Hysteroscopy Newsletter
is an opened forum to all
professionals who want
to contribute with their
knowledge and even
share their doubts with a
word-wide gynecological
community
This document discusses ovulation induction using gonadotropin preparations. It outlines the different types of gonadotropins including human menopausal gonadotropins (hMG), urofollitropin, highly purified FSH, and recombinant gonadotropins. The main indications for gonadotropin use are hypogonadotropic hypogonadism, clomiphene-resistant anovulation, unexplained infertility, and elderly patients. Various protocols are described such as step-up, step-down, chronic low-dose, and fixed dose regimens. Complications include ovarian hyperstimulation syndrome. The document recommends that gonadotropins only be used by
MANAGEMENT OF POOR RESPONDERS IN IVF BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of poor responders to ovarian stimulation. It defines poor responders according to the Bologna criteria as having two of the following: advanced age, a previous poor response, or abnormal biomarkers of ovarian reserve. It identifies various risk factors for poor response and stresses the importance of predicting response before treatment. It then discusses individualized controlled ovarian stimulation, including increasing gonadotropin doses, modifying GnRH analog protocols, using GnRH antagonists, and supplementing with growth hormone, estradiol, recombinant LH, and androgens to potentially improve outcomes for poor responders.
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESAboubakr Elnashar
This document discusses different methods for endometrial preparation in frozen embryo transfer (FET) cycles. It describes natural cycle FET, which can be done through a true natural cycle or modified natural cycle with an HCG trigger. It also outlines artificial/hormone replacement cycle FET, where estrogen and progesterone are administered without GnRH agonists in patients with remaining ovarian function. The key points are that the endometrium must be adequately prepared prior to embryo transfer, and the age of the embryos after thawing should correspond to the developmental age of the endometrium. The best method varies between patients and there is no clear consensus.
Luteal phase support in ART Cases Dr Sharda Jain Lifecare Centre
The document discusses luteal phase support in assisted reproductive technology (ART) cycles. It provides 3 key points:
1. Luteal phase deficiency is common in ART cycles due to multiple factors like multifollicular development and aspiration of granulosa cells, leading to premature luteolysis and defective progesterone secretion.
2. Progesterone supplementation is important for luteal phase support as progesterone prepares the endometrium, decreases uterine contractility, and regulates immunity - all of which are important for embryo implantation and maintenance of early pregnancy.
3. Oral dydrogesterone is recommended for luteal phase support in ART cycles due to its greater bioavailability allowing the use of lower doses, minimal side effects
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...DR SHASHWAT JANI
This document discusses optimizing success with intrauterine insemination (IUI). It lists male and female factors that can indicate IUI, including issues like retrograde ejaculation or cervical hostility. Standard protocols for IUI are discussed, including using clomiphene, gonadotropins, or a combination. The timing of hCG administration and IUI is outlined. Techniques for sperm preparation and factors affecting IUI success rates are also summarized. Limitations of IUI are noted.
Deck on current treatment approaches in endometriosis (PART II) Dr Jyoti AgAR...Lifecare Centre
Dydrogesterone is proposed as a new treatment for endometriosis. It effectively tackles chronic inflammation associated with endometriosis by reducing proinflammatory cytokines and increasing progesterone receptor expression. Clinical evidence shows that dydrogesterone provides symptomatic relief for endometriosis-related pain and improves quality of life. It also reduces the development of new endometriotic lesions and induces atrophy of ectopic endometrial tissue. Unlike other medications, dydrogesterone does not inhibit ovulation or require estrogen add-back therapy, and it may improve pregnancy outcomes for women with endometriosis.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
This document discusses ovulation induction using gonadotropin preparations. It outlines the different types of gonadotropins including human menopausal gonadotropins (hMG), urofollitropin, highly purified FSH, and recombinant gonadotropins. The main indications for gonadotropin use are hypogonadotropic hypogonadism, clomiphene-resistant anovulation, unexplained infertility, and elderly patients. Various protocols are described such as step-up, step-down, chronic low-dose, and fixed dose regimens. Complications include ovarian hyperstimulation syndrome. The document recommends that gonadotropins only be used by
MANAGEMENT OF POOR RESPONDERS IN IVF BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of poor responders to ovarian stimulation. It defines poor responders according to the Bologna criteria as having two of the following: advanced age, a previous poor response, or abnormal biomarkers of ovarian reserve. It identifies various risk factors for poor response and stresses the importance of predicting response before treatment. It then discusses individualized controlled ovarian stimulation, including increasing gonadotropin doses, modifying GnRH analog protocols, using GnRH antagonists, and supplementing with growth hormone, estradiol, recombinant LH, and androgens to potentially improve outcomes for poor responders.
