Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions

A Systematic Review and Meta-analysis

Sherif A M Shazly, Shannon K. Laughlin-Tommaso, Daniel M. Breitkopf, Matthew R. Hopkins, Tatnai L. Burnett, Isabel C. Green, Ann M. Farrell, M. Hassan Murad, Abimbola O. Famuyide

Research output: Contribution to journalReview article

Abstract

This systematic review and meta-analysis compares hysteroscopic morcellation with electrosurgical resection to treat uterine cavitary lesions. A search of Ovid MEDLINE, Ovid Embase, Scopus, and Web of Science was conducted through August 18, 2015, for randomized controlled trials (RCTs) and prospective and retrospective studies, regardless of surgical indication and study language or sample size. Seven studies were eventually included (4 RCTs and 3 retrospective observational studies), enrolling 650 women. The meta-analysis showed that the total procedure time was significantly shorter for morcellation than for resection (weighted mean difference = 9.36 minutes; 95% confidence interval [CI], −15.08 to −3.64). When reviewing RCTs only, intrauterine morcellation was associated with a smaller fluid deficit and lower odds of incomplete lesion removal. This difference was not statistically significant in observational studies. There was no significant difference in the odds of surgical complications (odds ratio = 0.72; 95% CI, 0.20–2.57) or the number of insertions (weighted mean difference = −3.04; 95% CI, −7.86–1.78). In conclusion, compared with hysteroscopic resection, hysteroscopic morcellation is associated with a shorter operative time and possibly lower odds of incomplete lesion removal. The certainty in evidence was limited by heterogeneity and the small sample size.

Original languageEnglish (US)
Pages (from-to)867-877
Number of pages11
JournalJournal of Minimally Invasive Gynecology
Volume23
Issue number6
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Meta-Analysis
Randomized Controlled Trials
Confidence Intervals
Sample Size
Observational Studies
Retrospective Studies
Therapeutics
Operative Time
MEDLINE
Language
Odds Ratio
Prospective Studies
Morcellation

Keywords

  • Hysteroscopy
  • Polyps
  • Uterine bleeding
  • Uterine leiomyoma

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Shazly, S. A. M., Laughlin-Tommaso, S. K., Breitkopf, D. M., Hopkins, M. R., Burnett, T. L., Green, I. C., ... Famuyide, A. O. (2016). Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions: A Systematic Review and Meta-analysis. Journal of Minimally Invasive Gynecology, 23(6), 867-877. https://doi.org/10.1016/j.jmig.2016.04.013

Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions : A Systematic Review and Meta-analysis. / Shazly, Sherif A M; Laughlin-Tommaso, Shannon K.; Breitkopf, Daniel M.; Hopkins, Matthew R.; Burnett, Tatnai L.; Green, Isabel C.; Farrell, Ann M.; Murad, M. Hassan; Famuyide, Abimbola O.

In: Journal of Minimally Invasive Gynecology, Vol. 23, No. 6, 01.09.2016, p. 867-877.

Research output: Contribution to journalReview article

Shazly, SAM, Laughlin-Tommaso, SK, Breitkopf, DM, Hopkins, MR, Burnett, TL, Green, IC, Farrell, AM, Murad, MH & Famuyide, AO 2016, 'Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions: A Systematic Review and Meta-analysis', Journal of Minimally Invasive Gynecology, vol. 23, no. 6, pp. 867-877. https://doi.org/10.1016/j.jmig.2016.04.013
Shazly, Sherif A M ; Laughlin-Tommaso, Shannon K. ; Breitkopf, Daniel M. ; Hopkins, Matthew R. ; Burnett, Tatnai L. ; Green, Isabel C. ; Farrell, Ann M. ; Murad, M. Hassan ; Famuyide, Abimbola O. / Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions : A Systematic Review and Meta-analysis. In: Journal of Minimally Invasive Gynecology. 2016 ; Vol. 23, No. 6. pp. 867-877.
@article{7135053d44574d8faa58d67b13eb1c6b,
title = "Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions: A Systematic Review and Meta-analysis",
abstract = "This systematic review and meta-analysis compares hysteroscopic morcellation with electrosurgical resection to treat uterine cavitary lesions. A search of Ovid MEDLINE, Ovid Embase, Scopus, and Web of Science was conducted through August 18, 2015, for randomized controlled trials (RCTs) and prospective and retrospective studies, regardless of surgical indication and study language or sample size. Seven studies were eventually included (4 RCTs and 3 retrospective observational studies), enrolling 650 women. The meta-analysis showed that the total procedure time was significantly shorter for morcellation than for resection (weighted mean difference = 9.36 minutes; 95{\%} confidence interval [CI], −15.08 to −3.64). When reviewing RCTs only, intrauterine morcellation was associated with a smaller fluid deficit and lower odds of incomplete lesion removal. This difference was not statistically significant in observational studies. There was no significant difference in the odds of surgical complications (odds ratio = 0.72; 95{\%} CI, 0.20–2.57) or the number of insertions (weighted mean difference = −3.04; 95{\%} CI, −7.86–1.78). In conclusion, compared with hysteroscopic resection, hysteroscopic morcellation is associated with a shorter operative time and possibly lower odds of incomplete lesion removal. The certainty in evidence was limited by heterogeneity and the small sample size.",
keywords = "Hysteroscopy, Polyps, Uterine bleeding, Uterine leiomyoma",
author = "Shazly, {Sherif A M} and Laughlin-Tommaso, {Shannon K.} and Breitkopf, {Daniel M.} and Hopkins, {Matthew R.} and Burnett, {Tatnai L.} and Green, {Isabel C.} and Farrell, {Ann M.} and Murad, {M. Hassan} and Famuyide, {Abimbola O.}",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.jmig.2016.04.013",
language = "English (US)",
volume = "23",
pages = "867--877",
journal = "Journal of Minimally Invasive Gynecology",
issn = "1553-4650",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Hysteroscopic Morcellation Versus Resection for the Treatment of Uterine Cavitary Lesions

