IBS Integrated Bigatti Shaver, an alternative approach to operative hysteroscopy

At present, conventional resectoscopy can be considered the gold standard procedure for major hysteroscopic operations [1]. Despite well-recognized advantages of resectoscopy, several problems, such as fluid overload, uterine perforation due to monopolar or bipolar current, lack of visualization resulting in a time-consuming procedure, and long learning curve, remain still unsolved. We have made, in cooperation with Karl Storz GmbH & Co., a new shaving system that, introduced through a straight operative channel of a panoramic 90‹ optic, allows to perform all kinds of major operative procedures such as polypectomy, G0, G1, and G2, submucosal myomectomy, and endometrial ablation. We have performed 44 operative hysteroscopy, including 24 polyps, 15 submucosal myomas, two polyps + submucosal myomas, three endometrial ablations. The polypsf size ranged from 5 to 40 mm, and all procedures were performed with the IBSR. The mean time for polypsf resection was 3Œ28. Ten cases of myomafs resection were performed exclusively with the IBSR of which four Type 0, two Type 1, four Type 2, the size ranged from 10 to 30 mm and the mean resection time was 14Œ. For five cases of myomafs resection, we started the operation with the IBSR, and we ended the procedure with the conventional monopolar resectoscope. The myomasf size ranged from 20 to 40 mm of which three Type 0, two Type 2, and the mean resection time was 32Œ. When the IBSR was used, the dilatation number reached 8.5 Hegar size that increased to 9.5 when we switched to conventional resectoscopy. We used sorbitol.mannitol at the beginning of the study and in all cases that we suspected the possibility of conversion to conventional monopolar resectoscope. As our learning curve improved, we switched to normal saline. No coagulation was needed when the IBSR was used. Two overload complications occurred: one was not depending on the method but to a malfunctioning of the EndomatR system. The second complication occurred during a G2.3 cm myomafs resection. This preliminary study is intended to evaluate the feasibility of this new technique that offers considerable advantages such as reduced dilatation of the cervix, better visualization during the procedure as tissue chips are removed at the same time of resection, no coagulation or cutting current is needed, the use of normal saline instead of sorbitol and mannitol, and a much faster learning curve.