Bigatti shaver versus Bipolar electrocautry in management of endometrial polyps in infertile women

Bigatti shaver versus Bipolar electrocautry in management of endometrial polyps in infertile women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bigatti shaver versus Bipolar electrocautry in management of endometrial polyps in infertile women Raya Muslim Al -Hassan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5808670/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Endometrial polyps may be characterized by heavy vaginal bleeding which needs surgical interventions like bipolar electrocautry surgery. They are commonly removed by excision using a resectoscope but this approach convey several complications like lack of complete removal, improper imaging , fluid intolerance and uterine or bowel injury .The new intrauterine Bigatti shaver (IBS) is a mechanical shaver that provides complete resection ,continuous fluid Input and deficit ,direct visualization and rare recurrence .Aim: To assess the intrauterine Bigatti shaver safety and value as hysteroscopic mechanical removal procedure for the management of endometrial polyps in comparison with resectoscope hysteroscopy. Methods:. The study was performed between October 2023 to October 2024 on sixty patients .All demographics and operative information like set-up time, resection time and complications were evaluated ,endometrial polyps were removed by two procedures, Bigatti shaver and resectoscope hysteroscopy .data collected and analyzed . Results: Sixty patients were divided into 2 groups for Bigatti shaver and resectoscope hysteroscopy .There is significant difference in operating time between Bigatti shaver and resectoscope (2.46 ± 0.65, 7.44 ± 1.08 respectively ), in addition to significant difference in fluid input(1108.06±250.03, 1803.45 ± 431.14 respectively ) but fluid defecits have no significant differences. In Bigatti shaver all patients have no bleeding as a complication when compared to resectoscope . Conclusion: .. The Bigatti shaver is a highly effective tool for the removal of endometrial polyps, offering a minimally invasive alternative to traditional methods. It combines mechanical tissue resection with continuous visualization, reduces the risk of uterine perforation and minimizes trauma to surrounding tissue, promoting faster recovery and enhanced patient outcomes Endometrial Polyps Bigatti Shaver Resectoscope Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Endometrial polyps (EP) are focal growths of the endometrium produced by hyperatrophy of endometrial glands and stroma surrounding a vascular core [1,2 ]. EP affect 7.8–34.9% of women, commonly in postmenopausal (11.8%) compared to premenopausal women (5.8%) [ 3 , 4 ]. They differ in size from a few millimeters to several centimeters, mostly benign.. A typical hyperplasia or endometrial tumor is present in 3.8% of postmenopausal cases [ 5 ] Several risk factors are linked with EP development, including age ,family history, chronic diseases (diabetes, hypertension, obesity), hyperestrogenism and Tamoxifen therapy[ 6 ]. EP are frequently asymptomatic [ 7 , 8 ]., but may present as abnormal uterine bleeding (AUB) or infertility in 3.7–65% of cases [ 9 ]. EP are often found in infertile women during gynecological examination or investigations related to infertility [ 10 ] .Polypectomy has been shown to improve fertility. [ 11 – 16 ] Management focused on symptoms, risk of malignancy and fertility issue. small asymptomatic EP may heal without treatment but larger polyps require surgical intervention [ 17 ] .Diagnosis with hysteroscopy technique has revealed that 16.5–26.5% of patients with infertility have EP, malignancy in polyps ranges from 0.5% − 4.8% [ 18 ] At the present time, hysteroscopy is the gold-standard procedure for EP management due to its direct visualization and high accuracy[ 19 ] .The resectoscope was widely used for operative hysteroscopy, although it has a relatively noticeable complication rate[ 20 – 22 ] . The new intrauterine Bigatti Shaver (IBS) is an innovative hysteroscopic technique that uses a rotating blade to shave and selectively eliminate endometrial polyps from their edge to their base with a small 8.5 sheath diameter that facilitates continuous saline inflow and tissue outflow for improved visualization. IBS causes no thermal injury, therefore minimizes damage to the healthy endometrium, and prevents adhesions.[ 23 ] . Material and Methodology This prospective study was conducted on sixty patients diagnosed with endometrial polyps by 3D ultrasound or office hysteroscopy .The patients were divided into two groups: Thirty one underwent Bigatti shaver (IBS) polypectomy. and twenty nine underwent resectoscope polypectomy . All procedures were carried out between october 2023 and October 2024. The operative time is the duration from the inserting of the Bigaatti shaver or resectoscope to the completion of the resection. The resection time, on the other hand, is the duration from the appearance of the shaver tip or resectoscope to the completion beside the total procedure time was recorded. Demographic information, operative time, fluid input,fluid deficit and surgical complications (bleeding, infection, uterine perforation) were all calculated. The inclusion criteria were women with infertility who underwent diagnostic office hysteroscopy, with polyps measuring 1 cm or more in length, and who provided informed consent. Patients with genital tract infections were excluded from the study. All patients received pre-operative