title: A Prospective Analysis of Hysteroscopic Morcellation in the Management of Intrauterine Pathologies.
abstract: OBJECTIVE
  To determine the effectiveness of the MyoSure intrauterine mechanical morcellator device for removal of intrauterine pathology.
  
  
  METHODS
  Prospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  This study was performed at the Royal Hospital for Women and Prince of Wales Private Hospital, Sydney, Australia. All women undergoing hysteroscopic removal of intrauterine pathology using the MyoSure device between January 2013 and June 2015 were included.
  
  
  RESULTS
  A total of 255 MyoSure procedures were performed, with 61% performed by trainees. Resection of leiomyomas occurred in 40% or cases, polyps in 39%, combination pathology in 9%, pregnancy products in 6%, and preinvasive or invasive disease in 5% of cases. Complete resection of pathology was achieved in 92% of polyps, 66% of leiomyomas, and 87% of pregnancy tissue. Leiomyomas were more likely to be completely resected when surgery was performed by an attending physician or senior resident, however there was no statistically significant difference in clinical outcomes. When leiomyomas were stratified according to size, 87% of leiomyomas ≤40 mm were completely resected with only 48% of leiomyomas >40 mm completely resected with the index surgery. No intraoperative complications occurred. Postoperative outcomes included symptom resolution in 76%, further surgery (repeat hysteroscopy or hysterectomy) in 10%, pregnancy in 2%, and medical/conservative management in 12% of patients.
  
  
  CONCLUSIONS
  The MyoSure device is very effective when used to resect endometrial polyps. Leiomyomas >40 mm are unlikely to be completely resected at a single operation when using the MyoSure device. Similar clinical outcomes were obtained when procedures were performed by trainees compared to senior clinicians.
authors.affiliation: Gynaecological Research and Clinical Evaluation Group (GRACE), University of New South Wales, New South Wales, Sydney, Australia; Royal Hospital for Women, Department of Gynaecological Surgery, New South Wales, Sydney, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Arnold
authors.affiliation: Gynaecological Research and Clinical Evaluation Group (GRACE), University of New South Wales, New South Wales, Sydney, Australia.
authors.forename: Ashradha
authors.initials: A
authors.lastname: Ketheeswaran
authors.affiliation: Gynaecological Research and Clinical Evaluation Group (GRACE), University of New South Wales, New South Wales, Sydney, Australia.
authors.forename: Mominah
authors.initials: M
authors.lastname: Bhatti
authors.affiliation: Gynaecological Research and Clinical Evaluation Group (GRACE), University of New South Wales, New South Wales, Sydney, Australia; Royal Hospital for Women, Department of Gynaecological Surgery, New South Wales, Sydney, Australia; Prince of Wales Private Hospital, New South Wales, Sydney, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Nesbitt-Hawes
authors.affiliation: Gynaecological Research and Clinical Evaluation Group (GRACE), University of New South Wales, New South Wales, Sydney, Australia; Royal Hospital for Women, Department of Gynaecological Surgery, New South Wales, Sydney, Australia; Prince of Wales Private Hospital, New South Wales, Sydney, Australia. Electronic address: j.abbott@unsw.edu.au.
authors.forename: Jason
authors.initials: J
authors.lastname: Abbott
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy / Q000379:methods; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000601:surgery; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D000069577:Morcellation; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D011247:Pregnancy; D011446:Prospective Studies; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Laparoscopy; Magnetic resonance imaging; Myomectomy; Right–left inversion