The Impact of Intracervical Terlipressin on Intravasation and Venous Embolization During Transcervical Myomectomy and Endometrium resection: A Randomized Controlled Study.

Abstract

Study objective: To investigate whether intracervical injection of terlipressin during hysteroscopic surgery could reduce the amount of intravasation, the incidence and severity of gas embolism, and the COHb levels in the blood.

Design: Randomized double-blind controlled trial.

Setting: Gynecologic surgical unit in a general hospital.

Patients: Patients who were scheduled for transcervical resection of type 1 or type 2 myomas (TCR-M), or for extensive transcervical endometrium resection (TCR-E).

Interventions: Patients were randomized to receive either terlipressin 0.85 mg or placebo injections intracervically at the beginning of the procedure.

Measurements: The amount of intravasation and level of COHb was measured at the end of the procedure. The incidence and severity of gas embolisms was determined during the procedure by transesophageal echocardiography (TEE). Study groups were compared using an Independent Samples T-Test or a Mann-Whitney U test as indicated.

Main results: Forty-four patients were included in this study. No significant differences were found in intravasation volume, venous emboli and post-surgery COHb between study groups. There was a trend towards more severe embolisms (grade IV embolisms: 12 versus 6, p = .08), paradoxical embolisms (4 versus 2, p = .55) and a shorter operation time (mean of 43 versus 36 minutes, p = .09) in patients who received terlipressin compared to placebo.

Conclusion: This study could not demonstrate a clear beneficial effect of intracervical terlipressin administration. However, further research is needed to investigate if terlipressin can reduce operation time, severe embolisms and the need for redo procedures.