cervical preparation with 400 mcg of misoprostol inserted two hours before the procedure, followed by cervical dilatation using a Hegar dilator up to size 8–9. Bigatti Shaver (IBS) Approch: The IBS setup consisted of a 6° scope with a continuous flow sheath and an operating channel for the mechanical shaving system. The sheath was connected to an irrigation pump to facilitate dilation of the uterine cavity and a suction pump for removing fluid and tissue fragments. Excess fluid was collected in a drainage bag positioned under the patient. For all cases, a 24 Fr outer sheath was used, along with normal saline irrigation. The suction pressure was set at 250 ml/min, with a maximum flow of 300 ml/min, maintaining uterine pressure within the range of 100–150 mmHg. Resectoscope Approch : The resectoscope procedure was performed using a 22 Fr resectoscope equipped with a 30° optical system and powered by bipolar energy. A traditional bipolar loop electrode was utilized throughout the procedure. The uterine cavity was distended with 0.9% sodium chloride solution, which was continuously irrigated using an automatic fluid pump set to a pressure of 80–100 mmHg. Data collection and Follow up: Patient data, including procedural and follow-up outcomes, were systematically collected and analyzed. by ANOVA test, T and Chi square test Results Results of both Bigatti Shaver and resectoscope polypectomy groups were calculated The operative time and fluid input were significantly less in the Bigatti Shaver group indicating a statistically significant difference. However, the fluid deficit did not show statistically significant differences between the two methods. Table 1 ,figures 1- 3. Table 1:Comparison between Bigatti shaver and Resectoscope polypectomy operative time fluid input and deficit Operative method P-value Bigatti Shaver Resctoscope Mean SD Mean SD Operative time (minutes) 2.46 0.65 7.44 1.08 0.000 Fluid input (ml) 1108.06 250.03 1803.45 431.14 0.000 Fluid defecit (ml) 79.19 17.33 79.83 16.28 0.885 t-test No infection or uterine injury in either group, with no statistically significant differences between the methods. Bleeding occurred in 2 cases (6.9%) in the resectoscope group and none in the Bigatti shaver group, which was not significant (p-value > 0.05) .Table 2. Table 2: Comparison between complications in Bigatti and resectoscope polypectomy Operative method P-value Bigatti Shaver Resctoscope Count % Count % Bleeding No 31 100% 27 93.1% 0.137 Yes 0 0% 2 6.9% Chi-square Resectoscope cases with bleeding had a significantly longer operative time and required significantly more fluid input. However, the fluid deficit did not differ significantly between bleeding and non-bleeding cases, as shown in Table 3 and Figure 4,5 and 6. Table 3: Bleeding cases ,operative time ,Fluid input, and fluid defecit Bleeding P-value No Yes Mean SD Mean SD Operative time (minutes) 4.7 2.6 8.5 0.7 0.048 Fluid input (ml) 1416.4 474.9 2250 353.6 0.017 Fluid defecit (ml) 79.5 17.0 80 0 0.966 T-test Discussion The most appropriate approach to manag an endometrial polyp should be determined based on a comprehensive assessment of the patient’s medical history (including their desire for future pregnancies) and the presence of associated symptoms. Considering these factors, clinicians decide whether to proceed with non-surgical management, conservative surgery, or radical surgery Hysteroscopic polypectomy is a conservative surgical technique that is both effective and safe, providing symptomatic relief for 75–100% of patients[ 24 ]. Regarding the impact of endometrial polyps and their removal on fertility, several observational studies suggest that endometrial polypectomy may enhance natural pregnancy rates in women with unexplained infertility[ 25 , 26 ]. The potential mechanisms linking polyps to infertility include adverse effects on endometrial thickness, local vascular supply, uterine cavity shape, and accessibility, indicating a molecular basis for reduced pregnancy rates in women with endometrial polyps.[ 27 ]. The findings of this study (comparing IBS with resectoscope polypectomy) align with several relevant articles, demonstrating that IBS is more effective than resectoscope polypectomy. IBS offers significant advantages, including reduced pain, shorter procedure time, and minimized fluid input. These benefits are largely due to its combined tissue-cutting and aspiration mechanism, which reduces the need for multiple instrument reinsertions through the cervix. The advancements in IBS mechanical tissue removal systems represent a significant technical improvement in polyp treatment, consistent with the findings of other researchers.[ 28 , 29 ] Moreover, IBS enhances efficacy and reduces complications commonly associated with conventional resectoscopy, such as genital infections, bleeding, pelvic inflammatory disease (PID), uterine perforation (rare), and cervical damage. Furthermore intrauterine Bisectional Surgery (IBS) is considered an ideal treatment for the removal of endometrial polyps. It effectively excises the endometrial basalis at the origin of the polyp, thereby minimizing the risk of recurrence. Furthermore, IBS serves as a reliable method for assessing the potential malignancy of the epithelial layer of endometrial polyps Conclusion We agree with other relevant studies which demonstrate that IBS is, safe ,effective, with excellent patient satisfaction. It is a reliable, patient-friendly technique for EP management, offering a significant improvement over traditional methods and we recommend long