Overview
The need to remove tissue from the uterine cavity arises in the majority of operative hysteroscopic procedures, such as removal of endometrial polyps, fibroids and retained products of conception.
These are very common procedures, but the necessary skill required to use the traditional resectoscope has become scarcer over the years. The larger the volume of tissue requiring removal, the longer the procedure.1 The traditional resection of tissue into chips or segments requires considerable skill and experience, whichever system is used. Ablation or vaporisation of tissue may be employed, but not where there is a risk of pre-malignant or malignant change.
The development of the TRUCLEAR™ 5C System (Medtronic plc acquired the system from Smith & Nephew), a hysteroscopic tissue removal device with a 5 mm scope, enables clinicians to remove larger volumes of tissue with a single instrument insertion into the uterine cavity.2 Although the potential complications of cervical dilatation still exist, these are minimized by the small diameter of the instrument as well as the inherent benefits derived from the instrument's slanted distal tip which allows for easy insertion. The simultaneously cutting and aspirating instrument allows the removal of pathology from the uterine cavity such as polyps and small fibroids in a rapid manner without using electrosurgery.2-3
The mechanical TRUCLEAR™ System has been shown to have a quicker learning curve as well as reducing operating time.4 A MAUDE database analysis has also shown that life-threatening complications such as fluid overload, uterine perforation, and bleeding do occur with hysteroscopic morcellation, but less frequently than with traditional electrocautery.1 The right choice of instrument in relation to the expected size of the pathology is based on the clinician's judgment and experience. The range of instruments available with the TRUCLEAR™ System should cover the majority of pathologies encountered in routine clinical practice.
In conclusion, these instruments offer an alternative approach vs resectoscopy4 to tissue removal from the uterine cavity and with effective miniaturization, they allow the treatment of focal intrauterine pathology in the outpatient setting as well as in challenging situations such as cervical stenosis in the postmenopausal patient. Clinicians need to be aware of these newer technologies to enable them to make the right choice for their patient.
1. Haber K, Hawkins E, Levie M, Chudnoff S. Hysteroscopic morcellation: review of the Manufacturer and User Facility Device Experience (MAUDE) Database. Journal of Minimally Invasive Gynecology. 2015; 22:110–114. Note: The primary limitations of the present study are that the adverse events […] were underreported and lacked relevant details, number of procedures performed was estimated, complications rates […] were not matched.
2. Pampalona JR, Bastos MD, Moreno GM, Pust AB, Montesdeoca GE, Guerra Garcia A, Mateu Prunonosa JC, Collado RC, Bresco Torras P. A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting: preliminary results. Journal of Minimally Invasive Gynecology. 2015; 22:439–445.
3. van Dongen H, Emanuel MH, Wolterbeek R, Trimbos JB, Jansen FW. Hysteroscopic morcellator for removal of intrauterine polyps and myomas: a randomized controlled pilot study among residents in training. Journal of Minimally Invasive Gynecology. 2008; 15:466–471.
4. Pampalona JR, García ER, Muñoz Casas E, Mateu, Pruñonosa JC, Bastos MD, Guerra García A, Brescó Torras P. Morcelador histeroscopico (Truclear System): nuestra experiencia inicial. Progresos de Obstetricia y Ginecología, 2012; 55(9):459–463.
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Upcoming Events
Visit Medtronic booth #26 at the 25th Annual Congress of the European Society for Gynaecological Endoscopy (ESGE) in Brussels from 3-5 October, 2016 and register for our lunch symposium.
One safe solution to complete more cases in operative hysteroscopy. TRUCLEAR™ System.
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Oct. 4, 2016, 12.45 – 13.45
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Silver Hall
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Square – Brussels
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Meeting center
CONTACT INFORMATION
United States:
Contact Sales
United Kingdom:
Oliver Ellis
Italy, Portugal, Spain, France, Greece:
Stefania Ippoliti
Netherlands, Belgium:
Hubert van den Hout
All others:
Franck Forget
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