COMPARISON OF HYSTEROSCOPIC CESAREAN SCAR DEFECT REPAIR WITH 26FR AND 16FR RESECTOSCOPE: A PROSPECTIVE PILOT STUDY.

ABSTRACT STUDY OBJECTIVE several studies have been published on hysteroscopic treatment of cesarean scar defect using the 26Fr resectoscope. This study compared the effects of the 26Fr resectoscope and the 16Fr miniresectoscope in terms of efficacy, safety profile, peri- and postoperative complications. DESIGN A prospective cohort study. SETTING Tertiary Care University Hospital (S. Orsola - Malpighi, Bologna, Italy). PATIENTS 309 symptomatic women with cesarean scar defect diagnosis were divided into two groups according to a temporal criterion: from March 2012 to March 2015, 155 consecutive women (control group) underwent isthmoplasty with the 26Fr resectoscope (Karl Storz, Tuttlingen, Germany), while from April 2015 to March 2018 154 consecutive women (study group) underwent isthmoplasty with the 16Fr resectoscope (Gubbini system, Tontarra Medizintechnik, Tuttlingen, Germany). INTERVENTION 155 women (control group) underwent isthmoplasty with the 26Fr resectoscope, and 154 women (study group) underwent isthmoplasty with the 16Fr resectoscope. The so-called “channel-like” 360° endocervical resection technique was applied. MEASUREMENT AND MAIN RESULTS The isthmoplasty time with the two resectoscopes, excluding cervical dilatation, was similar (P = 0.25), while the overall surgical time was shorter in case of mini-resectoscope. The use of the 16Fr resectoscope was significantly associated with a reduced volume of distension medium used (P CONCLUSIONS Isthmoplasty with 16Fr appears to be as effective as isthmoplasty with 26Fr resectoscope resectoscope in reducing PAUB and suprapubic pelvic pain. It is associated with a significant reduction in overall surgical time due to the nonnecessity of performing cervical dilatation. The 16Fr resectoscope facilitates the surgery of small anatomical spaces such as the cervical canal and reduces the complication rate linked to blind maneuvers not respecting the uterine anatomy.