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESAboubakr Elnashar
This document discusses different methods for endometrial preparation in frozen embryo transfer (FET) cycles. It describes natural cycle FET, which can be done through a true natural cycle or modified natural cycle with an HCG trigger. It also outlines artificial/hormone replacement cycle FET, where estrogen and progesterone are administered without GnRH agonists in patients with remaining ovarian function. The key points are that the endometrium must be adequately prepared prior to embryo transfer, and the age of the embryos after thawing should correspond to the developmental age of the endometrium. The best method varies between patients and there is no clear consensus.
Luteal phase support in ART Cases Dr Sharda Jain Lifecare Centre
The document discusses luteal phase support in assisted reproductive technology (ART) cycles. It provides 3 key points:
1. Luteal phase deficiency is common in ART cycles due to multiple factors like multifollicular development and aspiration of granulosa cells, leading to premature luteolysis and defective progesterone secretion.
2. Progesterone supplementation is important for luteal phase support as progesterone prepares the endometrium, decreases uterine contractility, and regulates immunity - all of which are important for embryo implantation and maintenance of early pregnancy.
3. Oral dydrogesterone is recommended for luteal phase support in ART cycles due to its greater bioavailability allowing the use of lower doses, minimal side effects
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...DR SHASHWAT JANI
This document discusses optimizing success with intrauterine insemination (IUI). It lists male and female factors that can indicate IUI, including issues like retrograde ejaculation or cervical hostility. Standard protocols for IUI are discussed, including using clomiphene, gonadotropins, or a combination. The timing of hCG administration and IUI is outlined. Techniques for sperm preparation and factors affecting IUI success rates are also summarized. Limitations of IUI are noted.
Deck on current treatment approaches in endometriosis (PART II) Dr Jyoti AgAR...Lifecare Centre
Dydrogesterone is proposed as a new treatment for endometriosis. It effectively tackles chronic inflammation associated with endometriosis by reducing proinflammatory cytokines and increasing progesterone receptor expression. Clinical evidence shows that dydrogesterone provides symptomatic relief for endometriosis-related pain and improves quality of life. It also reduces the development of new endometriotic lesions and induces atrophy of ectopic endometrial tissue. Unlike other medications, dydrogesterone does not inhibit ovulation or require estrogen add-back therapy, and it may improve pregnancy outcomes for women with endometriosis.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
This document discusses new frontiers in the management of endometriosis. It provides background on the history and diagnosis of endometriosis. Pain and infertility are identified as the main clinical features. Diagnosis involves ultrasound, MRI, laparoscopy and the Endometriosis Fertility Index staging system. Current medical treatment options discussed include NSAIDs, estro-progestins, progestins, danazol, and gonadotropin-releasing hormone analogues. Investigational options mentioned are aromatase inhibitors, anti-angiogenic drugs, and immunomodulators. The ideal treatment is described as one that is curative, treats both pain and fertility, and has an acceptable safety profile.
Dr. Sujoy Dasgupta is a reproductive medicine specialist who has extensive training and experience in India and abroad. He lists his qualifications and areas of practice. The document then discusses limitations of the 2010 WHO semen analysis guidelines, significance of sperm DNA fragmentation testing, definitions of mild and severe male factor infertility, and investigations and treatment approaches for various causes of male infertility including varicocele, congenital bilateral absence of vas deferens, cryptorchidism, hormonal abnormalities, and azoospermia. Key advice includes thorough evaluation and evidence-based therapies over long-term use of unproven drugs, and considering sperm retrieval and assisted reproduction rather than assuming donor sperm is the only option.
Optimal endometrial preparation for frozen embryo transfer cyclesnermine amin
This document discusses optimal endometrial preparation for frozen embryo transfer (FET) cycles. It describes different preparation protocols including natural, modified natural, and programmed artificial cycles. Programmed cycles use estrogen and progesterone supplementation to prepare the endometrium. The document emphasizes identifying the receptive implantation window and the importance of progesterone support. Personalizing FET timing based on endometrial development and reducing uterine contractions with progesterone can improve pregnancy rates. With advances in cryopreservation, FET cycles now often match or exceed the success of fresh cycles.
