Surgical Parameters Affecting Procedure Duration of Hysteroscopic Fibroid Resection: Results of a Retrospective Longitudinal Study

doi:10.21203/rs.3.rs-4886683/v1

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Surgical Parameters Affecting Procedure Duration of Hysteroscopic Fibroid Resection: Results of a Retrospective Longitudinal Study

https://doi.org/10.21203/rs.3.rs-4886683/v1

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Purpose

To identify and analyze the main surgical parameters affecting the operative time of hysteroscopic fibroid resection.

Methods

This retrospective observational study included 65 cases of outpatient hysteroscopic fibroid resection performed between March 2021 and May 2023 in outpatient office setting. Patients aged 18–50 with various indications such as infertility, recurrent pregnancy loss, or abnormal uterine bleeding (AUB) were included. The operative time, fibroid size, FIGO classification, and fibroid localization were recorded and analyzed using ANOVA, chi-square test, and linear regression models.

Results

The average operative duration for all surgeries was 557.41 (± 449.52) seconds. A significant correlation between fibroid size and operative time was found in FIGO 0 (p = 0.0003) and FIGO 1 (p < 0.0001) subgroups, with weaker correlation in FIGO II (p = 0.039). FIGO I surgeries took significantly longer than FIGO 0 (p = 0.044), and fundal fibroids were associated with longer operative times compared to posterior fibroids (p = 0.0329).

Conclusion

The size and FIGO classification of fibroids significantly influence operative time during hysteroscopic resection. Smaller and more accessible fibroids (FIGO 0 and 1) are resected faster than those embedded deeper in the uterine wall (FIGO 2). Detailed preoperative evaluation of fibroid characteristics can better predict operative time, aiding in patient preparation and optimized analgesia and perioperative planning as well as optimizing the use of operating theater. Further studies with larger sample sizes are recommended to validate these findings and explore additional influencing factors.

hysteroscopy

fibroid

resection

pain

infertility

bleeding

The overall size and FIGO class of the uterine fibroids significantly influence operative time during outpatient hysteroscopic resection.
A careful preoperative evaluation of fibroid characteristics can better predict operative time, optimizing analgesia planning and improving both patient’s comfort and surgical outcomes.
Good planning of procedures also allows for optimization of the use of the surgical schedule.

Fibroids are the most common benign tumor of the women reproductive tract [1]. Fibroids growing in or toward the uterine cavity, so called submucosal, are classified by the novel International Federation of Gynecology and Obstetrics (FIGO) among classes 0, 1, and 2 [2]. They distort the uterine cavity and can affect endometrial growing and uterine peristalsis [3].

Submucosal fibroids also often affect uterine bleeding and fertility, causing abnormal uterine bleeding, infertility or miscarriage, however there are still many unknowns about real pathophysiology of these processes [4–6]. According to available data surgical removal of these form of fibroids can improve bleeding disorders and fertility aspects as well [7].

Hysteroscopic removal of fibroid (also known as hysteroscopic myomectomy, specifically resectoscopic myomectomy), is a minimally invasive surgical procedure that has gained widespread acceptance for the treatment of symptomatic uterine fibroids [8]. This technique is particularly favored due to its efficacy in improving symptoms such as abnormal uterine bleeding (AUB), pelvic pain, and infertility while maintaining uterine integrity and minimizing patient recovery time [9]. Despite its advantages, the operative time for resectoscopic myomectomy can vary significantly and is influenced by a multitude of factors [10]. Understanding these factors is crucial for optimizing surgical outcomes, enhancing patient safety, and improving overall efficiency in gynecologic surgery. Optimizing the work of staff and organizing patient schedules and traffic in busy units is also an important issue [11].

Due to the technical developments, diameter of the instruments is less and less, resulting in the feasibility in an office setting [12]. Due to the smaller diameters, in many cases dilatation of the cervix is not needed, so general anesthesia and connected procedures and the need of operating theatre is not always necessary [13].

When they are limited in size, the myomectomy could be done in an outpatient setting. In fact, outpatient hysteroscopic procedures are highly cost-effective methods by avoiding costs of operative theatre, medical staff, equipment and drugs [14]. However, a selected number of patients could refer the procedure as painful. Pain or discomfort during outpatient hysteroscopic procedures depends on many factors. One of the most important is the experience of the surgeon and duration of the procedure [15].