follow up to detect other complications like intrauterine adhesion and recurrence Declarations Acknowledgement Author appreciate and thanks all female patients collaborate in this study. Ethical approval The study protocol, validity and reliability of research concept was conducted with integrity and ethical principles of Ethics Committee of Al Zahraa College of Medicine / University of Basrah with approval No [Ant- 010] at 26 / Sep / 2022 Consent for publication Author consent to the publication of this study Data availability All data generated or analyzed during this study are included in this manuscript . Competing interest Author declare no competing interest Funding No funding Author contributions Raya M Al-hassan suggested the concept , the hypothesis and applicable points . conducted the experiment, achieved the calculations. complete the analytic approaches and provided the logistic support to the manuscript. The author reviewed the manuscript, approved the final print and is responsible for contents of the manuscript References Cicinelli E, Bettocchi S, de Ziegler D, Loizzi V, Cormio G, Marinaccio M, et al . Chronic Endometritis, a Common Disease Hidden behind Endometrial Polyps in Premenopausal Women first Evidence from a Case-Control Study. Journal of Minimally Invasive Gynecology. 2019; 26: 1346–1350. Mariana De Cunha Vieira1, Amerigo Vitagliano2 , *, Mariana Costa Rossette3,Luiz Cavalcanti de Albuquerque Neto3, Alessandra Gallo4, Attilio Di Spiezio Sardo4. Endometrial Polyps: Update Overview on Etiology, Diagnosis, NHistory and Treatment. Clin. Exp. Obstet. Gynecol. 2022 ; 49(10): 232. Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol, 2011, 18(5): 569–581 https://doi.org/10.1016/j.jmig.2011.05.018 PMID: 21783430 Vitale, S.G.; Haimovich, S.; Laganà, A.S.; Alonso, L.; Sardo, A.D.S.; Carugno, J. Endometrial Polyps. An evidence-based diagnosis and management guide . Eur. J. Obstet. Gynecol. Reprod. Biol. 2021 , 260, 70–77. [CrossRef] [PubMed] Fagioli R, Vitagliano A, Carugno J, Castellano G, De Angelis MC, Di Spiezio Sardo A. Hysteroscopy in postmenopause: from diagnosis to the management of intrauterine pathologies. Climacteric. 2020; 23: 360–368. Savelli L, De Iaco P, Santini D, Rosati F, Ghi T, Pignotti E, Histopathologic features hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol, 2003, 188(4):927–931. https://doi.org/10.1067/mob. 2003.247 PMID: 12712087 Bohîlţea RE. Diagnosticul patologiei endometriale. Ed. Universitară “Carol Davila”, Bucureşti, Romania, 2018, 71–177. https://editura. umfcd.ro/diagnosticul-patologiei-endometriale/ Uglietti A, Buggio L, Farella M, Chiaffarino F, Dridi D, Vercellini P, Parazzini F . The risk of malignancy in uterine polyps: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol, 2019, 237:48–56. https://doi.org/10.1016/j.ejogrb.2019.04.009 PMID: 31009859 Whitaker L, Critchley HOD. Abnormal uterine bleeding. Best Practice & Research Clinical Obstetrics & Gynaecology. 2016;34: 54–65. Hinckley MD, Milki AA. 1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings. JSLS 2004;8:103–7. Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and management of endometrial polyps: a critical review of the literature. J MinimInvasive Gynecol,2011,18(5):569-581 https://doi.org/10.1016/j.jmig.2011.05.018 PMID: 21783430 Raz N, Feinmesser L, Moore O, Haimovich S. Endometrial polyps: diagnosis and treatment options – a review of literature. Minim Invasive Ther Allied Technol, 2021, 30(5):278–287. https:// doi.org/10.1080/13645706.2021.1948867 PMID: 34355659 Bakour SH, Khan KS, Gupta JK. The risk of premalignant and malignant pathology in endometrial polyps. Acta Obstet Gynecol Scand, 2000, 79(4):317–320. PMID: 10746849 Biron-Shental T, Tepper R, Fishman A, Shapira J, Cohen I. Recurrent endometrial polyps in postmenopausal breast cancer patients on Tamoxifen. Gynecol Oncol, 2003, 90(2):382–386. https://doi.org/10.1016/s0090-8258(03)00276-2 PMID: 12893204 Xia Yin1,2,3*, Xiaoshi Liu1,3*, Shu Zhang1,2,3, Jun Shi1,2,3, Aimin Zhao1,2,3, Di Wen1,2,3, Rudi Campo4 and Giuseppe Bigatti2. Polyps’ treatment with the 24Fr. Intrauterine BIGATTI Shaver (IBS®): A 1000 patients’ retrospective descriptive The Trocar official online journal of ISGE. Issue 2 Volume 5 / Page 62-72. Munro MG. Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity. Fertil Steril. 2019;111(4):629-640. Njume Peter Nijkang1,2, Lyndal Anderson2,3, Robert Markham1,2 and Frank Manconi. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Medicine Volume 7: 1 –12 © The Author(s) 2019 DOI: 10.1177/2050312119848247. Tanos V, Berry KE, Seikkula J, et al. The management of polyps in female reproductive organs. Int J Surg. 2017; 43:7-16 Shushan A, Revel A, Rojansky N. How often are endometrial polyps malignant? Gynecol Obstet Invest. 2004;58(4):212-215. Jedeikin R, Olsfanger D, Kessler I. Disseminated intravascular coagulopathy and adult respiratory distress syndrome: life-threatening complications of hysteroscopy. Am J Obstet Gynecol. 1990;162(1):44-45. Jansen FW, Vredevoogd CB, van UlzenK, Hermans J, Trimbos JB, Trimbos-Kemper TC. Complications ofhysteroscopy: a prospective,multicenter study. Obstet Gynecol.2000;96(2):266-270. Liying Yang, Hemashree Rajesh, Suling Yu. The Intrauterine Bigatti Shaver for Endometrial Lesions: Our Experience and modifications . Open Journal of Obstetrics and Gynecology, 2017, 7, 1-6. http://www.scirp.org/journal/ojog Bigatti, G. (2011) IBS® Integrated Bigatti Shaver, an Alternative Approach to Operative Hysteroscopy. Gynecological Surgery , 8, 187-191 https:/doi.org/10.1007/s10397-010-0634-8 Lieng M, Istre O, Qvigstad E. Treatment of endometrial polyps: a systematic review. Acta Obstetricia Et Gynecologica Scandinavica. 