Title: Incidence and risks of excessive distension absorption in hysteroscopic surgery using 5%
mannitol solution: a retrospective descriptive study.
Version: 2 Date: 09 Aug 2024
Reviewer:  Tarek Tawfik Amin
Reviewer's report:
BMC Women’s Health
Title: Excessive absorption of distending media in hysteroscopic surgery.
Comments to the authors:
- It seems that this a single center experience in China, your title should be expressing the answer
to your research question, what, where are essential in the title???
Abstract:
- “To clarify the incidence of excessive absorption of distending media in hysteroscopic surgery,
evaluate the use of 5% mannitol solution for hysteroscopic surgical procedures, and establish
a safe threshold for distension absorption. What do you by clarify? And in your study, your
prevalence will only reflect that of your setting (hospital) where the study was conducted???
- The objective statement needs to be rephrased- prevalence meant for observational category,
while evaluating the use of 5% mannitol solution--- this an experimental sort of design???
- Establishing a safe threshold is another quest which necessitate additional design which entails,
nomogram, calibration and accuracy measures????
- Design: was it database hospital-records retrospective or else???
- The main results in the abstract did not include any in relation to evaluation and determination
of threshold as stated in the objectives???
- “But it would be five times higher in certain procedures such as TCRF, RPOC removal and
TCRA. Resection using a needle electrode in HSR and TCRA may contribute to the short time
development of excessive distension absorption. 30.77% of the patients could not tolerate the
fluid deficit of less than 2500mL which was set as a threshold for isotonic distending media and
presented with circulation overload related signs or symptoms. I believe this section needs more
elaboration and moved to be part of the results not the conclusion???
Introduction:
- unpleasant conditions---- change this term (complications, consequences).
- TURP syndrome---- mention this abbreviation??
- What is the burden of the research question in terms of mortality, morbidity, hospitalization,
complications and costing making your research endeavor more needed???
- 5% mannitol solution is isotonic, it is also electrolyte-free, and the threshold for mannitol varies
according to different standards.----- repetition
- The rationale for conducting this study should be stated explicitly as well as the primary
objective (this section should be added).
Materials and methods:
- Brief description of the electronic medical records should be mentioned
- It would be very informative to insert a graph showing the procedures and patients in each
category and those eligible for inclusion at the beginning of this section???
- “Hysteroscopic scissor, Hysteroscopic Endo Operative System (HEOS), MyoSure
Hysteroscopic Tissue Removal System and bipolar electrosurgical instrument using isotonic
distension have been introduced since 2017. Patients underwent inpatient hysteroscopic surgical
procedures using isotonic distension media or hysteroscopic examinations were not recruited
in this study. This section is very confusing and need elaboration (you recruited records since
2015, change the procedure in 2017????).
Statistical analysis:
- Define how did you handle the data, how many elements were missed, the state of completeness
of the data-base etc.,
Results:
- In all tables add footnote to mention abbreviations and symbols
- Table 1: replace type of procedures (should be above the procedures) and replace it with
patients’ characteristics.
- Were there any patients with multiple procedures
- What were the pre-procedure patients’ conditions (chronic morbidities- previous surgery, renal
or other confounding element)?
- Collapse your patients into those affected and those who were not and try to find what possible
risk factor attributing to the complications following the procedures??
- In table 1: the number of clinical consequences????
- Table 3 is not very informative, use graph instead?
Discussion:
- Very lengthy with repletion of the results section
Conclusion section should be added after mention the limitation statement.
Reference
- Please check (pretty old reference) “Russell Macdonald, Albert Singer.Endometrial resection
and fluid absorption.Lancet.1989;2(8676):1387-1388.