treatment while reducing costs and resource usage, and may be considered as a preferred option in appropriate patients.

Background Hypoxemia is the most common adverse reaction during sedated hysteroscopy. Obesity is a risk factor for hypoxemia. For hysteroscopy, propofol is the most commonly used sedative. However, it can cause dose-dependent respiratory depression. This drawback has driven the search for sedatives with less respiratory depressant effects. Remimazolam is a new benzodiazepine drug with several advantages, including minimal impact on the respiratory and circulatory systems. This study aims to compare remimazolam and propofol in terms of safety and efficacy in patients with overweight or obesity who are undergoing sedated hysteroscopy. Methods This prospective, single-center, randomized, single-blind, controlled clinical trial will be conducted to examine the effect of remimazolam on the incidence of severe hypoxemia in patients with overweight or obesity. Patients ( n  = 600) scheduled to undergo sedated hysteroscopy will be randomly assigned to either the control or experimental group and will be sedated using propofol or remimazolam, respectively. Discussion The main objective of this study is to determine whether remimazolam can reduce the incidence of severe hypoxemia in patients with overweight or obesity during hysteroscopy. The results of this study are expected to provide evidence on the safety and efficacy of remimazolam in patients with overweight or obesity, which will enhance patient comfort and safety during sedated hysteroscopy. Trial registration ClinicalTrials.gov NCT06187896. Registered on January 3, 2024.

Background and Objectives: Hysteroscopy is a reliable technique which is highly useful for the evaluation and management of intrauterine pathology. Recently, the widespread nature of in-office procedures without the need for anesthesia has been requesting validation of practical approach in order to reduce procedure-related pain. In this regard, we performed a comprehensive review of literature regarding pain management in office hysteroscopic procedures. Materials and Methods: MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Global Health, Health Technology Assessment Database and Web of Science, other research registers (for example Clinical Trials database) were searched. We searched for all original articles regarding pain relief strategy during office hysteroscopy, without date restriction. Results have been collected and recommendations have been summarized according to the Appraisal of Guidelines for Research and Evaluation (AGREE) tool. Moreover, the strength of each recommendation was scored following the Grading of Recommendations Assessment (GRADE) system, in order to present the best available evidence. Results: Both pharmacological and non-pharmacological strategies for pain management are feasible and can be applied in office setting for hysteroscopic procedures. The selection of strategy should be modulated according to the characteristics of the patient and difficulty of the procedure. Conclusions: Accumulating evidence support the use of pharmacological and other pharmacological-free strategies for reducing pain during office hysteroscopy. Nevertheless, future research priorities should aim to identify the recommended approach (or combined approaches) according to the characteristics of the patient and difficulty of the procedure.

Hysteroscopy has truly revolutionized the field of diagnostic and operative gynecology. It is presently regarded as the gold standard method for both the diagnosis and treatment of intrauterine diseases and it has fundamentally altered the way gynecologists treat patients with such conditions. These pathologies can now be diagnosed and treated in an outpatient setting, thanks to technological advancements and instrument downsizing. Two hundred years of development and notable innovation are now reflected in the present hysteroscopic practice. This review attempts to trace the boundaries-pushing history of hysteroscopy by highlighting the advancements in technology and the therapeutic and diagnostic benefits offered by this groundbreaking approach.

IntroductionIntrauterine adhesions (IUAs) are one of the most common causes of uterine infertility. Hysteroscopic adhesiolysis is the primary treatment for IUA, but the rate of IUA recurrence is high in moderate to severe cases. While traditional guidelines recommend placing a non-copper stainless steel intrauterine device (IUD) into the uterine cavity after adhesiolysis to prevent readhesion, the preventive effect is uncertain. Our preliminary trials suggested that the collagen scaffold was more effective in moderate cases. This study aims to assess the efficacy and safety of a collagen scaffold versus IUD in preventing readhesion after hysteroscopic adhesiolysis in patients with moderate IUA.Methods and analysisThis multicentre, open-label, randomised controlled trial evaluates the efficacy and safety of a collagen scaffold compared with an IUD in preventing readhesion after hysteroscopic adhesiolysis in women with moderate IUA. This trial will be conducted at six teaching hospitals and plans to enrol 200 participants. The primary outcome is the non-recurrence rate of IUA 2 months after adhesiolysis. Secondary endpoints include changes in American Fertility Society scores before and after surgery and postoperative menstrual blood volume. The 95% CIs for the difference in non-recurrence rates between the two groups will be calculated. If the lower limit of this interval exceeds the superiority threshold of zero, the conclusion of superiority is confirmed.Ethics and disseminationThis study has received approval from the ethics committee of the Affiliated Drum Tower Hospital of Nanjing University Medical School (2022-491-02) and the ethics committees of the participating centres. Written informed consent will be obtained from each participant before starting any study procedures. The results of this trial will be published in a peer-reviewed journal.Trial registration numberChiCTR2300068271.