T2 - A Systematic Review and Meta-analysis

AU - Shazly, Sherif A M

AU - Laughlin-Tommaso, Shannon K.

AU - Breitkopf, Daniel M.

AU - Hopkins, Matthew R.

AU - Burnett, Tatnai L.

AU - Green, Isabel C.

AU - Farrell, Ann M.

AU - Murad, M. Hassan

AU - Famuyide, Abimbola O.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - This systematic review and meta-analysis compares hysteroscopic morcellation with electrosurgical resection to treat uterine cavitary lesions. A search of Ovid MEDLINE, Ovid Embase, Scopus, and Web of Science was conducted through August 18, 2015, for randomized controlled trials (RCTs) and prospective and retrospective studies, regardless of surgical indication and study language or sample size. Seven studies were eventually included (4 RCTs and 3 retrospective observational studies), enrolling 650 women. The meta-analysis showed that the total procedure time was significantly shorter for morcellation than for resection (weighted mean difference = 9.36 minutes; 95% confidence interval [CI], −15.08 to −3.64). When reviewing RCTs only, intrauterine morcellation was associated with a smaller fluid deficit and lower odds of incomplete lesion removal. This difference was not statistically significant in observational studies. There was no significant difference in the odds of surgical complications (odds ratio = 0.72; 95% CI, 0.20–2.57) or the number of insertions (weighted mean difference = −3.04; 95% CI, −7.86–1.78). In conclusion, compared with hysteroscopic resection, hysteroscopic morcellation is associated with a shorter operative time and possibly lower odds of incomplete lesion removal. The certainty in evidence was limited by heterogeneity and the small sample size.

AB - This systematic review and meta-analysis compares hysteroscopic morcellation with electrosurgical resection to treat uterine cavitary lesions. A search of Ovid MEDLINE, Ovid Embase, Scopus, and Web of Science was conducted through August 18, 2015, for randomized controlled trials (RCTs) and prospective and retrospective studies, regardless of surgical indication and study language or sample size. Seven studies were eventually included (4 RCTs and 3 retrospective observational studies), enrolling 650 women. The meta-analysis showed that the total procedure time was significantly shorter for morcellation than for resection (weighted mean difference = 9.36 minutes; 95% confidence interval [CI], −15.08 to −3.64). When reviewing RCTs only, intrauterine morcellation was associated with a smaller fluid deficit and lower odds of incomplete lesion removal. This difference was not statistically significant in observational studies. There was no significant difference in the odds of surgical complications (odds ratio = 0.72; 95% CI, 0.20–2.57) or the number of insertions (weighted mean difference = −3.04; 95% CI, −7.86–1.78). In conclusion, compared with hysteroscopic resection, hysteroscopic morcellation is associated with a shorter operative time and possibly lower odds of incomplete lesion removal. The certainty in evidence was limited by heterogeneity and the small sample size.

KW - Hysteroscopy

KW - Polyps

KW - Uterine bleeding

KW - Uterine leiomyoma

UR - http://www.scopus.com/inward/record.url?scp=84991093548&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84991093548&partnerID=8YFLogxK

U2 - 10.1016/j.jmig.2016.04.013

DO - 10.1016/j.jmig.2016.04.013

M3 - Review article

VL - 23

SP - 867

EP - 877

JO - Journal of Minimally Invasive Gynecology

JF - Journal of Minimally Invasive Gynecology

SN - 1553-4650

IS - 6

ER -