title: Hysteroscopic Morcellation Versus Loop Resection for Removal of Placental Remnants: A Randomized Trial.
abstract: To compare hysteroscopic morcellation with loop resection for the removal of placental remnants in terms of procedure time, adverse events, tissue availability, histology results, short-term effectiveness, and postoperative adhesions.
  
  
  
  A randomized controlled trial (Canadian Task Force classification I).
  
  
  
  A teaching and university hospital.
  
  
  
  Women with placental remnants.
  
  
  
  Hysteroscopic morcellation with the TRUCLEAR 8.0 Tissue Removal System (Smith & Nephew, Inc, Andover, MA) or loop resection with a rigid 8.5-mm bipolar resectoscope (Karl Storz GmbH, Tuttlingen, Germany).
  
  
  
  Forty-six and 40 women were included in the hysteroscopic morcellation and resection groups, respectively. The median operating time was significantly shorter for hysteroscopic morcellation compared with loop resection (6.2 minutes [interquartile range, 4.0-11.2 minutes] vs 10.0 minutes [5.8-16.4 minutes], p = .023). Both operating time and total procedure time, corrected for the diameter of the placental remnants, were significantly reduced for hysteroscopic morcellation compared with loop resection, by 40% (95% confidence interval, 15%-58%; p = .005) and 22% (95% CI, 5%-37%; p = .014), respectively. No adverse events occurred during hysteroscopic removal. Perforation at dilation in 8 cases of the hysteroscopic morcellation group resulted in 2 procedure discontinuations and 1 incomplete procedure. Incomplete removal was found in 1 uncomplicated hysteroscopic morcellation procedure and 2 resection procedures. Pathology results confirmed the presence of placental remnants in 27 of 40 (67.5%) and 26 of 37 (70%) patients in the hysteroscopic morcellation and resection groups, respectively. Second-look hysteroscopy showed de novo intrauterine adhesions in 1 of 35 patients (3%) in the hysteroscopic morcellation group and 1 of 30 (3%) patients in the resection group.
  
  
  
  Hysteroscopic morcellation is a faster alternative than loop resection. Both techniques are safe and show high rates of complete removal and tissue availability and low rates of de novo intrauterine adhesions.
authors: Women's Clinic, Ghent University Hospital, Ghent, Belgium. Electronic address: Tjalina.Hamerlynck@Ugent.be.
authors: Tjalina W O
authors: TW
authors: Hamerlynck
authors: Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands.
authors: Huib A A M
authors: HA
authors: van Vliet
authors: Department of Pathology, Ghent University Hospital, Ghent, Belgium.
authors: Anne-Sophie
authors: AS
authors: Beerens
authors: Women's Clinic, Ghent University Hospital, Ghent, Belgium.
authors: Steven
authors: S
authors: Weyers
authors: Women's Clinic, Ghent University Hospital, Ghent, Belgium; Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands.
authors: Benedictus C
authors: BC
authors: Schoot
mesh_terms: D000328:Adult; D001530:Belgium; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D000069577:Morcellation / Q000379:methods; D009426:Netherlands; D061646:Operative Time; D018457:Placenta, Retained / Q000601:surgery*; D011183:Postoperative Complications; D011247:Pregnancy; D016896:Treatment Outcome
keywords: Hysteroscopic morcellation; Intrauterine adhesions; Loop resection; Placental remnants; Randomized controlled trial