Abstract：
OBJECTIVE: To investigate the feasibility of operative hysteroscopy by a hysteroscopic tissue removal system (HTRS) without anesthesia in women with endometrial polyps (EP) or retained products of conception (RPOC).
METHODS: Prospective observational cohort study.
METHODS: University-affiliated Department of Obstetrics and Gynecology.
METHODS: Consenting women aged >18 years diagnosed with EP or RPOC from 9/2022 to 8/2023 confirmed by a prior office hysteroscopy.
METHODS: Office-based vaginoscopic operative hysteroscopy without anesthesia using the Mini-Elite Truclear HTRS. Oral misoprostol was prescribed for cervical ripening. The patients rated intraoperative and 5-minute postoperative pain levels on a visual analog scale, with mild pain defined as a score of 0 to 4, moderate as 5 to 7, and severe as 8 to 10. A successful procedure was defined as complete removal of the pathology.
RESULTS: Fifty patients were included in this pilot study, and 47 (94.0%) procedures were completed successfully, including 21/24 (87.5%) cases of EP and all cases of RPOC (26/26, p = .06). No intra- or postoperative complications occurred. The intraoperative pain levels were rated as mild, moderate, and severe by 26 (52.0%), 16 (32.0%) and 8 (16.0%) patients, respectively. Severe intraoperative pain was more common in nulliparous women and those >10 years from their last vaginal delivery and was not associated with patient age, menopausal status, presence of abnormal uterine bleeding, or pathology size. Severe postoperative pain, reported by 5 (10.0%) patients, was significantly associated with removal of EP compared with RPOC, longer operative time, and nulliparity or >10 years from the last vaginal delivery. The procedure was considered acceptable by 46 (92.0%) patients, and 45 (90.0%) would recommend it to a friend/relative.
CONCLUSIONS: Office-based operative hysteroscopy by the HTRS is successful and well tolerated by most women, especially for RPOC removal.
METHODS: Prospective observational cohort study.
METHODS: University-affiliated Department of Obstetrics and Gynecology.
METHODS: Consenting women aged >18 years diagnosed with EP or RPOC from 9/2022 to 8/2023 confirmed by a prior office hysteroscopy.
METHODS: Office-based vaginoscopic operative hysteroscopy without anesthesia using the Mini-Elite Truclear HTRS. Oral misoprostol was prescribed for cervical ripening. The patients rated intraoperative and 5-minute postoperative pain levels on a visual analog scale, with mild pain defined as a score of 0 to 4, moderate as 5 to 7, and severe as 8 to 10. A successful procedure was defined as complete removal of the pathology.
RESULTS: Fifty patients were included in this pilot study, and 47 (94.0%) procedures were completed successfully, including 21/24 (87.5%) cases of EP and all cases of RPOC (26/26, p = .06). No intra- or postoperative complications occurred. The intraoperative pain levels were rated as mild, moderate, and severe by 26 (52.0%), 16 (32.0%) and 8 (16.0%) patients, respectively. Severe intraoperative pain was more common in nulliparous women and those >10 years from their last vaginal delivery and was not associated with patient age, menopausal status, presence of abnormal uterine bleeding, or pathology size. Severe postoperative pain, reported by 5 (10.0%) patients, was significantly associated with removal of EP compared with RPOC, longer operative time, and nulliparity or >10 years from the last vaginal delivery. The procedure was considered acceptable by 46 (92.0%) patients, and 45 (90.0%) would recommend it to a friend/relative.
CONCLUSIONS: Office-based operative hysteroscopy by the HTRS is successful and well tolerated by most women, especially for RPOC removal.
摘要：
目的：探讨子宫内膜息肉（EP）或受孕产物保留（RPOC）的妇女在不麻醉的情况下通过宫腔镜组织切除系统（HTRS）进行宫腔镜手术的可行性。
方法：前瞻性观察性队列研究。
方法：大学附属妇产科。
方法：同意2022年9月至2023年8月18日诊断为EP或RPOC的年龄>18岁的女性，通过先前的办公室宫腔镜检查证实。
方法：使用Mini-EliteTruclearHTRS进行无麻醉的基于办公室的阴道镜手术宫腔镜检查。口服米索前列醇用于促宫颈成熟。患者在视觉模拟量表上评估了术中和术后5分钟的疼痛水平，轻度疼痛定义为0-4分，中度为5-7分，重度为8-10分。成功的手术被定义为完全切除病理。
结果：本初步研究纳入了50名患者，47例(94.0%)程序成功完成，包括21/24例（87.5%）EP和所有RPOC病例（26/26，p=.06）。无术中或术后并发症发生。术中疼痛程度评定为轻度，中度,严重的是26人(52.0%)，16例（32.0%）和8例（16.0%）患者，分别。严重的术中疼痛更常见于未产妇女和距离最后一次阴道分娩>10年的妇女。与患者年龄无关，更年期状态，异常子宫出血的存在，或病理大小。严重的术后疼痛，5名(10.0%)患者报告，与RPOC相比，与EP的去除显着相关，更长的手术时间，无产期或距最后一次阴道分娩>10年。46例（92.0%）患者认为该手术是可接受的，45（90.0％）会推荐给朋友/亲戚。
结论：通过HTRS进行的基于办公室的宫腔镜检查是成功的，并且大多数女性的耐受性良好，特别是RPOC去除。
方法：前瞻性观察性队列研究。
方法：大学附属妇产科。
方法：同意2022年9月至2023年8月18日诊断为EP或RPOC的年龄>18岁的女性，通过先前的办公室宫腔镜检查证实。
方法：使用Mini-EliteTruclearHTRS进行无麻醉的基于办公室的阴道镜手术宫腔镜检查。口服米索前列醇用于促宫颈成熟。患者在视觉模拟量表上评估了术中和术后5分钟的疼痛水平，轻度疼痛定义为0-4分，中度为5-7分，重度为8-10分。成功的手术被定义为完全切除病理。
结果：本初步研究纳入了50名患者，47例(94.0%)程序成功完成，包括21/24例（87.5%）EP和所有RPOC病例（26/26，p=.06）。无术中或术后并发症发生。术中疼痛程度评定为轻度，中度,严重的是26人(52.0%)，16例（32.0%）和8例（16.0%）患者，分别。严重的术中疼痛更常见于未产妇女和距离最后一次阴道分娩>10年的妇女。与患者年龄无关，更年期状态，异常子宫出血的存在，或病理大小。严重的术后疼痛，5名(10.0%)患者报告，与RPOC相比，与EP的去除显着相关，更长的手术时间，无产期或距最后一次阴道分娩>10年。46例（92.0%）患者认为该手术是可接受的，45（90.0％）会推荐给朋友/亲戚。
结论：通过HTRS进行的基于办公室的宫腔镜检查是成功的，并且大多数女性的耐受性良好，特别是RPOC去除。
