Do we still need to resect ? A six year review and patient satisfaction survey

1. success rate of 90%. endometrium(TCRE) at the Royal Victoria Infirmary, Newcastle and to assess patient satisfaction OPTIONALLOGO HERE Do we still need to resect? A six year review and patient satisfaction survey Dr UmaMaheshaArava, Dr DimitriosKoleskas, Dr Mark Roberts, Dr Tony ChalhoubRoyal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP, England OPTIONALLOGO HERE Methods Results Introduction Conclusions Transcervical resection of fibroids(TCRF) has traditionally been used to hysteroscopicallyresectsubmucous fibroids  that cause menstrual problems or that may be interfering with the ability to conceive has been combined with transcervical resection of the endometrium(TCRE) to treat menorrhagia. It has been considered the gold standard for the treatment of symptomatic submucousfibroids.1 However with the advent of newer endometrial ablation techniques that are less user dependent, there seems to be a gradual reduction in the use of resection techniques with the potential for loss of skill among the newer generation gynaecologists. TCRF and TCRE is a core component of hysteroscopic surgery and training should be directed to achieve and maintain this key skill, lest it be consigned to history. This was a prospective study over a six year period from 2005-2010 evaluating the effectiveness of TCRE/F and a retrospective one year study assessing patient satisfaction rates. Data regarding resection was collected prospectively on an ongoing basis and information about satisfaction was obtained using a patient satisfaction questionnaire. 73 patients who underwent TCRF with or without TCRE were included of whom 49 patients responded with information regarding bleeding pattern and satisfaction. Transcervical resection of fibroids is an established surgical procedure for women with submucosal fibroids and excessive uterine bleeding, infertility or repeated miscarriages.2 TCRM/E is an effective treatment for menorrhagia particularly in the presence of submucous fibroids and is associated with high levels of patient satisfaction. Efforts should be made to provide continous training in acquiring and maintaining resection techniques to prevent loss of skill particularly in the backdrop of emerging ablation techniques. Fluid overload of greater than 1 litre was the most frequent complication. Results Objectives • Menorrhagiawas the commonest indication for the • procedure. • 65 (89%) of patients had submucous fibroids on pre-op • ultrasound scan. References The majority of submucous fibroids resected were grade 1 CravelloL, Agostini A, Beerli M, Roger V, Bretelle F, Blanc B. Results of hysteroscopicmyomectomy. GynecolObstetFertil. 2004 Sep: 32(9): 825-8. Agdi M, Tulandi T. Endoscpic management of uterine fibroids. Best Prac Res ClinObstetGynaecol. 2008 Mar 4. (Abstract). Patient satisfaction was high at 90%. Most of the submucous fibroids measured 1-5 cms in size.