A clear advantage
In Uterine tissue removal

Overview

Retained products of conception (RPOC) could be encountered after spontaneous abortion or elective termination, and after normal vaginal or cesarean delivery.¹ RPOC may also be encountered after suction dilation and curettage (D&C) for early first trimester miscarriages. Hysteroscopic-directed resection allows for selective removal of RPOC and endometrial pathology, sparing the rest of the intrauterine cavity. Compared to conventional D&C, hysteroscopy involves less endometrial trauma resulting in less intrauterine adhesions and better fertility outcomes.²

Blind evacuation of the uterine cavity carries multiple risks including bleeding, infection and perforation that could potentially result in infertility.³ Multiple initial studies employed a conventional resectoscope during operative hysteroscopy to remove RPOC, but tissue resection with electrocautery carried more procedural risks and was difficult to learn.⁴

Although bleeding and pain are sensitive clinical criteria for RPOC, physicians are often left with a confusing clinical scenario, as these symptoms are common during the normal postpartum course. Utilizing the TRUCLEAR™ Hysteroscopic Tissue Removal System provides a directed evacuation of gestational products facilitating visualization and directed removal of RPOC especially in patients with uterine and intracavitary abnormalities.

A benefit of hysteroscopic removal of RPOC is the reduction of intrauterine adhesions from selective hysteroscopic curettage as compared to blind dilation and curettage (D&C).⁵ Patients may also benefit from hysteroscopic removal of RPOC, since it has been associated with a shorter time interval to conception signifying improved reproductive outcomes.²

In conclusion, hysteroscopic removal of RPOC continues to demonstrate both diagnostic and therapeutic benefits to patients. Through its continued use, the hysteroscopic technique for removal of RPOC will likely see an increase in safety and efficiency in the future compared to a blind D&C.

1. Westendorp IC, Ankum WM, MoI BW, Vonk J. Prevalence of Asherman’s syndrome after secondary removal of placental remnants of a repeat curettage for incomplete abortion. Human Reproduction. 1998; 13:3347-50.

2. Rein DT, Schmidt T, Hess AP, Volkmer A, Schondorf T, Breidenbach M. Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. Journal of Minimally Invasive Gynecology. 2011; 18:774-778.

3. Golan A, Dishi M, Shalev A, Keidar R, Ginath S, Sagiv R. Operative hysteroscopy to remove retained products of conception: novel treatment of an old problem. Journal of Minimally Invasive Gynecology 2011; 18:100-103.

4. Emanuel MH, Wamsteker K. The intrauterine morcellator: a new hysteroscopic operating technique to remove intrauterine polyps and myomas. Journal of Minimally Invasive Gynecology. 2005;12(1)62-66.

5. Smorgick N, Barel, O, F. Fuchs N, Ben-Ami I, Pansky M, Vaknin Z. Hysteroscopic management of retained products of conception: meta-analysis and literature review. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014; 173:19-22.

Dr. Teresa Tam, MD, FACOG, FACS

Board Certified in Obstetrics & Gynecologic Medicine

Dr. Teresa Tam is an AAGL fellowship-trained minimally invasive gynecologic surgeon whose private practice, All For Women Healthcare, is located in metropolitan Chicago. She is affiliated with Presence Saint Francis Hospital as the Director of Minimally Invasive Gynecologic Surgery department, and Rush University Medical Center as an Assistant Program Director. She is an executive committee board member of the Chicago Gynecological Society and has served as past president of the organization.

Along with her medical practice, Dr. Tam is also an accomplished medical researcher having several publications in well-recognized, peer-reviewed journals and produced a series of medical education videos. She is a noted presenter at national and international medical conferences. She is frequently invited as a speaker at The American College of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting and participates annually as a course director. She continues to serve as hysteroscopy lab faculty at the AAGL Global Congress.

She has received the Center of Excellence in Minimally Invasive Gynecology (COEMIG) surgeon designation awarded by AAGL and SRC. Among her many awards, she is most proud of receiving the National Faculty Award from the Association of Professors of Gynecology and Obstetrics/ Council on Resident Education in Obstetrics & Gynecology (APGO/CREOG) an unprecedented six times and Mentor of the Year Award for District VI from ACOG all for residency teaching.