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A systematic review and meta‐analysis of randomized controlled trials comparing hysteroscopic morcellation with resectoscopy for patients with endometrial lesions
Author(s) -
Li Chunbo,
Dai Zhiyuan,
Gong Yuping,
Xie Bingying,
Wang Bei
Publication year - 2017
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12012
Subject(s) - medicine , hysteroscopy , tolerability , randomized controlled trial , confidence interval , meta analysis , odds ratio , surgery , radiology , adverse effect
Abstract Background Results on the efficacy of hysteroscopic morcellation for patients with endometrial lesions remain conflicting. Objectives To compare hysteroscopic morcellation with conventional resectoscopy for removal of endometrial lesions. Search strategy Electronic databases were searched for reports published up to February 1, 2016, using terms such as “morcellator,” “morcellators,” “morcellate,” “morcellation,” “morcellated,” “hysteroscopy,” “hysteroscopy,” “uteroscope,” and “transcervical.” Selection criteria Randomized controlled trials were included if they assessed success rate, procedure speed, complications, tolerability, and/or learning curve. Data collection and analysis Data were extracted by two independent reviewers and a meta‐analysis was performed. Main results Four trials including 392 patients were analyzed. Successful removal of all endometrial lesions was more frequent with hysteroscopic morcellation than conventional resectoscopy (odds ratio 4.49, 95% confidence interval [CI] 1.94–10.41; P <0.001). Total operative time was also shorter with hysteroscopic morcellation (mean difference −4.94 minutes, 95% CI −7.20 to −2.68; P <0.001). No significant differences in complications were found. Meta‐analyses were not possible for tolerability and learning curve. In one study, hysteroscopic morcellation was acceptable to more patients ( P =0.009). Conclusions Hysteroscopic morcellation is associated with a higher operative success rate and a shorter operative time among patients with endometrial lesions than is resectoscopy. More high‐quality trials are required to validate these results.