Symptoms and General Pathology

All Conditions

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Neoplasms

Hyperplasia

Endometrial Hyperplasia

Polyps

Uterine Neoplasms

Pathological Conditions, Anatomical

Uterine Diseases

Genital Diseases, Female

Genital Diseases

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Genital Neoplasms, Female

Urogenital Neoplasms

Reproductive Control Agents

All Drugs and Chemicals

Levonorgestrel

Contraceptive Agents

Contraceptive Agents, Hormonal

Contraceptive Agents, Female

Contraceptives, Oral

Levonorgestrel intrauterine device (IUD)

Federica Scrimin, MD

The study aims to evaluate the long-term efficacy and prognosis of hysteroscopic resection and coagulation of the base of endometrial polyps with focal atypia in fertile women.

The introduction of hysteroscopy in clinical practice changed significantly our knowledge of uterine cavity, but did not stimulate the start of big studies with aim to evaluate the feasibility of conservative treatments for better defined diseases as endometrial polyp. The use of curettage(D\&C) has led the gynecologists to consider diffuse atypical endometrial hyperplasia and atypical polyp as the same disease. The treatment of these precancerous lesions recommended by scientific societies is aggressive (hysterectomy). Surprisingly, regarding hysterectomy we did not observe management modifications after the introduction of endoscopic techniques, as happened in other surgical disciplines.

To evaluate costs and health benefits of operational hysteroscopy we started in our Institute a study protocol in 1998. In a first trial we studied a conservative treatment of postmenopausal woman with high anesthesiologic risk who had endometrial polyps with atypia and no involvement of the base (Scrimin F. Am J Obstet Gynecol 2006;195:1328-30).

The good initial results and the request of conservative treatments by some women, desiring pregnancies, encouraged us to start this preliminary trial to evaluate the long-term efficacy and prognosis of hysteroscopic resection and coagulation of the base of endometrial polyps with focal atypia in a little sample of fertile women. Other studies suggest progestin treatment of well differentiated carcinoma in young women who desired to preserve their fertility. There is no evidence of a correlation between the tendency to develop endometrial polyps and the risk of endometrial carcinoma. The risk of malignant degeneration of endometrial polyps is not well known, but seems to range between 0.5% and 6%. On this background, we decided to study in the same population of fertile women and with a quasi-randomised design the possible additional effect of levonorgestrel-releasing intrauterine device (LNG-IUD).

Comparison: women assigned to odd numbers underwent polyp resection and endometrial surveillance with insertion of levonorgestrel intrauterine system (IUD group), women assigned to even numbers underwent polyp resection and endometrial surveillance without insertion of levonorgestrel intrauterine system (no IUD or control group).

Resectoscopic Treatment of Atypical Endometrial Polyps in Fertile Women

Operational Hysteroscopy Versus Traditional Surgery: Costs and Health Benefits

IRCCS Burlo Garofolo

Skin and Connective Tissue Diseases

Leiomyoma

Myofibroma

Menorrhagia

Neoplasms, Connective and Soft Tissue

Neoplasms by Histologic Type

Hemorrhage

Uterine Hemorrhage

Menstruation Disturbances

Amino Acids

Glycine

Hysteroscopic resection of fibroids, polyps and endometrium.

Anette Berg, MD

Olav Istre, MD., PhD.

The aim of the study is to evaluate bipolar equipment versus monopolar, and to see if there is any differences between the two types of bipolar equipment espescially regading both safety and effect.

* Trial design: A prospective randomised study with three arms, one arm with monopolar surgery and two different arms with bipolar surgery. Its a one center study.
* Trial population: Pre-or perimenopausal women reffered to our clinic with bleeding disorders and were we plan to do endometrial resection. Patients with a bleeding disorder due to fibroids type 0 and 1 will be included and patients with polyps were endometrial resection is planned at the same time will also be included.
* Preoperative selection: The fibroids will be mapped using transvaginal ultrasound according to the classification ESGE. Type 0 and 1 fibroids will be included. Diameter of the fibroid must not extend 4cm. The endometrium size double layer will be recorded. Uterine size anetrior /posterior diameter, longitudinal diameter (cavity; top fundal to isthmus) will be measured. Were polyps are included these will be measured; length and width. Higham score (PBAC), Se-hgb, Ferritin, FSH and Oestradiol will be documented at all visits. Menstrual pain will be documented due to a VAS-scale.
* Treatment regimen:Randomisation in blocs of 20 between monopolar and two types of bipolar surgery.
* Surgical Technique: The cervical canal will be dilated to Hegar 10 or 11 and a rigid resectoscope Ch. 26 is passed to the uterine cavity. Glycine 1,5% or Saline (Baxter) is infused to irrigate the uterine cavity (Iglesias technique) Automatic pressure cuff maintains an infusion pressure of 100mm Hg and suction 10-15mmHg is applied to the outflow tube in order to achieve a sufficient flow.Fibroids type 0 and 1 are resected in total if possible or flush to the plane of the uterine wall. The tissue chips are removed at intervals by currette and forceps. The operation will be performed by experienced surgeons.
* Primary response variables: Safety is our primary response variable. Fluid absorption and lowering of Se-Sodium will be analysed. These parameters are the only objective parameters which can tell us about safety. Nausea will be reorded on a VAS-scale.

  * Secondary resonse variables: Operating time, tissue removed, easisness of operation, levels of vaginal bleeding measured by the methosd of Hgham(PBAC)before and at follow up.

After 6 month and one year we will look at secondary intervention like repeated resection or hysterectomy.

Hysteroscopic Monopolar and Bipolar Resection

A Randomised Trial to Compare the Differences Between Monopolar Surgery (Loop Resection) With Glycine 1,5% and Bipolar Surgery With Saline (Olympus,Versapoint) on Hysteroscopic Surgery.

Ullevaal University Hospital

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Resectoscopic Treatment of Atypical Endometrial Polyps in Fertile Women	NCT00490087	Atypical Endome... Atypical Endome...	Levonorgestrel ...	25 Years - 50 Years	IRCCS Burlo Garofolo
Resectoscopic Treatment of Atypical Endometrial Polyps in Fertile Women	NCT00490087	Atypical Endome... Atypical Endome...	Levonorgestrel ...	25 Years - 50 Years	IRCCS Burlo Garofolo
Hysteroscopic Monopolar and Bipolar Resection	NCT00323999	Menorrhagia Fibroid Polyps	Hysteroscopic r...	18 Years - 60 Years	Ullevaal University Hospital
Hysteroscopic Monopolar and Bipolar Resection	NCT00323999	Menorrhagia Fibroid Polyps	Hysteroscopic r...	18 Years - 60 Years	Ullevaal University Hospital
Resectoscopic Treatment of Atypical Endometrial Polyps in Fertile Women	NCT00490087	Atypical Endome... Atypical Endome...	Levonorgestrel ...	25 Years - 50 Years	IRCCS Burlo Garofolo

Spots Global Cancer Trial Database for hysteroscopic resection