During outpatient hysteroscopy, resection of fibroid rarely causes pain, but movements in the cervical canal, distension of the cavity could increase the rate of discomfort in many cases. Additionally, even the less painful surgeries can cause unbearable discomfort in case it takes a prolonged operative time [16].

Another problem is how to predict in which patient the procedure should be considered difficult or the need for the operating theater to be involved. Operative time is a critical parameter in surgical practice, directly impacting the duration of anesthesia, risk of complications, surgical workload, and hospital resources. Prolonged operative times are associated with increased risks of intraoperative and postoperative complications, including fluid overload, hemorrhage, infection, and anesthesia-related issues [17]. Therefore, identifying and understanding the factors that influence operative time in hysteroscopic myomectomy is essential for improving patient outcomes and surgical efficiency. This also has a clear impact on the economics of health care.

However, comprehensive evaluations including surgical parameters and their role in fibroid resection’s operative time are still limited. Moreover, there is variability in the definitions and measurements of operative time, making comparisons across studies challenging. Therefore, to address these gaps, we aimed to perform a retrospective evaluation of office hysteroscopic myomectomy cases to systematically assess the correlation between surgical factors and operative time.

This was a retrospective observational study carried out between March 2021 and May 2023 in a private gynecological office setting (Óvárosi Private Practice, Debrecén, Hungary) between May 2021 and May 2023.

The design, analysis, interpretation, drafting, and revision stages have all taken into account the Helsinki Declaration, the Committee on Publication Ethics (COPE) guidelines (http://publicationethics.org/), and the Reporting of studies Conducted using Observational Routinely-collected Health Data (RECORD) Statement, of the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) collaborative, made available through the enhancing the quality and transparency of health research (EQUATOR) network (www.equator-network.org). Any information that could be used to formally identify the patient was removed from the data using anonymization. Every participant in this study signed a consent form granting permission for data collection and analysis for research purposes, and they were informed about the procedures. The study was approved by the Ethics Committee of University of Debrecen: DE KK RKEB.IKEB. 6342 − 2023).

Women aged from 18 to 50 years old were included in case of common indications for hysteroscopic resection of fibroids, including infertility, recurrent pregnancy loss or AUB.

Women who were deemed unsuitable for or declined an office hysteroscopic approach, had a preoperative diagnosis of a current malignant disease, either gynecological or non-gynecological, or had severe systemic illnesses (e.g. autoimmune, severe coagulopathies, or cardiac pathologies), were pregnant or had an acute or chronic genital or urinary tract infections were excluded from the study.

Outpatient hysteroscopic removal of submucous fibroids was performed after meticulous preoperative work-up. Parameters and sonographic characteristics of fibroids were evaluated with 2D and 3D transvaginal ultrasonography (Samsung HS40, Samsung Healthcare Global, Europe) and diameters of the fibroids were recorded in three dimensions. Volume of fibroids were calculated from the diameters using Radiology Volume Calculator with the generic ellipsoid volume formula [18]. Fibroids were therefore classified by the current FIGO classification whereas they had a submucous (from 0 to 2) part and by topographical localization (anterior, posterior, lateral or fundal).

Procedures were performed in the early follicular phase, in a lithotomy position. Without using general anaesthesia, paracervical analgesia or inhalative analgesia was used in selected cases.

Outpatient hysteroscopy started with entering the scope through the vagina, using vaginoscopic approach without grasping and dilating cervix. For all the surgeries bipolar resectoscope was used with the outer diameter of 18.5 Fr, using 60 W of bipolar current. In all cases, hysteroscopic resection was deemed complete for a fibroid to be included in the analysis. Time of resection was counted from the first electrosurgical cut till the last one. Time of entering and evaluating the uterine cavity were not include in the resection time.

Statistical analysis

Assuming three unbalanced groups according to FIGO classes, a sample size of 59 patients achieves 80% of the power with a significance level of 5% to detect a minimum mean difference of 0.84.

