Abstract
Background
Although uterine septum does not cause infertility, it may lead to recurrent abortion, preterm delivery, and premature rupture of membrane in over 25% of patients. The aim of this study was to evaluate feasibility and clinical value of hysteroscopic bipolar electric vaporization technique (Versapoint Bipolar Electrosurgical System) used in transcervical incision of septa (TCIS) in an outpatient setting.
Methods
Retrospectively, 447 cases of hysteroscopic TCIS were analyzed. Operative time, blood loss, consumption of uterus distension medium, and period of postoperative hospital stay were compared between outpatients and inpatients. Feasibility of outpatient TCIS using bipolar electric vaporization system under analgesia and without anesthesia was investigated. All hysteroscopic procedures were performed after review and approval by institutional ethical committee. Stata 8.0 software was used for statistical analysis, and t test and χ 2 test were used to evaluate association among numerical and categorical variables. p < 0.05 indicated statistically significant difference.
Results
The study included 121 inpatients (27.1%) and 326 outpatients (72.9%). Three hundred sixty-two cases (80.98%) were under only pethidine analgesia and 420 cases (93.96%) under local infiltration anaesthesia or analgesia. Of 447 cases of TCIS, 433 (96.87%) were accomplished under intravenous, local infiltration anaesthesia or pethidine analgesia. In all TCIS, 421 cases (94.18%) were carried out with mechanical microscissors and bipolar electric vaporization incision. No significant difference was identified between inpatients and outpatients in terms of operative time, blood loss, or consumption of uterus distension medium (p > 0.05). However, period of postoperative hospital stay was significantly shorter in outpatient TCIS than in inpatient TCIS by an average of 24 h or more (p < 0.01).
Conclusions
Hysteroscopic bipolar electric vaporization TCIS could be carried out safely and efficaciously in an outpatient setting, by using smaller hysteroscope and bipolar electrodes.
Similar content being viewed by others
References
Pace S, Cipriano L, Pace G, Catania R, Montanino G (2006) Septate uterus: reproductive outcome after hysteroscopic metroplasty. Clin Exp Obstet Gynecol 33:110–112
Sanders B (2006) Uterine factors and infertility. J Reprod Med 51:169–176
Pabuccu R, Gomel V (2004) Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility. Fertil Steril 81:1675–1678
Sui L, Wang Q, Zheng RL, Chen M (2005) Feasibility of transcervical incision of septa in office hysteroscopy. Shanghai J Med 28:187–190
Golan A, Sagiv R, Berar M, Ginath S, Glezerman M (2001) Bipolar electrical energy in physiologic solution—a revolution in operative hysteroscopy. J Am Assoc Gynecol Laparosc 8:252–258
Valli E, Vaquero E, Lazzarin N, Caserta D, Marconi D, Zupi E (2004) Hysteroscopic metroplasty improves gestational outcome in women with recurrent spontaneous abortion. J Am Assoc Gynecol Laparosc 11:240–244
Sparac V, Kupesic S, Ilijas M, Zodan T, Kurjak A (2001) Histologic architecture and vascularization of hysteroscopically excised intrauterine septa. J Am Assoc Gynecol Laparosc 8:111–116
Colacurci N, De Franciscis P, Mollo A, Litta P, Perino A, Cobellis L, De Placido G (2007) Small-diameter hysteroscopy with Versapoint versus resectoscopy with a unipolar knife for the treatment of septate uterus: a prospective randomized study. J Minim Invasive Gynecol 14:622–627
Vercallina P, Vandola N, Colombo A, Passadore C, Trespidi L, Fedele L (1993) Hysteroscopic metroplasty with resectoscope or microscissors for the correction of septate uterus. Surg Gynecol Obstet 176:439–442
Venturoli S, Colombo FM, Vianello F, Seracchioli R, Possati G, Paradisi R (2002) A study of hysteroscopic metroplasty in 141 women with a septate uterus. Arch Gynecol Obstet 266:157–159
Roge T, Homer M, Tin-Chiu L (2000) The septate uterus: a review of management and reproductive outcome. Fertil Steril 73:1–14
Onyeka BA, Rahman KM (2001) Treatment of menorrhagia before hysterectomy in a district general hospital. A retrospective review. J Obstet Gynaecol 21:64–66
Guida M, Pellicano M, Zullo F, Acunzo G, Lavitola G, Palomba S, Nappi C (2003) Outpatient operative hysteroscopy with bipolar electrode: a prospective multicenter randomized study between local anaesthesia and conscious sedation. Human Reprod 18:840–843
Marwah V, Bhandari SK (2003) Diagnostic and interventional microhysteroscopy with use of the coaxial bipolar electrode system. Fertil Steril 79:413–417
Clark TJ, Mahajan D, Sunder P, Gupta JK (2002) Hysteroscopic treatment of symptomatic submucous fibroids using a bipolar intrauterine system: a feasibility study. Eur J Obstet Gynecol Reprod Biol 100:237–242
Bettocchi S, Ceci O, Di Venere R, Pansini MV, Pellegrino A, Marello F, Nappi L (2002) Advanced operative office hysteroscopy without anaesthesia: analysis of 501 cases treated with a 5 Fr. Bipolar electrode. Human Reprod 17:2435–2438
Kabli N, Tulandi T (2008) A randomized trial of outpatient hysteroscopy with and without intrauterine anesthesia. J Minim Invasive Gynecol 15:308–310
Fürst SN, Philipsen T, Joergensen JC (2007) Ten-year follow-up of endometrial ablation. Acta Obstet Gynecol Scand 86:334–338
Acknowledgments
The authors would like to thank Prof. Yinhua Yu for manuscript editing. This work was supported by the Shanghai Leading Academic Discipline Project (project number B117).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sui, L., Wan, Q., Zheng, Rl. et al. Transcervical incision of septa: 447 cases. Surg Endosc 23, 2078–2084 (2009). https://doi.org/10.1007/s00464-008-0209-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-0209-1