Have you experienced changes in the regularity, frequency, heaviness or duration of your menstrual bleeding? If you have been concerned about it in the past, you are one of the many women who have experienced abnormal uterine bleeding (called AUB). AUB accounts for one third of gynaecologist consultations and costs women, their families and the community a large sum in time from work and especially in sanitary protection! There are a number of causes for AUB but some of the causes are due to pathology in the uterus – polyps (called AUB-P), fibroids (myomas or AUB-L), pregnancy-related issues and rarely, but importantly, cancer.
Several management options are available to treat these pathologies but have limitations for both the surgeon and the woman. A new device has been in Australia now for a few years and addresses many of these limitations.
What is this device?
It is a hysteroscopic morcellator – a machine that sounds scarier than it is. It is generally considered safe and comes in a small package, but gets the job done. Essentially it is a narrow tube that is inserted through the cervix to visualise the uterus, with fluid pumped in at a low and steady pressure to keep the uterus open. Using a foot pedal to provide mechanical energy, a blade rotates completely within the inner tube to cut away any tissue that is in the uterus. The pieces that are cut are then suctioned into a vacuum and sent off to the lab to be looked at under a microscope to confirm the diagnosis. The hysteroscopic morcellator comes in different sizes to treat different pathologies.
Over the past couple of years, the GRACE Research team has been performing a study to evaluate the outcomes of this device, demonstrate how effective and safe the hysteroscopic morcellator is, and to help doctors understand when it should be used and if it solves the patient’s initial problems.
With the current results, it was shown that women most commonly used the device to solve abnormal uterine bleeding, and sometimes infertility issues with occasional use when there are retained products after miscarriage or delivering a baby.
The cutting time is a good indication of how quickly the device is able to remove the pathology. The median cutting time for removal of myomas was 4 min 15 sec and the median cutting time for polyps was 32.5 sec with over 94% of the pathology either completely or mostly removed, showing it is fast and effective at removing pathology.
The fluid that is used to keep the uterus open is very important. It allows the surgeon to see, but too much absorption may cause issues with salt irregularities or overload the heart. The type of fluid used will determine which of these complications may occur and using a normal saline solution is the safest. Using this device, the average loss of fluid into the body for myomas was 680 mL and median saline deficit for polyps was 200 mL, which are well below the safe threshold of 2500 mL and no complications occurred in the study. Most importantly, the study showed that that over 90% of the women’s initial symptoms or concerns were resolved after using the morcellator.
Morcellation of fibroids has been in the press recently but this technique does not suffer with any of the problems that have been written about. It may not always be suitable for you or your fibroids and it is always best to discuss this with your doctor. If you are suitable then you will join the hundreds of women that we have successfully and safely treated and be well on your way to reduced bleeding or even starting a family. Good news!
The above study (Removal of intrauterine pathology using a mechanical Hysteroscopic morcellator, HREC Ref 13/232) is currently underway at UNSW under the direction of Associate Professor Jason Abbott and the GRACE research team. Study sites are the Royal Hospital for Women and the Prince of Wales Private Hospital.