First, the normality of the continuous variable distribution was examined. After that, they were presented as mean ± standard deviation (SD), and group differences were evaluated using the analysis of variance (ANOVA) with Tukey’s Honestly Significant Differences (HSD) post-estimation. Based on categorical data, which were reported as absolute numbers and percentages, the groups were compared using the chi-square test. A linear regression model was used to evaluate the relative differences in surgery durations between different FIGO classes and localizations. STATA 14.1 (Statacorp LLC, College Station, TX, USA) was employed for each statistical analysis.

Main characteristics

Data of hysteroscopic fibroid resection were recorded, collected and analyzed in 65 cases. Average age of the patients was 41.51 (± 4.71) years, average BMI was 25.66 (± 4.66) kg/m2. Average age of the patients with class 0 to 2 fibroids was 41.31 (± 4.45) (16 cases), 40.86 (± 3.43) (22 cases), 40.51 (± 5.58) (27 cases) years for each category, and average BMI was 25.84 (± 5.27) kg/m2, 25.2 (± 4.9) kg/m2, 25.9 (± 4.17) kg/m2 respectively (p = 0.528). The indication was infertility in 42 (64.61%) cases, AUB in 23 (35.39%) cases.

Average size of the fibroids in FIGO 0, 1, 2 subgroups were 8.5 (± 6.94) cm3, 4.19 (± 4.67) cm3, 5.03 (± 7.21) cm3, respectively. Average operative of all surgeries combined was 557.41 (± 449.52) seconds.

Analyzing the subgroups, average operative time was 525.12 (± 406.29) seconds in cases of FIGO 0, 588.32 (± 426.18) seconds in cases of FIGO 1, 550.43 (± 451.12) in cases of FIGO 2 classes.

Linear regression analysis

A linear regression model for describing explanatory variables’ effect on the surgical duration according to size, FIGO class and localization of the fibroid as well as patient age was built. The model gained a r2 of 0.4571 (p < 0.001), depicting a linear correlation between the variables and surgical duration.

Size

Correspondence between size and procedure time was stronger in the FIGO 0 (p = 0.0003) and FIGO 1 (p < 0.0001) subgroups and weaker in the FIGO 2 (p = 0.039) subgroup (Fig. 1).

FIGO classification

Surgeries of FIGO 1 fibroids took significantly longer than those of FIGO 0 fibroids across the whole range of lesion sizes (p = 0.044); in FIGO 2 vs. FIGO 0, procedure time was significantly longer if lesion volume was not greater than 8 cm³ (p = 0.042); and in FIGO 2 versus FIGO 1, no evidence of excess duration was found other than at lesion volumes of 0.5 cm³ (p = 0.034) (Fig. 2).

Localization and age

A fundal fibroid was associated with longer surgery duration compared to a posterior fibroid (p = 0.0329). Other analyzed localizations did not affect the correspondence (anterior vs posterior p = 0.1104, lateral vs posterior p = 0.345). Moreover, there was no correlation between patient’s age (p = 0.987) and procedure time.

This retrospective study showed that the correlation between the size of the submucous uterine fibroid and operative time for outpatient hysteroscopic resection was stronger in cases where fibroids had easier access (FIGO classes 0 and 1). In FIGO 2 fibroid cases, size and time correlation was had weaker due to challenging and time-taking resection of the “hidden” fibroid. Comparing FIGO 1 to 0 classes, resection of class 0 fibroids was faster independently from the size. Comparing class 2 to 0, due to the challenging resection from the deep part of the fibroid, in smaller size cases (not greater than 8 cm³), type 2 surgeries were significantly longer.

Submucous fibroids are proven to cause severe bleeding disorders [5]. On the contrary, the relationship between fibroids and fertility-related complaints (infertility, recurrent miscarriages) has been investigated extensively [4], but strong evidence remains elusive and more data is necessary to build final conclusions [19]. Hysteroscopic resection is the primary surgical procedure for treating fibroids in this location. Fibroid resection can be performed using various methods, including electrosurgical instruments, lasers, mechanical instruments, “cold loops” and hysteroscopic tissue retrieval systems (HTRS) during operative hysteroscopy [20].

