Prospective randomised trial comparing gonadotrophin-releasing hormone analogues with triple tourniquets at open myomectomy.

OBJECTIVE: To compare intra-operative blood loss with triple tourniquets to occlude uterine blood supply against preoperative treatment with gonadotrophin-releasing hormone (GnRH) analogues at open myomectomy. DESIGN: A prospective randomised controlled trial. SETTING: University teaching hospital. POPULATION: Forty women undergoing open myomectomy for symptomatic fibroids. METHODS: Women due to undergo open myomectomy were randomised to either 3 months pre-treatment with a GnRH analogue or the intra-operative application of triple tourniquets (number 1 polyglactin suture [Vicryl Ethicon Inc., Somerville, NJ, USA] tied around the cervix and a size 10 polythene suction catheter tied around the infundibulo-pelvic ligaments) to occlude the uterine blood supply. MAIN OUTCOME MEASURES: The primary outcome measure was intra-operative blood loss. Secondary outcome measures included postoperative blood loss, blood transfusion rate and postoperative morbidity. RESULTS: The two groups were similar in baseline characteristics. An average of 15 and 22 fibroids were removed from the GnRH analogue and tourniquet groups respectively. Intra-operative estimated blood loss was significantly higher in the GnRH analogue group (median 2482 ml, 75% percentile 1744-3151) than when triple tourniquets were used (median 640 ml, 75% percentile 418-881), giving a difference between means of 1842 ml (P<0.001). Similarly, significantly more women required blood transfusion in the GnRH analogue group (70 versus 30%, P<0.025). Postoperative morbidity was similar between the two groups. There were two serious complications in the tourniquet group, but they were not considered to be directly related to occlusion of the uterine blood supply. CONCLUSIONS: Triple tourniquets are significantly more effective than preoperative treatment with GnRH analogues at reducing intra-operative blood loss at open myomectomy.

A randomised trial comparing the H Pipelle with the standard Pipelle for endometrial sampling at 'no-touch' (vaginoscopic) hysteroscopy.

OBJECTIVES: To evaluate the effectiveness and tolerance of H Pipelle compared with the standard Pipelle as an endometrial biopsy device at outpatient 'no-touch' hysteroscopy. DESIGN: A prospective randomised trial carried out in an outpatient diagnostic hysteroscopy clinic. SETTING: A large undergraduate teaching hospital. POPULATION: Sixty women investigated for abnormal menstruation in an outpatient diagnostic hysteroscopy clinic. METHODS: Prospective randomised trial comparing the H Pipelle with the standard Pipelle de Cornier. MAIN OUTCOME MEASURES: Adequacy of the biopsy specimens and women's experience. RESULTS: Ninety-three percent (H Pipelle) and 87% (Pipelle) of the biopsy specimens were judged to be adequate for histological diagnosis (P > 0.05). However, obtaining endometrial sampling with the H Pipelle was significantly quicker (median times: 39 seconds [H Pipelle] and 102 seconds [Pipelle], P < 0.0001) and less painful (median visual analogue scale score: 1 [H Pipelle] and 5 [Pipelle], P = 0.011). CONCLUSIONS: The H Pipelle not only makes it possible to perform hysteroscopy and endometrial biopsy with minimal instrumentation but is also associated with a shorter biopsy time and less discomfort than the standard Pipelle without any loss of biopsy adequacy.