Resectoscopic Surgery Part I: Overcoming Obstacles and Mastering the Basics

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Surgical Technology

Background:

• The continuous flow gynecologic resectoscope (CFGR) revolutionized minimally invasive gynecologic surgery (MIGS) upon its introduction in 1989.
• The advent of global endometrial ablation (GEA) devices and hysteroscopic morcellators (HMs) has led to a decline in CFGR utilization.
• This decline is regrettable as the CFGR is uniquely suited for procedures not achievable with newer technologies.

Purpose of the Study:

• To re-evaluate the relevance and indispensable role of the CFGR in modern MIGS.
• To outline the necessary operating room team composition, instrumentation, and skills for basic resectoscopic surgery.
• To detail advanced applications including ultrasound-guided procedures and management of complex cases like post-ablation failures and intramural myomas.

Main Methods:

• Review of the CFGR's capabilities and comparison with newer technologies.
• Discussion of essential components for performing resectoscopic surgery, including team roles and skills.
• Exploration of advanced techniques, including ultrasound guidance for intermediate and complex cases.

Main Results:

• The CFGR enables precise procedures such as endomyometrial resection, hysteroscopic metroplasty, isthmocele correction, intramural myoma resection, and management of endometrial ablation failures.
• It offers versatility, consolidating functions of multiple disposable platforms.
• Despite its benefits, significant impediments to CFGR use exist, including limited educational resources, trained experts, medico-legal concerns, and institutional challenges.

Conclusions:

• The CFGR remains a vital tool for gynecologic surgeons performing advanced MIGS procedures.
• Addressing educational and logistical barriers is crucial for restoring the CFGR's widespread use.
• A comprehensive understanding of its application, from basic to complex cases with ultrasound guidance, is essential for maximizing its potential.