Efficacy, safety, and feasibility of the treatment of intrauterine pathologies with the hysteroscopic morcellator: A systematic review

Abstract

Background: Hysteroscopy has evolved from a diagnostic to a diagnostic and operative tool, and currently represents the reference standard for both the diagnosis and treatment of intrauterine diseases. In this context, the hysteroscopic morcellator is increasingly gaining popularity because of its simplified approach. Objectives: To evaluate the efficacy, safety, and feasibility of the hysteroscopic morcellator for the treatment of intrauterine pathologies. Search Strategy: Electronic databases were searched for English-language trials describing surgical procedures for uterine pathologies performed with the hysteroscopic morcellator until February 1, 2024. Selection Criteria: Retrospective or prospective original studies reporting the treatment of uterine pathologies with the hysteroscopic morcellator were included. Data Collection and Analysis: Data were collected on study features, characteristics of included populations, surgical procedures, complications, and results/outcomes. Main Results: Thirty-nine papers that met the inclusion criteria were included in this systematic review. A descriptive synthesis of the results was provided according to the pathology that was hysteroscopically removed/corrected: endometrial polyps, uterine leiomyomas, and retained products of conception. Conclusions: The hysteroscopic morcellator offers effective and efficient removal of intrauterine lesions, with minimal risk of complications. Despite some limitations identified, such as potential bleeding and the need for additional surgical steps in certain cases, the overall findings support the utility of this technique in clinical practice.