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 )Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 ) MODERATOR
DR SHARDA JAIN
DR ILA GUPTA
DR DIPTI NABH
panelist
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain Lifecare Centre
Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of remaining eggs. It can be caused by factors like advanced age, chemotherapy, genetics, and lifestyle. Ovarian reserve tests assess markers like antral follicle count, anti-Mullerian hormone, and follicle-stimulating hormone to predict ovarian response. A combination of biochemical tests is effective for predicting diminished ovarian reserve. When test results indicate poor ovarian reserve, treatment options include protocols using gonadotropins, letrozole, or dehydroepiandrosterone to potentially increase live birth rates from in vitro fertilization.
This document describes various ovarian stimulation protocols for infertility treatment, including oral medications, injectable medications, and monitoring techniques. It summarizes protocols for natural cycles, mild stimulation, conventional stimulation, antagonist protocols, and protocols for poor responders. Key points include the use of clomiphene citrate, gonadotropins like hMG and rFSH, protocols with and without downregulation, monitoring with ultrasound and hormones, and tailoring the protocol based on ovarian reserve and previous response. The goal is to recruit multiple follicles for retrieval while avoiding overstimulation and maintaining endometrial receptivity.
Advancements in the Medical Management of Male InfertilitySandro Esteves
This document summarizes a presentation on male infertility conditions and their medical treatment. It discusses conventional treatments such as treating subclinical genital tract infections with antibiotics. It also discusses novel treatments such as using recombinant human chorionic gonadotropin (hCG) to restore spermatogenesis in men with hypogonadotropic hypogonadism. Additionally, it outlines how excessive oxidative stress and obesity-related factors can cause male infertility and the treatments available to address these, including the use of antioxidants and anastrozole. The document provides an overview of medical treatments for specific male infertility conditions.
Thin Endometrium & Infertility(Part – I) , Dr. Sharda Jain , Life Care Centre Lifecare Centre
The document summarizes key aspects of the endometrium and its role in fertility. It discusses how the endometrium undergoes cycles of regeneration each month in preparation for implantation. A thin endometrium can impair implantation and cause infertility. Various factors like clomiphene citrate use, reduced blood flow, polycystic ovarian syndrome, and endometritis may contribute to a thin endometrium. Evaluating the endometrium through ultrasound and hysteroscopy is important for infertility workup and treatment. Managing a thin endometrium remains a challenge in treating infertility.
This document discusses different types of ovarian stimulation and anovulation. It describes four types of anovulation classified by the WHO and treatments for each. It covers controlled ovarian stimulation, types of gonadotropins used for stimulation including urinary and recombinant preparations, and protocols for use of clomiphene citrate, aromatase inhibitors, metformin, and gonadotropins in treatment. Adjuvant treatments to improve outcomes with clomiphene citrate are also discussed.
Ovarian Stimulation in IUI- Overview. Dr. jyoti Bhaskar, Dr. Sharda Jain, Dr....Lifecare Centre
The document discusses ovarian stimulation protocols for IUI. It describes the rationale for controlled ovarian hyperstimulation in IUI as increasing the number of eggs available for fertilization and overcoming subtle defects in ovulation. The optimal stimulation is described as achieving 2-3 follicles 18-20mm in size with a thick trilaminar endometrium. Clomiphene citrate, tamoxifen, and various gonadotropins are discussed as drugs used for ovarian stimulation for IUI. Low dose gonadotropin protocols are recommended to increase success rates while minimizing risks of multiples and OHSS.
This document provides biographical information about Dr. Narendra Malhotra, an obstetrician and gynecologist from India. It lists his professional roles and accomplishments, which include being president of FOGSI, dean of ICMU, director of the Ian Donald School of Ultrasound, and editor of several medical books and journals. It also provides contact information for Malhotra Hospitals in Agra, India, where Dr. Malhotra practices and serves as a consultant for IVF procedures in several other cities.
