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.
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota; Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
authors.forename: Sherif A M
authors.initials: SA
authors.lastname: Shazly
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shannon K
authors.initials: SK
authors.lastname: Laughlin-Tommaso
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Breitkopf
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hopkins
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tatnai L
authors.initials: TL
authors.lastname: Burnett
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Isabel C
authors.initials: IC
authors.lastname: Green
authors.affiliation: Mayo Clinic Library, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Farrell
authors.affiliation: Evidence-based Practice Center, Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota. Electronic address: famuyide.abimbola@mayo.edu.
authors.forename: Abimbola O
authors.initials: AO
authors.lastname: Famuyide
mesh_terms: D004598:Electrosurgery / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D000069577:Morcellation / Q000706:statistics & numerical data*; D061646:Operative Time; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D014599:Uterus / Q000601:surgery*
keywords: Hysteroscopy; Polyps; Uterine bleeding; Uterine leiomyoma