Due to technological advancements and the demands of modern lifestyles, more and more of these surgeries are now performed in outpatient settings. Office hysteroscopy offers advantages over traditional methods performed in operating rooms [21], such as eliminating the need for anesthesia, staff, and hospitalization, making it more cost-effective and feasible and less stressful [22]. The most significant limiting factor during surgical procedures without anesthesia is the stress, discomfort or pain experienced by the patient. The impact of the type of surgery, instrument, and instrument diameter on the level of discomfort has been researched by many authors, but definitive correlations have not been established till now [23, 24]. One factor affecting the level of discomfort is the duration of the procedure. In most cases, hysteroscopic resection of fibroids is performed in small bites, meaning the duration of eliminating a fibroid correlates with its volume. Various conditions of the fibroid, which influence the difficulty of resection, have been analyzed by Lasmar et al. Depending on the localization of the fibroids within the uterine wall, FIGO types 0, 1, and 2 are differentiated. The more embedded the fibroid is in the uterine wall (FIGO 2), the harder it is to reach for resection. The localization of the fibroid within the uterine cavity (anterior, posterior, lateral, fundal) can also affect the surgery's duration, this is simply due to the angles of access to the lesion.

The challenge and duration of resection can vary due to the size, localization, and FIGO class of the fibroid. The rate of complications and the success of complete resection are also dependent on these factors. In 2005, Lasmar et al. published a scoring system [25] that predicts the challenge, success in complete resection, and the chance of complications based on the fibroid's conditions. The STEPW system assigns points for Size, Topography, Extension of the base, Penetration, and lateral Wall localization. According to the final score, three groups are established: low complexity hysteroscopy, complex surgery, and non-hysteroscopic techniques are recommended [25]. In 2021, the ISGE Task Force published a review with 14 recommendations concerning hysteroscopic fibroid resection to enhance the success of surgeries, ensure patient safety, and aid surgeons in choosing the appropriate therapeutic options [26]. Despite these quite good and relatively simple scales, most doctors do not use them at all and describe fibroids rather imprecisely.

As mentioned above, various methods are available for fibroid resection, including the use of scissors, lasers, resectoscopes, the cold loop method during hysteroscopy, and HTRS [27–31]. In recent decades, resectoscopic procedures using the slicing technique have been predominant, but HTRS is increasingly gaining prominence [32–35]. The advantage of resectoscopy is the effective maintenance of hemostasis during the procedure. However, its disadvantages include a longer learning curve compared to HTRS, more frequent movements in and out of the cavity for chip removal, and complications arising from the use of mono- or bipolar current, where there is always a risk of possible intestinal or bladder injury [28, 32, 35, 36].

Several limitations should be noted and acknowledged. Firstly, The absence of a control group makes it difficult to compare the outcomes of hysteroscopic resection with other treatment methods. Secondly, the study does not provide follow-up data on patient outcomes post-surgery, which is crucial for assessing the long-term efficacy and safety of the procedure. In addition, the use of paracervical or inhalative analgesia in selected cases introduces variability in the procedural approach, which may affect the outcomes and their interpretation. Moreover, being conducted in a single practice, the findings may lack generalizability to other settings, such as public hospitals, or different geographic locations. First of all, it does not take into account a larger group of doctors who have different degrees of training in these advanced procedures. Lastly, although reaching the minimum number of required patients, the study includes only 65 cases, which may limit the statistical power and the ability to generalize findings.

However, several strengths are also retrievable. Firstly, the focus on outpatient hysteroscopic procedures without general anesthesia reflects a modern and patient-friendly approach, potentially increasing the study’s relevance to current clinical practices. In our opinion, in the coming years the number of patients treated in outpatient clinics rather than in hospital wards will continue to increase. Moreover, the use of standardized classification system (FIGO) and a detailed description of the hysteroscopic procedure enhance the study's methodological rigor and reproducibility.

In conclusion, our results underscore the importance of detailed preoperative evaluation. By accurately measuring the size (diameters and volume) of the fibroid, the duration of surgery can be more reliably predicted. This information allows patients to better prepare for the procedure and enables healthcare providers to tailor the type and extent of analgesia more precisely according to the anticipated duration of the surgery. It also allows, above all, to optimize the work of a given office and plan equipment and the number of procedures. Further studies involving a larger number of cases are necessary to obtain more robust data. An expanded dataset would facilitate the detection of additional correlations between surgery duration and other relevant factors, thereby enhancing our understanding and management of hysteroscopic fibroid resection.

