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Surgical Management of Retained Placental Tissue with the Hysteroscopic Morcellation Device.

ABSTRACT: Conventionally, surgical management of retained placental tissue is largely performed using blind dilatation and curettage. Hysteroscopic removal using diathermy loop has been shown to be successful while increasing complete removal rates and reducing risk of uterine perforation. Our two cases demonstrated that complete removal of placental tissues can be achieved with hysteroscopic morcellation device which is known to be associated with less operative time and less operative risk compared to diathermy loop. Preoperative transamin can reduce intraoperative bleeding, while careful preparation must be made for bleeding immediately after the procedure when the hysteroscope is withdrawn and distended uterus slowly contracts.

SUBMITTER: Lee MHM

PROVIDER: S-EPMC6367913 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Female sterilization is the second most commonly used method of contraception in the United States. Female sterilization can now be performed through laparoscopic, abdominal, or hysteroscopic approaches. The hysteroscopic sterilization may be a safer option than sterilization through laparoscopy or laparotomy because it avoids invading the abdominal cavity and undergoing general anaesthesia. Hysteroscopic sterilization mainly includes chemical agents and mechanical devices. Common issues related to the toxicity of the chemical agents used have raised concerns regarding this kind of contraception. The difficulty of the transcervical insertion of such mechanical devices into the fallopian tubes has increased the high incidence of device displacement or dislodgment. At present, Essure® is the only commercially available hysteroscopic sterilization device being used clinically. The system is irreversible and is not effective immediately.Our new hysteroscopic sterility system consists of nickel-titanium (NiTi) shape memory alloy and a waterproof membrane. The NiTi alloy is covered with two coatings to avoid toxic Ni release and to prevent stimulation of epithelial tissue growth around the oviducts. Because of the shape memory effect of the NiTi alloy, the device works like an umbrella: it stays collapsed at low temperature before placement and opens by the force of shape memory activated by the body temperature after it is inserted hysteroscopically into the interstitial tubal lumen. The rim of the open device will incise into interstitial myometrium during the process of unfolding. Once the device is fixed, it blocks the tube completely. When the patient no longer wishes for sterilization, the device can be closed by perfusing liquid with low temperature into the uterine cavity, followed by prospective hysteroscopic removal. After the device removal, the fallopian tube will revert to its physiological functions.Currently, experimental and clinical studies are needed to attest the safety, efficiency and reversibility of the novel sterilization device.If our hypothesis is confirmed, appropriate and reversible contraceptive can be achieved with the device we have designed, which may have significant repercussions for numerous women worldwide.

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Surgical Management of Retained Placental Tissue with the Hysteroscopic Morcellation Device.

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