2010; 89: 992–1002. Byung Chul Jee1,2, Hye Gyeong Jeong1,2. Management of endometrial polyps in infertile women: A mini-review, Clin Exp Reprod Med 2021;48(3):198-202 Varasteh NN, Neuwirth RS, Levin B, Keltz MD. Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women. Obstet Gynecol 1999;94:168–71. Chen Wang 1 , Hui Chen 2, India Morgan 3, Valeriya Prytkova 4 , Belinda Kohl-Thomas 3,5, J. Preston Parry 6 and Steven R. Lindheim 4,5,7,*. Effectiveness of Manual Hysteroscopic Tissue Removal Device for Intrauterine Polyps in Infertile Women in Both Operating and Office Settings, J. Clin. Med. 2024, 13, 2244. https://doi.org/10.3390/jcm13082244 Noventa M, Ancona E, Quaranta M, Vitagliano A, Cosmi E, D’Antona D, et al Intrauterine Morcellator Devices: the Icon of Hysteroscopic Future or Merely a Marketing Image1. ? A Systematic Review Regarding Safety, Efficacy, Advantages, and Contraindications ;Reproductive Sciences. 2015; 22: 1289–1296. Yin X, Cheng J, Ansari SH, et al.Hysteroscopic tissue removal systemsfor the treatment of intrauterinepathology: a systematic review andmeta-analysis. Facts Views Vis Obgyn.2018;10(4):207-213. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5808670","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":401918846,"identity":"4b6941f5-9ade-4e37-ae02-bb15be8b88ba","order_by":0,"name":"Raya Muslim Al 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04:25:55","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":24174,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFluid deficit in bleeding cases\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5808670/v1/fb0d20dc3aae4b38644a2e65.png"},{"id":73924876,"identity":"eb6dcf0d-f53b-4513-a12c-401c1bcb8863","added_by":"auto","created_at":"2025-01-16 04:25:55","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":218003,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e31 year old lady 5 years with primary infertility have 2 cm endometrial polyp, before and after polypectomy\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-5808670/v1/7bc9dbde10d4f31481227ed8.png"},{"id":73924866,"identity":"73c69471-0c8e-4746-bd3d-e0c7e6b899b6","added_by":"auto","created_at":"2025-01-16 04:25:54","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":410001,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e37 year old lady P2 had abnormal uterine bleeding due to multiple polyps before and after\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-5808670/v1/d98297d555c342945a1f92ca.png"},{"id":74687819,"identity":"dfe2e411-e1ec-425b-8681-2b77449e9864","added_by":"auto","created_at":"2025-01-24 17:31:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1903584,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5808670/v1/6aa70291-688d-4cb5-ae2f-e852ce2e5fb1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bigatti shaver versus Bipolar electrocautry in management of endometrial polyps in infertile women","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometrial polyps (EP) are focal growths of the endometrium produced by hyperatrophy of endometrial glands and stroma surrounding a vascular core [1,2 ]. EP affect 7.8\u0026ndash;34.9% of women, commonly in postmenopausal (11.8%) compared to premenopausal women (5.8%) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. They differ in size from a few millimeters to several centimeters, mostly benign.. A typical hyperplasia or endometrial tumor is present in 3.8% of postmenopausal cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSeveral risk factors are linked with EP development, including age ,family history, chronic diseases (diabetes, hypertension, obesity), hyperestrogenism and Tamoxifen therapy[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. EP are frequently asymptomatic [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]., but may present as abnormal uterine bleeding (AUB) or infertility in 3.7\u0026ndash;65% of cases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. EP are often found in infertile women during gynecological examination or investigations related to infertility [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] .Polypectomy has been shown to improve fertility. [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eManagement focused on symptoms, risk of malignancy and fertility issue. small asymptomatic EP may heal without treatment but larger polyps require surgical intervention [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] .Diagnosis with hysteroscopy technique has revealed that 16.5\u0026ndash;26.5% of patients with infertility have EP, malignancy in polyps ranges from 0.5% \u0026minus;\u0026thinsp;4.8% [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAt the present time, hysteroscopy is the gold-standard procedure for EP management due to its direct visualization and high accuracy[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] .The resectoscope was widely used for operative hysteroscopy, although it has a relatively noticeable complication rate[\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eThe new intrauterine Bigatti Shaver (IBS) is an innovative hysteroscopic technique that uses a rotating blade to shave and selectively eliminate endometrial polyps from their edge to their base with a small 8.5 sheath diameter that facilitates continuous saline inflow and tissue outflow for improved visualization. IBS causes no thermal injury, therefore minimizes damage to the healthy endometrium, and prevents adhesions.