News Release

New womb surgery technique

Peer-Reviewed Publication

European Society of Human Reproduction and Embryology

A doctor in the Netherlands has developed a new method of keyhole surgery for the womb which is quicker, simpler and safer than the present technique.

Within a year or two it is likely to turn the current treatment involving a general anaesthetic into an outpatient procedure under local anaesthetic, and as surgeons become proficient and use it widely it is also expected to cut substantially the number of hysterectomies.

The gynaecologist who developed the specialised instrument presented details today (Monday 26 June) to the conference of the European Society of Human Reproduction and Embryology in Bologna, Italy.

Dr Mark Emanuel from Spaarne Hospital, Haarlem, said the device -- known as an IntraUterine Shaver -- could remove uterine tissue mechanically with a surgical blade set within a specially designed endoscope inserted into the uterus via the cervix.

The current method of minimally invasive surgery is resectoscopy, which also involves endoscopy via the cervix, but uses a wire loop electrode and electrical current to remove tissue. The technique can produce a number of potentially dangerous side-effects arising either from burns, or from the special liquids involved in the method entering blood vessels and upsetting the balance of electrolytes in the blood. In extreme cases complications can lead to fluid in the lungs or brain, heart failure and, rarely, even death.

Fifteen patients with endometrial polyps or superficial fibroids, have already been treated with the new instrument with no side-effects and a multi-centre randomised trial of 100 patients is planned. At present, Spaarne Hospital is the only hospital in the world using the technique.

"The most important aspect of the new method is its simplicity," said Dr Emanuel. Resectoscopy is effective but involves a large number of steps, is tiring, difficult to learn and to become expert at. Many doctors are reluctant to use it, preferring hysterectomies. So there is a need for an alternative technique. The shaver's safety and easiness of use will, hopefully, increase the number of gynaecologists who will use hysteroscopic methods. This means that the number of patients who will benefit from the advantages of minimal access surgery instead of undergoing unnecessary hysterectomies should also increase."

Dr Emanuel said that other advantages were that it could use saline solution for distending and washing the uterus instead of riskier electrolyte-free solutions and it preserved the removed tissue for histological examination to rule out cancer. It also halved the average operating time.

He is now working on developing new blades and burrs so that the device is suitable for removing the entire womb lining where that is necessary and also on reducing the diameter of the instrument. If it can be made smaller, women should be able to have the procedure under local anaesthetic as an outpatient .

"The new blades could be ready next year and we hope to have the smaller device in the clinic in a couple of years or so," he said.

Around 10 per cent of women have menstrual disorders of whom about a third have polyps and fibroids. Women with major fibroids that extend deeply into the uterine wall would not be suitable for the new technique but many surgeons would not use resectoscopy on those patients either.

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Note: Programme number: O-036

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