Disclosure Statement: The authors declare that they have no conflicts of interest to disclose regarding this publication.

Funding: This work received no funding.

Author contribution

Gaetano Riemma: Protocol/project development; Data analysis; Manuscript writing

Salvatore Giovanni Vitale: Protocol/project development; Data analysis; Manuscript writing

Márton György Lipták: Data collection; Manuscript editing

Michał Ciebiera: Data collection; Manuscript editing

Bence Zoltán Boldogh: Data management; Manuscript editing

Liliana Mereu: Data management; Manuscript editing

Kincső Sára Kovács: Protocol/project development; Manuscript editing

Péter Török: Protocol/project development; Data analysis; Manuscript writing

Ethics approval

The study was approved by the Ethics Committee of University of Debrecen: DE KK RKEB.IKEB. 6342-2023).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

Not applicable.

Sparic R, Mirkovic L, Malvasi A, Tinelli A (2016) Epidemiology of Uterine Myomas: A Review. Int J Fertil Steril 9:424–435
Munro MG, Critchley HOD, Fraser IS, FIGO Menstrual Disorders Committee (2018). The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. ;143(3):393–408. 10.1002/ijgo.12666. Epub 2018 Oct 10. Erratum in: Int J Gynaecol Obstet. 2019;144(2):237. doi: 10.1002/ijgo.12709. PMID: 30198563
Somigliana E, Reschini M, Bonanni V, Busnelli A, Li Piani L, Vercellini P (2021) Fibroids and natural fertility: a systematic review and meta-analysis. Reprod Biomed Online 43(1):100–110. 10.1016/j.rbmo.2021.03.013Epub 2021 Mar 23. PMID: 33903032
Pritts EA, Parker WH, Olive DL (2009) Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 91(4):1215–1223. 10.1016/j.fertnstert.2008.01.051Epub 2008 Mar 12. PMID: 18339376
Urman B, Yakin K, Ertas S, Alper E, Aksakal E, Riemma G, Angioni S, Vitale SG (2024) Fertility and anatomical outcomes following hysteroscopic adhesiolysis: An 11-year retrospective cohort study to validate a new classification system for intrauterine adhesions (Urman-Vitale Classification System). Int J Gynaecol Obstet. ;165(2):644–654. 10.1002/ijgo.15262.. PMID: 38013507
Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders (2011) FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113(1):3–13 Epub 2011 Feb 22. PMID: 21345435
Vitale SG, Riemma G, Ciebiera M, Cianci S (2020) Hysteroscopic treatment of submucosal fibroids in perimenopausal women: when, why, and how? Climacteric 23(4):355–359 Epub 2020 May 15. PMID: 32410475
Lasmar RB, Lasmar BP, Moawad NS, HYSTEROSCOPIC MYOMECTOMY, Medicina (2022) (Kaunas) 58(11):1627. 10.3390/medicina58111627PMID: 36422166; PMCID: PMC9692806
Vitale SG, Carugno J, Riemma G, Török P, Cianci S, De Franciscis P, Parry JP (2021) Hysteroscopy for Assessing Fallopian Tubal Obstruction: A Systematic Review and Diagnostic Test Accuracy Meta-analysis. J Minim Invasive Gynecol 28(4):769–778 Epub 2020 Nov 25. PMID: 33246040
Salazar CA, Isaacson KB (2018) Office Operative Hysteroscopy: An Update. J Minim Invasive Gynecol 25(2):199–208. 10.1016/j.jmig.2017.08.009Epub 2017 Aug 10. PMID: 28803811
Zelivianskaia A, Robinson JK 3rd (2022) Office Hysteroscopy: Setting up Your Practice for Success. Obstet Gynecol Clin North Am. ;49(2):315–327. 10.1016/j.ogc.2022.02.011. PMID: 35636811
Mencaglia L, Carri G, Prasciolu C, Giunta G, Albis Florez ED, Cofelice V, Mereu L (2013) Feasibility and complications in bipolar resectoscopy: preliminary experience. Minim Invasive Ther Allied Technol 22(1):50–55. 10.3109/13645706.2012.6701