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] .\u003c/p\u003e"},{"header":"Material and Methodology","content":"\u003cp\u003eThis prospective study was conducted on sixty \u0026nbsp;patients diagnosed with endometrial polyps by 3D ultrasound or office hysteroscopy .The patients were divided into two groups: Thirty one \u0026nbsp;underwent Bigatti shaver (IBS) polypectomy. and twenty nine \u0026nbsp;underwent resectoscope polypectomy . \u0026nbsp;All procedures were carried out between october 2023 and October 2024. The operative time is \u0026nbsp;the duration from the inserting \u0026nbsp;of the Bigaatti shaver \u0026nbsp;or resectoscope to the completion of the resection. The resection time, on the other hand, is \u0026nbsp;the duration from the appearance of the shaver tip or resectoscope to the completion beside the total procedure time \u0026nbsp;was recorded.\u003c/p\u003e\n\u003cp\u003eDemographic information, operative time, fluid input,fluid deficit and surgical complications (bleeding, infection, uterine perforation) were all calculated. The inclusion criteria were women with infertility who underwent diagnostic office hysteroscopy, with polyps measuring 1 cm or more in length, and who provided informed consent. Patients with genital tract infections were excluded from the study. All patients received pre-operative cervical preparation with 400 mcg of misoprostol inserted two hours before the procedure, followed by cervical dilatation using a Hegar dilator up to size 8\u0026ndash;9.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBigatti Shaver (IBS) Approch:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe IBS setup consisted of a 6\u0026deg; scope with a continuous flow sheath and an operating channel for the mechanical shaving system. The sheath was connected to an irrigation pump to facilitate dilation of the uterine cavity and a suction pump for removing fluid and tissue fragments. Excess fluid was collected in a drainage bag positioned under the patient. For all cases, a 24 Fr outer sheath was used, along with normal saline irrigation. The suction pressure was set at 250 ml/min, with a maximum flow of 300 ml/min, maintaining uterine pressure within the range of 100\u0026ndash;150 mmHg.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResectoscope Approch :\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe resectoscope procedure was performed using a 22 Fr resectoscope equipped with a 30\u0026deg; optical system and powered by bipolar energy. A traditional bipolar loop electrode was utilized throughout the procedure. The uterine cavity was distended with 0.9% sodium chloride solution, which was continuously irrigated using an automatic fluid pump set to a pressure of 80\u0026ndash;100 mmHg.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and Follow up:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient data, including procedural and follow-up outcomes, were systematically collected and analyzed. by ANOVA test, T and Chi square test \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eResults of both Bigatti Shaver and resectoscope polypectomy groups were calculated The operative time and fluid input were significantly less in the Bigatti Shaver \u0026nbsp; \u0026nbsp; \u0026nbsp;group \u0026nbsp;indicating a statistically significant difference. However, the fluid deficit did not show statistically significant differences between the two methods. Table 1 ,figures 1- 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:Comparison between Bigatti shaver and Resectoscope polypectomy \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eoperative time fluid input and deficit\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.546%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 32.1963%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 5.6933%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.546%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6994%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBigatti Shaver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.0859%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.816%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResctoscope\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.5951%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.546%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6994%;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.0859%;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.816%;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.5951%;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.546%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time (minutes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6994%;\"\u003e\n \u003cp\u003e2.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.0859%;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.816%;\"\u003e\n \u003cp\u003e7.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.5951%;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.6933%;\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.546%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFluid input (ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6994%;\"\u003e\n \u003cp\u003e1108.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.0859%;\"\u003e\n \u003cp\u003e250.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.816%;\"\u003e\n \u003cp\u003e1803.