Evaluation of whether there is residual polyp tissue after hysteroscopic morcellation at Cam and Sakura City Hospital: a retrospective cohort study

Abstract Background In polypectomy with mechanical hysteroscopic morcellators, the tissue removal procedure continues until no polyp tissue remains. The decision that the polypoid tissues were removed completely is made based on visual evaluation. In a situation where the polyp tissue was visually completely removed and no doubt that the polyp has been completely removed, short spindle-like tissue fragments on the polyp floor continue in most patients. There are no studies in the literature on whether visual evaluation provides adequate information at the cellular level in many patients in whom polypoid tissues have been determined to be completely removed. The aim of the present study was to analyze the pathological results of the curettage procedure, which was applied following the completion of polyp removal with operative hysteroscopy, and to evaluate whether there was residual polyp tissue in the short spindle-like tissue fragments that the mechanical hysteroscopic morcellator could not remove. The secondary aims of this study were to compare conventional loop resection hysteroscopy with hysteroscopic morcellation for the removal of endometrial polyps in terms of hemoglobin/hematocrit changes, polypectomy time and the amount of medium deficit. Methods A total of 70 patients with a single pedunculate polypoid image of 1.5-2 cm, which was primarily visualized by office hysteroscopy, were included in the study. Patients who had undergone hysteroscopic polypectomy were divided into two groups according to the surgical device used: the morcellator group (n = 35, Group M) and the resectoscope group (n = 35, Group R). The histopathological results of hysteroscopic specimens and curettage materials of patients who had undergone curettage at the end of operative hysteroscopy were evaluated. In addition, the postoperative 24th hour Hb/HCT decrease amounts in percentage, the polypectomy time which was measured from the start of morcellation, and deficit differences were compared between groups. Results In total, 7 patients in the morcellator group had residual polyp tissue detected in the full curettage material. The blood loss was lower in the morcellator group than in the resectoscope group (M, R; (-0.07 ± 0.08), (-0,11 ± 0.06), (p < 0.05), respectively). The deficit value of the morcellator group were higher (M, R; (500 ml), (300 ml), (p < 0.05), respectively). The polypectomy time was shorter in the morcellator group (M, R; mean (2.30 min), (4.6 min), (p < 0.05)). Conclusions Even if the lesion is completely visibly removed during hysteroscopic morcellation, extra caution should be taken regarding the possibility of residual tissue. There is a need for new studies investigating the presence of residual polyp tissue

Effects of melatonin on uterine hypertrophy/hyperplasia: A preliminary experimental rat study

Endometrial hyperplasia is a process of endometrial proliferation that results in a thickening of the endometrial tissue. Melatonin might be able to change the pathophysiological process and prognosis into a positive way that might prevent and heal endometrial hyperplasia, which is the first stage of endometrial cancer. For this perspective, we tried to investigate the effect of melatonin on uterine hypertrophy/hyperplasia in an experimental rat model. Forty Wistar-Albino rats were undergone bilateral oophorectomy and randomized into four groups. To create a model of uterine hypertrophy/hyperplasia in all groups, except the control group [C] (n = 10), 4 mg/kg/day estradiol hemihydrate were given for 14 days. The uterine hypertrophy/hyperplasia was evaluated histopathologically in the left uterine horns, then the groups were treated for 14 days as follows; melatonin (10 mg/kg/day/po) [M] (n = 10), melatonin + estradiol hemihydrate (10 mg/kg/day/po and 4 mg/kg/day/po) [M + E] (n = 10), and dark environment [D] (n = 10). Finally, the effects of the melatonin were examined histopathologically in the right uterine horns. An uterine hypertrophy/hyperplasia model was established in all groups compared to the control group (p < 0.05). In the [M] and [M + E] groups, epithelial cell height and luminal epithelial cell height significantly decreased (41?m vs 12?m, p = 0.005; 14?m vs 10?m, p = 0.005, respectively for [M] group) and (32?m vs 14?m, p = 0.012; 17?m vs 10?m, p = 0.017, respectively for [M + E] group). The [D] group exhibited a significant decrease in epithelial cell height (33?m vs 20?m, p = 0.017). With or without estrogen exposure, melatonin-treated and physiologically melatonin-released rats experienced a significant uterine hypertrophy/hyperplasia recovery. Melatonin may have protective effects on endometrial hyperplasia