Background The incidence of caesarean scar pregnancy (CSP) has significantly increased due to the increasing prevalence of caesarean deliveries and advances in diagnostic imaging. However, no consensus has yet been reached on the optimal therapeutic approach. Type II CSP leads to disease heterogeneity, characterized by multiple treatment options and the absence of a unified therapeutic approach. Hysteroscopic treatment for CSP has demonstrated a notable success rate, particularly in cases of type I CSP. High-intensity focused ultrasound (HIFU) ablation has emerged as a novel, non-invasive treatment option that minimizes intraoperative blood loss. However, its use may be excessive in low-risk cases. Here, we report a protocol for a randomized clinical trial designed to evaluate the necessity of performing HIFU in CSP treatment when combined with suction curettage under hysteroscopic guidance. Methods We aim to propose a randomized clinical trial that will enroll 140 participants. All participants will undergo surgical suction curettage guided by hysteroscopy, randomized into groups with or without HIFU pretreatment. Data on demographic characteristics, disease characteristics, ultrasound findings, and laboratory test results will be collected before the intervention. The primary outcome will be the intraoperative blood loss. Secondary outcomes will include the incidence of near haemorrhage, therapeutic success rates, and subsequent pregnancy outcomes within a 2-year follow-up period. Discussion Hysteroscopy has exhibited favourable therapeutic outcomes in the management of CSP, though it remains associated with a risk of intraoperative haemorrhage. HIFU has shown promise as a preoperative adjuvant modality. However, the comparative clinical advantages of standalone hysteroscopic intervention versus HIFU-assisted protocols are insufficiently explored in prospective clinical studies. This investigation seeks to assess both the standalone efficacy of hysteroscopic resection and the efficacy of combined therapy incorporating HIFU pretreatment for type II CSP. Trial registration Registration number: ChiCTR2000034332. Registration date: 2nd July 2020.

Background Intrauterine adhesions (IUA) are a challenging clinical problem in reproductive infertility. The most common causes are intrauterine surgery and abortions. We aimed to investigate whether early second-look office hysteroscopy can prevent IUA. Methods A single-center, prospective, two-armed, randomized controlled trial was designed to explore the efficacy of early office hysteroscopy after first-trimester induced abortion (suction dilatation and curettage [D&C]) and to further analyze fertility outcomes. Women aged 20–45 years undergoing suction D&C and desiring to conceive were recruited. Between October 2019 and September 2022, 66 women were enrolled, of whom 33 were allocated to group A (early hysteroscopy intervention). The women in intervention group A were planned to receive 2 times of hysteroscopies (early and late). In group B, women only underwent late (6 months post suction D&C) hysteroscopy. Results The primary outcome was the IUA rate assessed using office hysteroscopy 6 months after artificial abortion. Secondary outcomes included menstrual amount/durations and fertility outcomes. In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second. In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam 6 months after an artificial abortion. Twenty-one women did not receive late hysteroscopy due to pregnancy. The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy. Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates. Conclusions Early hysteroscopy following suction D&C can detect intrauterine lesions. IUA detected early by hysteroscopy can disappear on late examination and become insignificant for future pregnancies. Notably, the pregnancy outcomes showed a favorable trend in the early hysteroscopy group, but there were no statistically significant differences. Trial registration ClinicalTrials.gov , ID: NCT04166500. Registered on 2019-11-10. https://clinicaltrials.gov/ct2/show/NCT04166500 .

ObjectiveThe aim of this study is to prove that a short dry lab training prior to the surgery is efficient to acquire basic hysteroscopic skills and that these skills are transferable directly to the operation theater.MethodsThirty-nine gynecologists who never attended a training course or practiced hysteroscopy before were evaluated. Participants were randomly divided into trainees (n = 21) and control (n = 18). Trainees attended a short time dry lab prior the exposure to the OR. The controls went directly to the OR. Participants were asked to identify the different landmarks of the uterine cavity and to perform a punch biopsy under the supervision of a gynecologist expert in hysteroscopy. A video recording for all the exercises was done, and showed independently to two expert surgeons in hysteroscopy for evaluation. The experts were also asked to distinguish between the trainees and the control.ResultsFor both experts, the trainees’ performance was statistically better than that of the controls (p < 0.001) for the identification of the uterus land marks and the punch biopsy. The two experts identified 80.9 and 85.7%, respectively, of the trainees. The participants’ subgroup ID and the experts’ identification were statistically correlated (p < 0.001).ConclusionA short time dry lab is efficient to acquire basic hysteroscopic skills and these skills are transferable directly to the OR.

This study aimed to investigate the effect of cervical length on procedure time and VAS pain scores during office hysteroscopy. A cross-sectional study was conducted on 50 patients who underwent office hysteroscopy for various indications such as abnormal uterine bleeding and infertility. Exclusion criteria included active vaginal infection, previous cervical surgery, and chronic pelvic pain. Cervical length was measured via transvaginal ultrasound prior to the procedure. Procedure time and VAS pain scores were recorded and analyzed. Patients with a retroverted uterus had higher post-procedure VAS scores (7.6 ± 0.8) compared to those with an anteverted uterus (4.9 ± 1.9, p < 0.001). Cervical length was found to be a significant predictor of both procedure time (β = 5.711, p < 0.001) and VAS pain score change (β = 0.167, p < 0.001). Procedure time was significantly longer in patients with increased cervical length (R 2  = 79.6%, p < 0.001). Additionally, an anteverted uterus was associated with a shorter procedure time (118.2 ± 49.2 s) compared to a retroverted uterus (142.7 ± 46.8 s, p < 0.001). Cervical length was a significant predictor of VAS pain scores (β = 0.167, p < 0.001), with each millimeter increase leading to a 0.167-unit rise. While univariate analysis showed a negative association between age and VAS scores (β = -0.299, p = 0.035), this was not significant in the multivariate model (p = 0.586). Cervical length also significantly prolonged procedure time (β = 5.711, R 2  = 79.6%, p < 0.001). Cervical length is a significant factor influencing both the duration and pain experienced during office hysteroscopy. Consideration of cervical length can improve patient comfort and procedural efficiency in clinical practice.