Morcelador histeroscópico (Truclear System (R)): nuestra experiencia inicial / Morcellator hysteroscopy (Truclear System(R)): preliminary experience

Objetivo. Eficacia y seguridad del sistema de morcelación histeroscópica. Pacientes y métodos. Estudio observacional retrospectivo durante el periodo 2004-2009, que incluye a un total de 411 pacientes diagnosticadas de patología intracavitaria a las que se les realizó una histeroscopia quirúrgica con un sistema de morcelación mecánica. Resultados. Se realizaron 327 polipectomías y 76 miomectomías, con una tasa de éxito del 99,2% y con un tiempo quirúrgico medio de 9,2 min y 22,3 min, respectivamente. Conclusión. La técnica de morcelación histeroscópica es segura y eficaz, presenta una corta curva de aprendizaje, unos buenos tiempos quirúrgicos y una baja tasa de complicaciones (AU)

Objective. To evaluate the efficacy and safety of the hysteroscopic morcellator. Patients and methods. We carried out a retrospective observational study of 411 patients diagnosed with intracavitary disease, who underwent surgical hysteroscopy with the mechanical morcellation system from 2004 to 2009. Results. We performed 327 polypectomies and 76 myomectomies. The success rate was 99.2%. The mean operative time was 9.2 minutes and 22.3 minutes, respectively. Conclusion. The hysteroscopic morcellation technique is safe and effective, has a short learning curve, a reasonable operating time, and low rate of surgical complications (AU)

Satisfaction and tolerance with office hysteroscopic tubal sterilization.

OBJECTIVE: To evaluate women's satisfaction and tolerance of hysteroscopic sterilization. DESIGN: Prospective analysis of case series. SETTING: Gynecology department in a teaching hospital. PATIENT(S): A total of 1,630 women who underwent hysteroscopic sterilization by placement of Essure microinserts (Conceptus, Inc., Mountain View, CA) from January 2003 to June 2006. INTERVENTION(S): Transvaginal ultrasound examination, pelvic x-ray examination, and hysterosalpingography 3 months after sterilization with Essure microinserts. Satisfaction was assessed by a visual analog scale. Adverse effects and tolerance also were recorded. MAIN OUTCOME MEASURE(S): Transvaginal ultrasound and pelvic x-ray confirmation of correct localization of microinserts and patient's satisfaction and tolerance after a 3-month follow-up. RESULT(S): The rate of successful insertion was 99%. Most of women returned to their daily activities on the same day of insertion, and 86.5% considered the procedure painless or scarcely painful. All the patients were highly satisfied after hysteroscopic sterilization: 91% of subjects by visual analog scale (on a 0 to 10 scale) rated the method at 10 (high satisfaction degree), and none of the subjects rated it under 8. For patients, the most valuable aspects of the procedure were absence of surgery room (52.7%), method's quickness and comfort (19.9%), and permanent sterilization (18.2%). More than 97% of the patients said that they would recommend the procedure to others. CONCLUSION(S): This study provides evidence that Essure microinserts can be placed in a usual gynecologic consultation room in standard conditions without any type of anesthesia or sedation and are associated with great overall patient satisfaction. Women also have high tolerance for the procedure and describe minor postoperative pain.

Techniques to maximize flexible ureteroscope longevity.

OBJECTIVES: To assess methods to improve the longevity and durability of flexible ureteroscopes by using the ureteral access sheath, 200-microm holmium laser fiber, and nitinol baskets or graspers during routine ureteroscopic procedures. Despite adequate advances in fiberoptics and endoscope design, the decreased size of currently available flexible ureteroscopes makes damage inevitable after repeated use. However, new auxiliary tools may be able to enhance ureteroscope durability. METHODS: The indications for performing flexible ureteroscopy were proximal ureteral stones (n = 32), renal calculi (n = 59), treatment of upper tract transitional cell carcinoma (n = 3), evaluation of hematuria or filling defect (n = 7), and treatment of ureteral strictures or ureteropelvic junction obstruction (n = 8). Using four new 7.5F flexible ureteroscopes, we prospectively evaluated the number of passes of each ureteroscope until more than 20 optical fibers were broken, more than a 25 degrees loss of deflection in either direction had occurred, or the instrument sustained injury requiring repair by the manufacturer. RESULTS: One hundred nine flexible ureteroscopic procedures (average 27.5 procedures per instrument; range 19 to 34) were performed with the four new flexible ureteroscopes before being sent for repair. Adjuncts to reduce scope damage during these procedures were the use of the ureteral access sheath (n = 109), nitinol devices allowing lower pole stone retrieval (n = 27), and the 200-microm holmium laser fiber for stone fragmentation, tumor ablation, and incision of ureteropelvic junction/ureteral stenoses (n = 91). The average number of passes until more than 20 optical fibers were broken was 15.3 (range 12 to 20), until more than a 25 degrees loss of deflection occurred was 50.3 (range 42 to 66), or until the scope required repair was 66.7 (range 46 to 82). CONCLUSIONS: Flexible ureteroscopy will be used increasingly to manage upper urinary tract pathologic findings. Historically, the number of procedures performed before a flexible ureteroscope requires repair averaged 6 to 15. By incorporating the new ureteroscopic accessories, such as nitinol devices, a ureteral access sheath, and the 200-microm holmium laser fiber into common practice, one can reduce the strain on these fragile 7.5F endoscopes, thereby maximizing their longevity.