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.5951%;\"\u003e\n \u003cp\u003e431.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.6933%;\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.546%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFluid defecit (ml)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6994%;\"\u003e\n \u003cp\u003e79.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.0859%;\"\u003e\n \u003cp\u003e17.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.816%;\"\u003e\n \u003cp\u003e79.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.5951%;\"\u003e\n \u003cp\u003e16.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.6933%;\"\u003e\n \u003cp\u003e0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57.227%;\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;t-test\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNo infection or uterine injury \u0026nbsp;in either group, with no statistically significant differences between the methods. Bleeding occurred in 2 cases (6.9%) in the resectoscope group and none in the Bigatti shaver group, which was not significant (p-value \u0026gt; 0.05) .Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Comparison between complications in Bigatti and resectoscope \u0026nbsp;polypectomy\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"702\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 342px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative method\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBigatti Shaver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResctoscope\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e93.1%\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e6.9%\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99.8575%;\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-square\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResectoscope cases with bleeding had a significantly longer operative time and required significantly more fluid input. However, the fluid deficit did not differ significantly between bleeding and non-bleeding cases, as shown in Table 3 and Figure 4,5 and 6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Bleeding cases ,operative time ,Fluid input, and fluid defecit\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"651\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 203px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time (minutes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e0.048\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFluid input (ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1416.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e474.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e2250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e353.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e0.017\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFluid defecit (ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e79.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e0.966\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eT-test\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe most appropriate approach to manag an endometrial polyp should be determined based on a comprehensive assessment of the patient\u0026rsquo;s medical history (including their desire for future pregnancies) and the presence of associated symptoms. Considering these factors, clinicians decide whether to proceed with non-surgical management, conservative surgery, or radical surgery\u003c/p\u003e \u003cp\u003eHysteroscopic polypectomy is a conservative surgical technique that is both effective and safe, providing symptomatic relief for 75\u0026ndash;100% of patients[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Regarding the impact of endometrial polyps and their removal on fertility, several observational studies suggest that endometrial polypectomy may enhance natural pregnancy rates in women with unexplained infertility[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The potential mechanisms linking polyps to infertility include adverse effects on endometrial thickness, local vascular supply, uterine cavity shape, and accessibility, indicating a molecular basis for reduced pregnancy rates in women with endometrial polyps.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings of this study (comparing IBS with resectoscope polypectomy) align with several relevant articles, demonstrating that IBS is more effective than resectoscope polypectomy. IBS offers significant advantages, including reduced pain, shorter procedure time, and minimized fluid input. These benefits are largely due to its combined tissue-cutting and aspiration mechanism, which reduces the need for multiple instrument reinsertions through the cervix. The advancements in IBS mechanical tissue removal systems represent a significant technical improvement in polyp treatment, consistent with the findings of other researchers.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] Moreover, IBS enhances efficacy and reduces complications commonly associated with conventional resectoscopy, such as genital infections, bleeding, pelvic inflammatory disease (PID), uterine perforation (rare), and cervical damage. Furthermore intrauterine Bisectional Surgery (IBS) is considered an ideal treatment for the removal of endometrial polyps. It effectively excises the endometrial basalis at the origin of the polyp, thereby minimizing the risk of recurrence. Furthermore, IBS serves as a reliable method for assessing the potential malignancy of the epithelial layer of endometrial polyps\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe agree with other relevant studies which demonstrate that IBS is, safe ,effective, with excellent patient satisfaction. It is a reliable, patient-friendly technique for EP management, offering a significant improvement over traditional methods and we recommend long follow up to detect other complications like intrauterine adhesion and recurrence\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor appreciate and thanks all female patients collaborate in this study. