A systematic review and meta-analysis of randomized controlled trials comparing hysteroscopic morcellation with resectoscopy for patients with endometrial lesions.

BACKGROUND

Results on the efficacy of hysteroscopic morcellation for patients with endometrial lesions remain conflicting.

OBJECTIVES

To compare hysteroscopic morcellation with conventional resectoscopy for removal of endometrial lesions.

SEARCH STRATEGY

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."

SELECTION CRITERIA

Randomized controlled trials were included if they assessed success rate, procedure speed, complications, tolerability, and/or learning curve.

DATA COLLECTION AND ANALYSIS

Data were extracted by two independent reviewers and a meta-analysis was performed.

MAIN 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.