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Visual dilation and curettage for the fertility-sparing treatment of atypical endometrial hyperplasia/endometrial intra-epithelial neoplasia: an easy to perform in-office technique
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  1. Paolo Casadio1,
  2. Antonio Raffone2,3,
  3. Paolo Salucci3,
  4. Diego Raimondo1,
  5. Renato Seracchioli1,3,
  6. Jose Carugno4 and
  7. Attilio Di Spiezio Sardo2
  1. 1Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
  2. 2Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Napoli, Campania, Italy
  3. 3Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Emilia-Romagna, Italy
  4. 4Department of Gynecology and Reproductive Sciences, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Paolo Salucci, Alma Mater Studiorum Università di Bologna, Bologna 40138, Italy; paolo.salucci{at}studio.unibo.it

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Hysteroscopic endometrial resection when added to progestin therapy has been shown to improve the outcomes of fertility-sparing treatment in patients diagnosed with atypical endometrial hyperplasia/endometrial intra-epithelial neoplasia .1 2 Unfortunately, with such a technique, the extension and depth of endometrium removal appears poorly reproducible. Moreover, the procedure must be performed in the operating room, and potential thermal damage of the specimen may affect its quality for histological examination.3 Hysteroscopic tissue removal systems have shown greater safety and better outcomes for the length of the procedure, the learning curve, and successful complete removal of benign intrauterine pathology compared with resectoscopes.4 However, further studies are needed to investigate the role of hysteroscopic tissue removal systems in patients with malignant pathology. Hysteroscopic procedures, when performed in the office/outpatient setting, are cost-effective, with a low complication rate and high patient satisfaction.5 However, their use in the fertility-sparing treatment of atypical endometrial hyperplasia/endometrial intra-epithelial neoplasia has never been described. The aim of this video article was to demonstrate the use of hysteroscopic tissue removal systems for the fertility-sparing treatment of patients with endometrial hyperplasia/endometrial intra-epithelial neoplasia.

We report the management of two women diagnosed with atypical endometrial hyperplasia/endometrial intra-epithelial neoplasia who expressed the desire to preserve fertility. After counseling, women opted for fertility-sparing treatment of the disease.

Fertility-sparing treatment was performed in the office setting and consisted of hysteroscopic endometrial resection using a hysteroscopic tissue removal system, followed by immediate insertion of a 52 mg levonorgestrel-releasing intrauterine device. The total procedure time (endometrial resection and intrauterine device insertion) ranged from 10 to 13 min. The women were closely followed up every 3 months with endometrial biopsy to assess the response to treatment.

A hysteroscopic tissue removal system allowed us to perform hysteroscopic endometrial resection in an-office setting. Its use is a safe and feasible in-office/outpatient alternative for the fertility-sparing treatment of women diagnosed with atypical endometrial hyperplasia/endometrial intra-epithelial neoplasia. However, further studies are needed to investigate the safety of using hysteroscopic tissue removal systems for the treatment of uterine pre-malignant or malignant pathology.

Video 1 Hysteroscopic endometrial resection using a hysteroscopic tissue removal system

Data availability statement

All data relevant to the study are included in the article.

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References

Footnotes

  • Contributors PC: guarantor, conceptualization and surgery. AR: manuscript preparation. PS: video editing and manuscript preparation. DR: reviewing and editing. RS: supervision, editing, and reviewing. JC: audio narration, reviewing, and editing. ADSS: supervision and surgery.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.