innovative non-electrical hysteroscopic polypectomy technique for enhanced fertility preservation in women

Hysteroskopisk teknik med mikrosax och pincett för borttagning av polyper

Endometrial polyps are abnormal tissue growths in the uterine lining with significant implications for fertility and reproductive health1. The estimated incidence rate of endometrial polyps is approximately 35% among patients with infertility2, though this figure may vary. These polyps can disrupt embryo implantation by inducing structural deformities in the uterine cavity and impacting the endometrium&#39;s ability to support implantation3,4,5,6. While hysteroscopic surgery is a common procedure for removing endometrial polyps, it is not without risks, with uterine perforation being the primary complication, particularly during the removal of multiple polyps7. Hysteroscopy with resectoscopes and classic mechanical resection with scissors and/or graspers remain standard for evaluating and treating the pathology of the cervical canal and endometrial cavity8. The application of electric energy during the procedure can result in endometrial damage, especially in cases involving anatomical variations such as a unicornuate uterus9. Mechanical technology such as morcellators and scissors are less painful than electrical devices when eliminating structural lesions in the office10.
In response to these challenges, a novel approach is proposed involving the combined use of micro-scissors and forceps during hysteroscopy. This technique aims to minimize the risk of injury to the endometrium, particularly the basal layer while ensuring the complete excision of polyps to enhance fertility outcomes for women. The technique is easy to learn and requires two doctors to perform the operation. Doctors with experience in hysteroscopy are capable of executing this procedure. It is a new and unique technique that eliminates thermal damage in a very common gynecologic indication.
Overall, this innovative approach presents a safer and more precise method for eliminating endometrial polyps, particularly in women with fertility concerns, offering a valuable alternative to traditional hysteroscopic procedures and potentially enhancing outcomes for patients requiring treatment for endometrial polyps.

Författare i fokus: En reproduktiv hysteroskopimetod för fullständig borttagning av endometriepolyp och förbättrad endometriemottaglighet

Förbättrad hysteroskopisk resektion av endometriepolyper med hjälp av 6-FR mikrosax och pincett

Our research is mainly about reproductive hysteroscopy, and the main problem we want to solve is how to ensure that the uterine environment of endometrial patients achieves optimal pregnancy conditions. The main challenge now is how to completely remove endometrial polyps while protecting the patient's fertility and not damaging the basal layer of the endometrium. Our surgical protocol can ensure the total removal of polyps and at the same time maximize the patient's endometrial receptivity in order to improve the patient's fertility.

Innovativ icke-elektrisk hysteroskopisk polypektomiteknik för förbättrad fertilitetsbevarande hos kvinnor

innovative-non-electrical-hysteroscopic-polypectomy-technique-for

Research

JoVE Journal

Medicine

Innovative Non-Electrical Hysteroscopic Polypectomy Technique for Enhanced Fertility Preservation in Women

Improved Hysteroscopic Resection of Endometrial Polyps Using 6-Fr Micro-Scissors and Forceps

Endometrial polyps commonly contribute to female infertility, and hysteroscopic resection is the established surgical approach for their treatment. Numerous resection methods are available, with the most used and cost-effective options being cold resection employing micro-scissors or hot resection using an electric loop. However, both methods involve sharp resection, posing a challenge in achieving complete polyp removal while avoiding damage to the uterine endometrium. To address this issue, this study proposes an innovative approach: the combined use of the 6 Fr micro-scissors and forceps under hysteroscopy. The method entails utilizing 6 Fr micro-scissors to initially remove large polyps, followed by using 6 Fr micro-forceps to extract the remaining polyp tissue expeditiously and bluntly near the basal layer of the endometrium. This approach not only prevents surgical damage to the basal layer of the endometrium but also mitigates the risk of residual polyps resulting from incomplete resection. This method is particularly suitable for women with fertility requirements, offering additional considerations for the selection of treatment options for endometrial polyp resection.

The novel technique presented here employs a combination of 6-Fr micro-scissors and forceps for hysteroscopic treatment of endometrial polyps, demonstrating encouraging outcomes for infertile patients afflicted with this condition.

Endometrial polyps commonly contribute to female infertility, and hysteroscopic resection is the established surgical approach for their treatment. ...

To begin, place the anesthetized patient in the lithotomy position and secure the lower legs with bandages on both sides. With the help of an anesthesiologist, establish peripheral venous access on the patient. Then, assemble the hysteroscope lens, adjust the focus, and set the white balance.Set the hysteroscope pressure at 100 millimeters of mercury and a flow rate of 300 milliliters per minute, using 0.9%saline as the distension medium. Using cervical forceps, grasp the lower right lip of the cervix and perform iodine disinfection for the vagina, fornix, and cervix. Introduce the hysteroscope into the uterine cavity through the cervical canal.Perform cervical dilation using Hegar dilators, ranging from Number 3.5 to Number 5.5. To begin polyp removal for patients with a single uterine polyp, use the blunt end of the micro forceps to pinpoint the basal layer of the endometrium. Place the forceps in the anatomical gap between the endometrial polyp and the basal layer to grasp the basal portion of the endometrial polyp.Swiftly withdraw the micro forceps to ensure complete separation of the polyp base from the endometrial base. Collect the excised polyp tissue for pathological examination. To remove multiple endometrial polyps, use micro scissors to excise most of the polyps to increase the surgical space and enhance visibility within the operative field.Then, remove any remaining polyp bases as demonstrated previously. Now, start the polyp excision sequence with the posterior uterine wall, followed by the uterine lateral wall and corners, and then the anterior uterine wall.