Proposal of a modified transcervical endometrial resection (TCER) technique for menorrhagia treatment. Feasibility, efficacy, and patients' acceptability

The aim of this study is to evaluate the feasibility, efficacy, safeness, and patients' acceptability of a modified transcervical endometrial resection (TCER) technique for the treatment of menorrhagia. Eighty-four premenopausal women with menorrhagia after careful investigation and 2 months therapy with GnRHa underwent a modified TCER. It was performed with a standard dual channel, 26 French irrigating resectoscope (Karl Storz, GmbH, Germany) after cervix dilatation to 10 mm and sorbitol mannitol solution used as distension medium. The modified technique was based on the resection of the endometrium and of the first myometrial layers only on the anterior and posterior walls, without treating fundus and cornual areas as usually performed. Endometrial resection was performed to a depth of 4 to 5 mm. Clinical and hysteroscopic follow-up was performed for 60 months. Early and late complications, changing in bleeding patterns, and patients' satisfaction were recorded. Sixty-four out of 73 patients that completed the 60 months improved. Eumenorrhea was achieved in 68.5 %, hypomenorrhea in 5.5 %, and amenorrhea in 13.7 %. Most of the patients (86.3 %) showed satisfaction at the follow-up interview. Control hysteroscopy showed that post modified TCER uterine cavity maintained the possibility of macroscopic and histopathology investigation during follow-up. Modified TCER is a technique easy to perform and effective in the long-term resolution of menorrhagia. In particular, it avoids the formation of synechiae and the shrinkage of the uterine cavity that may be the cause of various long-term complications, such as the delay in the diagnosis of endometrial carcinoma onset.