Hysteroscopic Surgery as an Alternative for Hysterectomy

Uterine septum can negatively affect reproductive outcomes in women. Based on evidence from retrospective observational studies, hysteroscopic incision has been considered a solution to improve reproductive performance, however there has been recent controversy on the need for surgery for uterine septum. High quality evidence from prospective studies is still lacking, and until it is available, experts are encouraged to publish their data. We are therefore presenting our data that involves analysis of the patient characteristics, surgical approach and long-term reproductive outcomes of women who received treatment for uterine septum under the care of a single surgeon. This includes all women (99) who underwent hysteroscopic surgery for uterine septum between January 2001 and December 2019. Of those 99 women treated for intrauterine septum who were trying to conceive, 91.4% (64/70) achieved pregnancy, 78.6% (55/70) had live births and 8.6% (6/70) had miscarriages. No statistically significant difference was found in the live birth rates when data was analyzed in subgroups based on age, reason for referral/aetiology and severity of pathology. Our study results support the view that surgical treatment of uterine septa is beneficial in improving reproductive outcomes.

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Advanced Hysteroscopic Surgery Training

JSLS Journal of the Society of Laparoendoscopic Surgeons ◽

10.4293/jsls.2014.00396 ◽

2014 ◽

Vol 18 (4) ◽

pp. e2014.00396 ◽

Cited By ~ 4

Author(s):

Mark M. Erian ◽

Glenda R. McLaren ◽

Anna-Marie Erian

Keyword(s):

Surgery Training ◽

Hysteroscopic Surgery

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The use of misoprostol before hysteroscopic surgery in non-pregnant premenopausal women: a randomized comparison of sublingual, oral and vaginal administrations

Human Reproduction ◽

10.1093/humrep/deq083 ◽

2010 ◽

Vol 25 (8) ◽

pp. 1942-1948 ◽

Cited By ~ 17

Author(s):

Y.-Y. Lee ◽

T.-J. Kim ◽

H. Kang ◽

C. H. Choi ◽

J.-W. Lee ◽

...

Keyword(s):

Premenopausal Women ◽

Hysteroscopic Surgery

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Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-05993-0 ◽

2021 ◽

Author(s):

Marlene Hager ◽

Johannes Ott ◽

Christian Göbl ◽

Iris Holzer ◽

Rudolf Seemann ◽

...

Keyword(s):

Cohort Study ◽

Primary Outcome ◽

Fluid Shift ◽

Tubal Patency ◽

Tubal Occlusion ◽

Hysteroscopic Surgery ◽

Before And After ◽

Vaginal Sonography ◽

Pouch Of Douglas ◽

Medical University

Abstract Purpose To determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency. Methods In a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation. Results Laparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift. Conclusion When CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency.

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