Instruments and techniques
The Intra Uterine Morcellator: A new hysteroscopic operating technique to remove intrauterine polyps and myomas

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Study objective

A new hysteroscopic operating technique was compared retrospectively with conventional resectoscopy.

Design

Retrospective comparison (Canadian Task Force Classification II-2).

Setting

Gynecology department of a university-affiliated teaching hospital.

Patients

Fifty-five women, 27 with endometrial polyps and 28 with submucous myomas.

Intervention

Patients were treated with a prototype of the Intra Uterine Morcellator (IUM). This cutting device, 35 cm in length, was inserted into a straight working channel of a 90-mm hysteroscope.

Measurements and main results

The major advantages were ease of removal of tissue fragments through the instrument and the use of saline solution instead of electrolyte-free solutions used in monopolar high-frequency resectoscopy. The mean operating time was 8.7 minutes (95% CI: 7.3–10.1) for the removal of endometrial polyps compared with 30.9 minutes (CI: 27.0–34.8) for resectoscopy, and 16.4 minutes (CI: 12.6–20.2) for submucous myomas compared with 42.2 minutes (CI: 39.7–44.7) for resectoscopy. All procedures were uneventful.

Conclusion

This new technique is faster, and it appears to be easier to perform. Therefore, it can be expected to result in fewer fluid-related complications and to lead to a shorter learning curve when compared with conventional resectoscopy.

Section snippets

Materials and methods

The IUM consists of a set of two metal, hollow, rigid, disposable tubes that fit into each other. The inner tube rotates within the outer tube, driven mechanically by an electrically powered control unit and controlled by a foot pedal that activates the rotation and regulates the direction of rotation of the inner tube. The control unit is connected to a handheld motor drive unit in which the IUM is inserted. The optimal number of rotations per minute (RPM) used with the prototype was 750 (the

Results

Some baseline characteristics of the different patient groups are listed in Table 1. There were no obvious differences between the IUM and resection groups. The outcomes of the procedures are listed in Table 2. All procedures were uneventful.

There was a shorter operating time for the IUM relative to conventional resection procedure in the removal of polyps and also myomas (type 0 and 1 separately and together).

There was less fluid deficit for the IUM relative to conventional resection procedure

Discussion

With this new method of minimal-access surgery in gynecology intrauterine tissue, such as endometrial polyps and submucous myomas, can be cut and aspirated effectively and safely without the use of a conventional resectoscope.

Although removal of polyps obviously was easier than removal of myomas, which is reflected in differences in operating time, overall operating time was reduced when compared with conventional resection. The main reason for this advantage, in our opinion, is the aspiration

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Financial support was received from Smith and Nephew, Andover, MA.

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Copyright © 2005 AAGL. Published by Elsevier Inc. All rights reserved.