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol, validity and reliability of research concept was conducted with integrity and ethical principles of Ethics Committee of Al Zahraa College of Medicine / University of Basrah with approval No [Ant- 010] \u0026nbsp;at \u0026nbsp;26 / Sep / 2022\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor consent to the publication of this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this manuscript\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor declare no competing interest\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Raya M Al-hassan suggested the concept , the hypothesis and applicable points . conducted the experiment, achieved the calculations. complete the analytic approaches and provided the logistic support to the manuscript. \u0026nbsp;The author reviewed the manuscript, approved the final print and is responsible for contents of the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCicinelli E, Bettocchi S, de Ziegler D, Loizzi V, Cormio G, Marinaccio M, \u003cem\u003eet al\u003c/em\u003e. Chronic Endometritis, a Common Disease Hidden behind Endometrial Polyps in Premenopausal Women first Evidence from a Case-Control Study. Journal of Minimally Invasive Gynecology. 2019; 26: 1346\u0026ndash;1350.\u003c/li\u003e\n \u003cli\u003eMariana De Cunha Vieira1, Amerigo Vitagliano2\u003cem\u003e,\u003c/em\u003e*, Mariana Costa Rossette3,Luiz Cavalcanti de Albuquerque Neto3, Alessandra Gallo4, Attilio Di Spiezio Sardo4. Endometrial Polyps: Update Overview on Etiology, Diagnosis, NHistory and Treatment.\u003cem\u003e\u0026nbsp;Clin. Exp. Obstet. Gynecol.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e2022\u003c/strong\u003e; 49(10): 232.\u003c/li\u003e\n \u003cli\u003eSalim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and management of endometrial polyps: a critical review of the literature. 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Am J Obstet Gynecol, 2003, 188(4):927\u0026ndash;931. https://doi.org/10.1067/mob. 2003.247 PMID: 12712087\u003c/li\u003e\n \u003cli\u003eBoh\u0026icirc;lţea RE. Diagnosticul patologiei endometriale. Ed. Universitară \u0026ldquo;Carol Davila\u0026rdquo;, Bucureşti, Romania, 2018, 71\u0026ndash;177. https://editura. umfcd.ro/diagnosticul-patologiei-endometriale/\u003c/li\u003e\n \u003cli\u003eUglietti A, Buggio L, Farella M, Chiaffarino F, Dridi D, Vercellini P, Parazzini F . The risk of malignancy in uterine polyps: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol, 2019, 237:48\u0026ndash;56. https://doi.org/10.1016/j.ejogrb.2019.04.009 PMID: 31009859\u003c/li\u003e\n \u003cli\u003eWhitaker L, Critchley HOD. Abnormal uterine bleeding. Best Practice \u0026amp; Research Clinical Obstetrics \u0026amp; Gynaecology. 2016;34: 54\u0026ndash;65.\u003c/li\u003e\n \u003cli\u003eHinckley MD, Milki AA. 1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings. JSLS 2004;8:103\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eSalim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and management of endometrial polyps: a critical review of the literature. J MinimInvasive Gynecol,2011,18(5):569-581 https://doi.org/10.1016/j.jmig.2011.05.018 PMID: 21783430\u003c/li\u003e\n \u003cli\u003eRaz N, Feinmesser L, Moore O, Haimovich S. Endometrial polyps: diagnosis and treatment options \u0026ndash; a review of literature. Minim Invasive Ther Allied Technol, 2021, 30(5):278\u0026ndash;287. https:// doi.org/10.1080/13645706.2021.1948867 PMID: 34355659\u003c/li\u003e\n \u003cli\u003eBakour SH, Khan KS, Gupta JK. The risk of premalignant and malignant pathology in endometrial polyps. Acta Obstet Gynecol Scand, 2000, 79(4):317\u0026ndash;320. PMID: 10746849\u003c/li\u003e\n \u003cli\u003eBiron-Shental T, Tepper R, Fishman A, Shapira J, Cohen I. Recurrent endometrial polyps in postmenopausal breast cancer patients on Tamoxifen. Gynecol Oncol, 2003, 90(2):382\u0026ndash;386. https://doi.org/10.1016/s0090-8258(03)00276-2 PMID: 12893204\u003c/li\u003e\n \u003cli\u003eXia Yin1,2,3*, Xiaoshi Liu1,3*, Shu Zhang1,2,3, Jun Shi1,2,3, Aimin Zhao1,2,3, Di Wen1,2,3, Rudi Campo4 and Giuseppe Bigatti2. Polyps\u0026rsquo; treatment with the 24Fr. Intrauterine BIGATTI Shaver (IBS\u0026reg;): A 1000 patients\u0026rsquo; retrospective descriptive The Trocar official online journal of ISGE. Issue 2 Volume 5 / Page 62-72.\u003c/li\u003e\n \u003cli\u003eMunro MG. Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity. Fertil Steril. 2019;111(4):629-640.\u003c/li\u003e\n \u003cli\u003eNjume Peter Nijkang1,2, Lyndal Anderson2,3, Robert Markham1,2 and Frank Manconi. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Medicine Volume 7: 1 \u0026ndash;12 \u0026copy; The Author(s) 2019 DOI: 10.1177/2050312119848247.\u003c/li\u003e\n \u003cli\u003eTanos V, Berry KE, Seikkula J, et al. The management of polyps in female reproductive organs. Int J Surg. 2017; 43:7-16\u003c/li\u003e\n \u003cli\u003eShushan A, Revel A, Rojansky N. How often are endometrial polyps malignant? Gynecol Obstet Invest. 