Hysteroscopic morcellation, evolution or revolution? — YRD

Hysteroscopic morcellation, evolution or revolution? (1474)

Rajendra Sankpal

Hysteroscopy in Gynecology has revolutionary changes in the recent past. Introduction of the resectoscopy and operative sheath with mechanical instruments revolutionised the management of benign Gynecological pathologies. In this way the management of the benign pathologies became the day care affair reducing the morbidity. Further the introduction of office Hysteroscopy made the Hysteroscopic surgery from day care to an office procedure. This change is really beneficial to the patient. The progress of monopolar resectoscope to bipolar further reduced the complications associated with the Glycine as the distension medium, but the  risk of perforation and electrical injury to bowel still remains the same, though the risk is very minimal in the hands of a refined Hysteroscopic surgeon. Hysteroscopic morcellator, a tubular, rotating, mechanical energy system was developed since more than 10 years. The development of such morcellators have occurred to curtail the likely complication of conventional resectoscopy especially fluid overload, perforation of uterus, bowel injury & haemorrhage. Technically the Hysteroscopic morcellator is a boon for resection of Grade 0 and Grade 1 submucus myoma. On the other hand resection of Grade II myoma and the deeper mayomas  at the fundal and cornual regions is technically not easy as compared to the  Grade 0 myoma with the morcellators. On the basis of acknowledged limited information, the life-threatening complications such as fluid overload, uterine perforation and bleeding do occur with hysteroscopic morcellation but less frequently than with traditional electrocautery. Hysteroscopic morcellator is a good evolution in the management of submucus myoma. Further refinement in the equipment is needed to easily tackle the deeper submucus myomas. Furthermore cost is a limiting factor to use this technology exclusively for submucus myoma and polyps.