Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Leung C (1)(2), Kwong LT (1)(2), So PL (1)(2), Wong SF (1)(2), Chow KM (1)(2)
Affiliation :
(1) Department of Obstetrics and Gynaecology, Tuen Mun Hospital
(2) Department of Obstetrics and Gynaecology, Pok Oi Hospital
Introduction :
Abnormal uterine bleeding is a common problem for women and can be caused by endometrial lesions such as polyps and myomas. Hysteroscopic morcellation has become an instrument of choice in tackling these lesions as compared with the traditional bipolar resectoscope. Since November 2018, the NTWC hospital cluster has introduced its use as an office procedure – being a pioneer in Hong Kong. It avoids the risks associated with general anaesthesia and enables a shorter recovery time and faster return to mobility. It also minimizes costs and maximizes resources related to operating theatre use. We aim to review the clinical safety, effectiveness and patient acceptance towards this service.
Objectives :
To evaluate the hysteroscopic morcellation service as a day procedure in Tuen Mun Hospital and Pok Oi Hospital with regards to procedure details and safety, completeness of resection, patients' pain scores and satisfaction levels, and clinical outcome.
Methodology :
Medical records of women who underwent the procedure using the Intrauterine Bigatti Shaver between 1 November 2018 and 31 October 2022 at Tuen Mun Hospital or Pok Oi Hospital were retrospectively reviewed. Patient characteristics, clinical details, procedure details, nature of lesions, procedural difficulties, patients’ pain scores and satisfaction levels were analyzed. Procedural complications and clinical outcomes were also reviewed.
Result & Outcome :
Results
Over the 4-year period, 242 patients who underwent hysteroscopic morcellation were included. The most common presenting symptom was post-menopausal bleeding. Majority of patients (87.2%) had endometrial polyps. There were in total 523 endometrial polyps and 29 myomas; 99.4% of endometrial polyps and 79.3% of myomas were removed. Most patients reported only mild pain (visual analogue score 0-3) intraoperatively, immediately after the procedure and upon discharge. More than 95% of the patients were satisfied with the procedure. There were no complications of cervical trauma or uterine perforation, only two cases had bleeding and one case had infection that were managed subsequently. Upon follow up, 94% of patients reported symptom improvement.
Conclusion
Our findings suggest that office hysteroscopic morcellation is not only a safe and effective method to manage endometrial lesions, but also well accepted by patients and save them from undergoing resection with general anaesthesia.