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Hysteroscopy Newsletter is an opened forum to all professionals who want to contribute with their knowledge and even share their doubts with a word-wide gynecological community
Hysteroscopy Newsletter is an opened forum to all professionals who want to contribute with their knowledge and even share their doubts with a word-wide gynecological
community
This document discusses new frontiers in the management of endometriosis. It provides background on the history and diagnosis of endometriosis. Pain and infertility are identified as the main clinical features. Diagnosis involves ultrasound, MRI, laparoscopy and the Endometriosis Fertility Index staging system. Current medical treatment options discussed include NSAIDs, estro-progestins, progestins, danazol, and gonadotropin-releasing hormone analogues. Investigational options mentioned are aromatase inhibitors, anti-angiogenic drugs, and immunomodulators. The ideal treatment is described as one that is curative, treats both pain and fertility, and has an acceptable safety profile.
Dr. Sujoy Dasgupta is a reproductive medicine specialist who has extensive training and experience in India and abroad. He lists his qualifications and areas of practice. The document then discusses limitations of the 2010 WHO semen analysis guidelines, significance of sperm DNA fragmentation testing, definitions of mild and severe male factor infertility, and investigations and treatment approaches for various causes of male infertility including varicocele, congenital bilateral absence of vas deferens, cryptorchidism, hormonal abnormalities, and azoospermia. Key advice includes thorough evaluation and evidence-based therapies over long-term use of unproven drugs, and considering sperm retrieval and assisted reproduction rather than assuming donor sperm is the only option.
Optimal endometrial preparation for frozen embryo transfer cyclesnermine amin
This document discusses optimal endometrial preparation for frozen embryo transfer (FET) cycles. It describes different preparation protocols including natural, modified natural, and programmed artificial cycles. Programmed cycles use estrogen and progesterone supplementation to prepare the endometrium. The document emphasizes identifying the receptive implantation window and the importance of progesterone support. Personalizing FET timing based on endometrial development and reducing uterine contractions with progesterone can improve pregnancy rates. With advances in cryopreservation, FET cycles now often match or exceed the success of fresh cycles.
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 )Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 ) MODERATOR
DR SHARDA JAIN
DR ILA GUPTA
DR DIPTI NABH
panelist
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain Lifecare Centre
Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of remaining eggs. It can be caused by factors like advanced age, chemotherapy, genetics, and lifestyle. Ovarian reserve tests assess markers like antral follicle count, anti-Mullerian hormone, and follicle-stimulating hormone to predict ovarian response. A combination of biochemical tests is effective for predicting diminished ovarian reserve. When test results indicate poor ovarian reserve, treatment options include protocols using gonadotropins, letrozole, or dehydroepiandrosterone to potentially increase live birth rates from in vitro fertilization.
This document describes various ovarian stimulation protocols for infertility treatment, including oral medications, injectable medications, and monitoring techniques. It summarizes protocols for natural cycles, mild stimulation, conventional stimulation, antagonist protocols, and protocols for poor responders. Key points include the use of clomiphene citrate, gonadotropins like hMG and rFSH, protocols with and without downregulation, monitoring with ultrasound and hormones, and tailoring the protocol based on ovarian reserve and previous response. The goal is to recruit multiple follicles for retrieval while avoiding overstimulation and maintaining endometrial receptivity.
Advancements in the Medical Management of Male InfertilitySandro Esteves
This document summarizes a presentation on male infertility conditions and their medical treatment. It discusses conventional treatments such as treating subclinical genital tract infections with antibiotics. It also discusses novel treatments such as using recombinant human chorionic gonadotropin (hCG) to restore spermatogenesis in men with hypogonadotropic hypogonadism. Additionally, it outlines how excessive oxidative stress and obesity-related factors can cause male infertility and the treatments available to address these, including the use of antioxidants and anastrozole. The document provides an overview of medical treatments for specific male infertility conditions.
Thin Endometrium & Infertility(Part – I) , Dr. Sharda Jain , Life Care Centre Lifecare Centre
The document summarizes key aspects of the endometrium and its role in fertility. It discusses how the endometrium undergoes cycles of regeneration each month in preparation for implantation. A thin endometrium can impair implantation and cause infertility. Various factors like clomiphene citrate use, reduced blood flow, polycystic ovarian syndrome, and endometritis may contribute to a thin endometrium. Evaluating the endometrium through ultrasound and hysteroscopy is important for infertility workup and treatment. Managing a thin endometrium remains a challenge in treating infertility.
This document discusses different types of ovarian stimulation and anovulation. It describes four types of anovulation classified by the WHO and treatments for each. It covers controlled ovarian stimulation, types of gonadotropins used for stimulation including urinary and recombinant preparations, and protocols for use of clomiphene citrate, aromatase inhibitors, metformin, and gonadotropins in treatment. Adjuvant treatments to improve outcomes with clomiphene citrate are also discussed.