De Franciscis P, Riemma G, Schiattarella A, Cobellis L, Colacurci N, Vitale SG, Cianci A, Lohmeyer FM, La Verde M (2020) Impact of Hysteroscopic Metroplasty on Reproductive Outcomes of Women with a Dysmorphic Uterus and Recurrent Miscarriages: A Systematic Review and Meta-Analysis. J Gynecol Obstet Hum Reprod 49(7):101763. 10.1016/j.jogoh.2020.101763Epub 2020 Apr 21. PMID: 32330671
Vitale SG, Laganà AS, Török P, Lasmar RB, Carugno J, Palumbo M, Tesarik J (2022) Virtual sonographic hysteroscopy in assisted reproduction: A retrospective cost-effectiveness analysis. Int J Gynaecol Obstet 156(1):112–118. 10.1002/ijgo.13651
Török P, Molnár S, Herman T, Jashanjeet S, Lampé R, Riemma G, Vitale SG (2020) Fallopian tubal obstruction is associated with increased pain experienced during office hysteroscopy: a retrospective study. Updates Surg 72(1):213–218. 10.1007/s13304-020-00712-xEpub 2020 Jan 28. PMID: 31993995
Florio P, Puzzutiello R, Filippeschi M, D'Onofrio P, Mereu L, Morelli R, Marianello D, Litta P, Mencaglia L, Petraglia F (2012 Jan-Feb) Low-dose spinal anesthesia with hyperbaric bupivacaine with intrathecal fentanyl for operative hysteroscopy: a case series study. J Minim Invasive Gynecol 19(1):107–112. 10.1016/j.jmig.2011.08.728
Mor M, Kochav MG, Ezratty J, Dovev MN, Eisenberg N, Smorgick N (2024) Feasibility of Office-based Operative Hysteroscopy by a Tissue Removal System without Anesthesia. J Minim Invasive Gynecol. May 11:S1553-4650(24)00207-3. 10.1016/j.jmig.2024.05.005. Epub ahead of print. PMID: 38740128
Radiogyan Calculator (2024) (https://radiogyan.com/radiology-volume-calculator/ - Accessed June 01
Metwally M, Raybould G, Cheong YC, Horne AW (2020) Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev 1(1):CD003857. 10.1002/14651858.CD003857.pub4PMID: 31995657; PMCID: PMC6989141
Vitale SG, Moore O, Riemma G, Carugno J, Yarto ML, Haimovich S (2023) Hysteroscopic laser ablation of symptomatic uterine fibroids: insights from a prospective study. Climacteric. ;26(5):497–502. doi: 10.1080/13697137.2023.2205581. Epub 2023 May 11. PMID: 37165870
Cicinelli E, J Minim Invasive Gynecol (2005) Sep-Oct;12(5):396–400 Diagnostic minihysteroscopy with vaginoscopic approach: rationale and advantages. 10.1016/j.jmig.2005.06.004. PMID: 16213424
Clark TJ (2004) Outpatient hysteroscopy and ultrasonography in the management of endometrial disease. Curr Opin Obstet Gynecol. ;16(4):305 – 11. 10.1097/01.gco.0000136491.26463.c2. PMID: 15232484
De Silva PM, Stevenson H, Smith PP, Justin Clark T, Temperature of the Distension Medium on Pain During Office Hysteroscopy (2021) A Systematic Review of the Effect of Type, Pressure, and. J Minim Invasive Gynecol. ;28(6):1148–1159.e2. doi: 10.1016/j.jmig.2021.01.003. Epub 2021 Jan 11. PMID: 33444792
Török P, Major T (2013) Evaluating the level of pain during office hysteroscopy according to menopausal status, parity, and size of instrument. Arch Gynecol Obstet 287(5):985–988. 10.1007/s00404-012-2667-xEpub 2012 Dec 19. PMID: 23250340
Lasmar RB, Barrozo PR, Dias R, Oliveira MA (2005) Jul-Aug;12(4):308 – 11 Submucous myomas: a new presurgical classification to evaluate the viability of hysteroscopic surgical treatment–preliminary report. J Minim Invasive Gynecol. 10.1016/j.jmig.2005.05.014. PMID: 16036188
Loddo A, Djokovic D, Drizi A, De Vree BP, Sedrati A, van Herendael BJ (2022) Hysteroscopic myomectomy: The guidelines of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 268:121–128 Epub 2021 Dec 1. PMID: 34902749
