IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscopy : a randomised comparative study

Conventional bipolar resectoscopy is widely recognized as the first choice for major hysteroscopic operations. We recently proposed an alternative approach to operative hysteroscopy called Integrated Bigatti Shaver (IBS®) that improves visualization during the procedure, reducing several problems of conventional resectoscopy such as fluid overload, water intoxication, uterine perforation and long surgeon's learning curve. In cooperation with Karl Storz GmbH & Co., we created a new shaving system that, when introduced through the straight operative channel of a panoramic 90° optic, allows performance of many major hysteroscopic operations. The present randomised comparative study was designed to compare 50 cases performed with conventional bipolar resectoscope with 50 cases performed with the IBS®. Several types of major intrauterine pathologies such as polyps and submucosal myomas (according to ESGE classification) were included in the study. Two cases of via falsa were reported. In one case, the procedure was immediately stopped with no further complication for the patient, whereas in the second patient, the complication did not compromise the operative course. Dilatation time, overall procedure time, resection time and fluid balance were carefully monitored during each procedure in the two groups. The aim of the study was to compare the two techniques to confirm several advantages offered by the IBS® such as reduced dilatation of the cervix, better visualization during the procedure because tissue chips are removed at the same time as the resection, no need for coagulation or cutting current, utilization of normal saline and a much faster learning curve.