2004;58(4):212-215.\u003c/li\u003e\n \u003cli\u003eJedeikin R, Olsfanger D, Kessler I. Disseminated intravascular coagulopathy and adult respiratory distress syndrome: life-threatening complications of hysteroscopy. Am J Obstet Gynecol. 1990;162(1):44-45.\u003c/li\u003e\n \u003cli\u003eJansen FW, Vredevoogd CB, van UlzenK, Hermans J, Trimbos JB, Trimbos-Kemper TC. Complications ofhysteroscopy: a prospective,multicenter study. Obstet Gynecol.2000;96(2):266-270.\u003c/li\u003e\n \u003cli\u003eLiying Yang, Hemashree Rajesh, Suling Yu. The Intrauterine Bigatti Shaver for Endometrial Lesions: Our Experience and modifications . Open Journal of Obstetrics and Gynecology, 2017, 7, 1-6. http://www.scirp.org/journal/ojog\u003c/li\u003e\n \u003cli\u003eBigatti, G. (2011) IBS\u0026reg; Integrated Bigatti Shaver, an Alternative Approach to Operative Hysteroscopy. Gynecological Surgery , 8, 187-191 https:/doi.org/10.1007/s10397-010-0634-8\u003c/li\u003e\n \u003cli\u003eLieng M, Istre O, Qvigstad E. Treatment of endometrial polyps: a systematic review. Acta Obstetricia Et Gynecologica Scandinavica. 2010; 89: 992\u0026ndash;1002.\u003c/li\u003e\n \u003cli\u003eByung Chul Jee1,2, Hye Gyeong Jeong1,2. Management of endometrial polyps in infertile women: A mini-review, Clin Exp Reprod Med 2021;48(3):198-202\u003c/li\u003e\n \u003cli\u003eVarasteh NN, Neuwirth RS, Levin B, Keltz MD. Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women. Obstet Gynecol 1999;94:168\u0026ndash;71.\u003c/li\u003e\n \u003cli\u003eChen Wang 1 , Hui Chen 2, India Morgan 3, Valeriya Prytkova 4 , Belinda Kohl-Thomas 3,5, J. Preston Parry 6 and Steven R. Lindheim 4,5,7,*. Effectiveness of Manual Hysteroscopic Tissue Removal Device for Intrauterine Polyps in Infertile Women in Both Operating and Office Settings, J. Clin. Med. 2024, 13, 2244. https://doi.org/10.3390/jcm13082244\u003c/li\u003e\n \u003cli\u003eNoventa M, Ancona E, Quaranta M, Vitagliano A, Cosmi E, D\u0026rsquo;Antona D, et al Intrauterine Morcellator Devices: the Icon of Hysteroscopic Future or Merely a Marketing Image1. ? A Systematic Review Regarding Safety, Efficacy, Advantages, and Contraindications ;Reproductive Sciences. 2015; 22: 1289\u0026ndash;1296.\u003c/li\u003e\n \u003cli\u003eYin X, Cheng J, Ansari SH, et al.Hysteroscopic tissue removal systemsfor the treatment of intrauterinepathology: a systematic review andmeta-analysis. Facts Views Vis Obgyn.2018;10(4):207-213.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometrial Polyps, Bigatti Shaver, Resectoscope ","lastPublishedDoi":"10.21203/rs.3.rs-5808670/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5808670/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEndometrial polyps may be characterized by heavy vaginal bleeding which needs surgical interventions like bipolar electrocautry surgery. They are commonly removed by excision using a resectoscope but this approach convey several complications like lack of complete removal, improper imaging , fluid intolerance and uterine or bowel injury .The new intrauterine Bigatti shaver (IBS) is a mechanical shaver that provides complete resection ,continuous fluid Input and deficit ,direct visualization and rare recurrence .Aim: To assess the intrauterine Bigatti shaver safety and value as hysteroscopic mechanical removal procedure for the management of endometrial polyps in comparison with resectoscope hysteroscopy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was performed between October 2023 to October 2024 on sixty patients .All \u003cbr\u003e\n demographics and operative information like set-up time, resection time and complications\u003c/p\u003e\n\u003cp\u003ewere evaluated ,endometrial polyps were removed by two procedures, Bigatti shaver and resectoscope hysteroscopy .data collected and analyzed .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSixty patients were divided into 2 groups for Bigatti shaver and resectoscope hysteroscopy\u003c/p\u003e\n\u003cp\u003e.There is significant difference in operating time between Bigatti shaver and resectoscope (2.46 ± 0.65, 7.44 ± 1.08 respectively ), in addition to significant difference in fluid input(1108.06±250.03, 1803.45 ± 431.14 respectively ) but fluid defecits have no significant\u003c/p\u003e\n\u003cp\u003edifferences. In \u0026nbsp;\u0026nbsp;Bigatti shaver all patients have no bleeding as a complication when compared to resectoscope .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e.. The Bigatti shaver is a highly effective tool for the removal of endometrial polyps, offering a minimally invasive alternative to traditional methods. It combines mechanical tissue resection with continuous visualization, reduces the risk of uterine perforation and minimizes trauma to surrounding tissue, promoting faster recovery and enhanced patient outcomes\u003c/p\u003e","manuscriptTitle":"Bigatti shaver versus Bipolar electrocautry in management of endometrial polyps in infertile women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-16 04:25:49","doi":"10.21203/rs.3.rs-5808670/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d2d1220-e4cd-44ed-bd25-64397ee3b189","owner":[],"postedDate":"January 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-24T17:23:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-16 04:25:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5808670","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5808670","identity":"rs-5808670","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}