Friedman JA, Wong JMK, Chaudhari A, Tsai S, Milad MP (2018) Hysteroscopic myomectomy: a comparison of techniques and review of current evidence in the management of abnormal uterine bleeding. Curr Opin Obstet Gynecol. ;30(4):243–251. 10.1097/GCO.0000000000000475. PMID: 29939852
Shazly SA, Laughlin-Tommaso SK, Breitkopf DM, Hopkins MR, Burnett TL, Green IC, Farrell AM, Murad MH, Famuyide AO (2016 Sep-Oct) Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 23(6):867–877 Epub 2016 May 7. PMID: 27164165
Vitale SG, Riemma G, Carugno J, Perez-Medina T, Alonso Pacheco L, Haimovich S, Parry JP, Di Spiezio Sardo A, De Franciscis P (2022) Postsurgical barrier strategies to avoid the recurrence of intrauterine adhesion formation after hysteroscopic adhesiolysis: a network meta-analysis of randomized controlled trials. Am J Obstet Gynecol 226(4):487–498e8. 10.1016/j.ajog.2021.09.015
Vitale SG, Laganà AS, Caruso S, Garzon S, Vecchio GM, La Rosa VL, Casarin J, Ghezzi F (2021) Comparison of three biopsy forceps for hysteroscopic endometrial biopsy in postmenopausal patients (HYGREB-1): A multicenter, single-blind randomized clinical trial. Int J Gynaecol Obstet. ;155(3):425–432. 10.1002/ijgo.13669. Epub 2021 Apr 4. PMID: 33686708
Vitale SG, Di Spiezio Sardo A, Riemma G, De Franciscis P, Alonso Pacheco L, Carugno J (2022) In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey. Updates Surg. Feb 5. 10.1007/s13304-022-01246-0. Epub ahead of print. PMID: 35122582
Vitale SG, Angioni S, D’Alterio MN, Ronsini C, Saponara S, De Franciscis P, Riemma G (2024) Risk of endometrial malignancy in women treated for breast cancer: the BLUSH prediction model – evidence from a comprehensive multicentric retrospective cohort study. Climacteric. 10.1080/13697137.2024.2376189Epub ahead of print
Garuti G, Angioni S, Mereu L, Calzolari S, Mannini L, Scrimin F, Casadio P, Alberti DD, Nappi L, Busato E, Leone FPG, Perrini G, Cela V, Luerti M (2020) Hysteroscopic view with targeted biopsy in the assessment of endometrial carcinoma. What is the rate of underestimatated diagnosis? The results of a multicenter Italian trial. Gynecol Surg 17:10. https://doi.org/10.1186/s10397-020-01077-0
Florio P, Filippeschi M, Imperatore A, Mereu L, Franchini M, Calzolari S, Mencaglia L, Litta P (2012) The practicability and surgeons’ subjective experiences with vaginal danazol before an operative hysteroscopy. Steroids 77:528–533
Mereu L, Giunta G, Carri C, Prasciolu C, Albis Florez ED, Mencaglia L (2012) Nomegestrol acetate versus combined oral contraceptive as rapid endometrial preparation for operative hysteroscopy: a prospective randomised pilot study. Gynecol Surg 9:401–404. https://doi.org/10.1007/s10397-012-0740-x
Chiofalo B, Palmara V, Vilos GA, Pacheco LA, Lasmar RB, Shawki O, Giacobbe V, Alibrandi A, Di Guardo F, Vitale SG (2021) Reproductive outcomes of infertile women undergoing see and treat office hysteroscopy: a retrospective observational study. Minim Invasive Ther Allied Technol 30(3):147–153. 10.1080/13645706.2019.1705

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Surgical Parameters Affecting Procedure Duration of Hysteroscopic Fibroid Resection: Results of a Retrospective Longitudinal Study

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Abstract

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Conclusion

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What does this study add to the clinical work

Introduction

Methods

Statistical analysis

Results

Main characteristics

Linear regression analysis

Size

FIGO classification

Localization and age

Discussion

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