Cold scissors ploughing technique in hysteroscopic adhesiolysis: a comparative study

Area of Science:

• Reproductive Medicine
• Minimally Invasive Gynecological Surgery
• Hysteroscopy

Background:

• Intrauterine adhesions (IUAs) are a common gynecological issue, often treated with hysteroscopic methods.
• Current hysteroscopic techniques for IUAs lack consensus regarding optimal approaches, particularly for managing associated scar tissue.

Purpose of the Study:

• To compare the efficacy and safety of a novel hysteroscopic technique for treating IUAs.
• To evaluate the impact of the ploughing technique on postoperative outcomes, including adhesion scores and pregnancy rates.

Main Methods:

• Retrospective analysis of 179 patients with hysteroscopic adhesions (HA) from January 2016 to October 2017.
• Patients were divided into three groups: ploughing group (PG) using cold scissors with ploughing technique, traditional group (TG) with cold scissors only, and electrosurgical group (EG) using a resectoscope.
• Outcomes assessed included surgical complications, technique replacement rates, reduction in American Fertility Society (AFS) scores, and pregnancy/live birth rates.

Main Results:

• The ploughing group (PG) showed significantly lower postoperative AFS scores compared to both the traditional group (TG) and electrosurgical group (EG).
• Pregnancy outcomes were significantly improved in the PG compared to the TG and EG.
• No surgical complications or technique replacements were reported in any group, indicating high safety and feasibility.

Conclusions:

• The cold scissors ploughing technique is an effective, feasible, and safe method for managing intrauterine adhesions and scar tissue.
• This technique demonstrates superior outcomes in reducing adhesion scores and improving pregnancy rates, suggesting its potential as a preferred hysteroscopic approach.