title: A systematic review and meta-analysis of randomized controlled trials comparing hysteroscopic morcellation with resectoscopy for patients with endometrial lesions.
abstract: BACKGROUND
  Results on the efficacy of hysteroscopic morcellation for patients with endometrial lesions remain conflicting.
  
  
  OBJECTIVE
  To compare hysteroscopic morcellation with conventional resectoscopy for removal of endometrial lesions.
  
  
  METHODS
  Electronic databases were searched for reports published up to February 1, 2016, using terms such as "morcellator," "morcellators," "morcellate," "morcellation," "morcellated," "hysteroscopy," "hysteroscopy," "uteroscope," and "transcervical."
  
  
  METHODS
  Randomized controlled trials were included if they assessed success rate, procedure speed, complications, tolerability, and/or learning curve.
  
  
  METHODS
  Data were extracted by two independent reviewers and a meta-analysis was performed.
  
  
  RESULTS
  Four trials including 392 patients were analyzed. Successful removal of all endometrial lesions was more frequent with hysteroscopic morcellation than conventional resectoscopy (odds ratio 4.49, 95% confidence interval [CI] 1.94-10.41; P<0.001). Total operative time was also shorter with hysteroscopic morcellation (mean difference -4.94 minutes, 95% CI -7.20 to -2.68; P<0.001). No significant differences in complications were found. Meta-analyses were not possible for tolerability and learning curve. In one study, hysteroscopic morcellation was acceptable to more patients (P=0.009).
  
  
  CONCLUSIONS
  Hysteroscopic morcellation is associated with a higher operative success rate and a shorter operative time among patients with endometrial lesions than is resectoscopy. More high-quality trials are required to validate these results.
authors.affiliation: Department of Obstetrics and Gynaecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Chunbo
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynaecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Dai
authors.affiliation: Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: Yuping
authors.initials: Y
authors.lastname: Gong
authors.affiliation: Department of Gynaecology and Obstetrics, Gynaecology and Obstetrics Hospital of Fudan University, Shanghai, China.
authors.forename: Bingying
authors.initials: B
authors.lastname: Xie
authors.affiliation: Department of Anesthesia, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: Bei
authors.initials: B
authors.lastname: Wang
mesh_terms: D004598:Electrosurgery; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D059032:Learning Curve; D000069577:Morcellation / Q000379:methods*; D061646:Operative Time; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014591:Uterine Diseases / Q000601:surgery*
keywords: Endometrial lesions; Hysteroscopic morcellation; Meta-analysis; Minimally invasive technique; Resectoscopy