Hysteroscopic niche resection
Hysteroscopic niche resection was performed according to a standardized
protocol under the general anesthesia in the Daycare Surgery department.
A resectoscope (Ch. 26 model WA22061 with a 12° optic 22001A) equipped
with a 3-mm-deep and 5-mm-wide loop (Olympus, Germany) was used. As
distention medium we used 0.9% NaCl under 120 mmHg intrauterine
pressure. Patients were in lithotomy position, after bimanual
examination to determine the size and the position of the uterus, the
cervix was disinfection and grasped with a tenaculum forceps. Dilatation
of the cervix up to Hegar 9, aspiration of the endometrium for
histological examination and hysteroscopic examination of the uterine
cavity. Then the outflow tract was resected and the niche surface
including all small vessels in the niche were coagulated (Figure S1).
Patients were observed postoperatively for at least 3 hours.
Both procedures were performed by one
trained doctor with extensive experience in performing the procedures.