Ovarian Stimulation in IUI- Overview. Dr. jyoti Bhaskar, Dr. Sharda Jain, Dr....Lifecare Centre
The document discusses ovarian stimulation protocols for IUI. It describes the rationale for controlled ovarian hyperstimulation in IUI as increasing the number of eggs available for fertilization and overcoming subtle defects in ovulation. The optimal stimulation is described as achieving 2-3 follicles 18-20mm in size with a thick trilaminar endometrium. Clomiphene citrate, tamoxifen, and various gonadotropins are discussed as drugs used for ovarian stimulation for IUI. Low dose gonadotropin protocols are recommended to increase success rates while minimizing risks of multiples and OHSS.
This document provides biographical information about Dr. Narendra Malhotra, an obstetrician and gynecologist from India. It lists his professional roles and accomplishments, which include being president of FOGSI, dean of ICMU, director of the Ian Donald School of Ultrasound, and editor of several medical books and journals. It also provides contact information for Malhotra Hospitals in Agra, India, where Dr. Malhotra practices and serves as a consultant for IVF procedures in several other cities.
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Hysteroscopy Newsletter is an opened forum to all professionals who want to contribute with their knowledge and even share their doubts with a word-wide gynecological community
Hysteroscopy Newsletter is an opened forum to all professionals who want to contribute with their knowledge and even share their doubts with a word-wide gynecological
community
Now available a new issue !!
Hysteroscopy and cystic adenomyosis, interview with Prof. Osama Shawki, Tamoxifen and hysteroscopy, Postmenstrual vaginal bleeding, endoscopycongress, new devices, and much more
This study compared the effectiveness and safety of bipolar energy system (Versapoint) versus diode laser for outpatient hysteroscopic polypectomy. The study found that both techniques were effective for removing endometrial polyps, though the bipolar energy system was associated with less pain and required less time to perform the procedure. Overall, the bipolar energy system and diode laser were both found to be good options for performing outpatient hysteroscopic polypectomy.
A new number of this Newsletter about Hysteroscopy. Interview with Stefano Bettocchi to know more about the vaginoscopic approach. Endometrial Polyps, Should they always be removed?. Do you know what's an amniotic sheet?. Techniques for in-office myomectomy, Hydrosalpinx before IVF and some information about the global congress on hysteroscopy. Enjoy this latest issue!!!
Hysteroscopy Newsletter 4th Issue online!!!
Dear colleagues,
We are pleased to inform you that the fourth issue of our publication is ready and available for you to enjoy. We hope that our great enthusiasm and eagerness for a better knowledge of hysteroscopy, will make reading this journal arouse your interest in this fascinating field. Hysteroscopy Newsletter is an opened forum to all professionals who want to contribute with their knowledge and even share their doubts with a word-wide gynecological community.
SHARE & ENJOY IT !!!!!!
http://www.hysteroscopy.info/
Hysteroscopy Newsletter is an opened forum to all professionals who want to contribute with their knowledge and even share their doubts with a word-wide gynecological
community
The document discusses the evolution of hysteroscopic techniques from the 1990s with the development of miniaturized hysteroscopes, allowing for outpatient procedures without anesthesia. It notes that this "see and treat" approach has become standard for gynecologists worldwide and has led to clearer reductions in patient discomfort and recovery time compared to previous resectoscopic procedures. The article also addresses ongoing issues like the need for proper training and barriers like equipment costs that have limited more widespread adoption of these office hysteroscopic techniques.
Now available a new issue !!
Hysteroscopy and reproduction, The HOME-DU technique, devices, interview with Rudi Campo talking about his new TROPHY hysteroscope, the resident's corner, hysteroscopy for beginners, endometrial assessment prior to fertility treatments, review of unicornuate uterus, and much more...
Dear colleagues,
We are pleased to inform you that the third issue of our publication is ready and available for you to enjoy. We hope that our great enthusiasm and eagerness for a better knowledge of hysteroscopy, will make reading this journal arouse your interest in this fascinating field. Hysteroscopy Newsletter is an opened forum to all professionals who want to contribute with their knowledge and even share their doubts with a word-wide gynecological community.
SHARE & ENJOY IT !!!!!!
Hysteroscopy Newsletter
is an opened forum to all
professionals who want
to contribute with their
knowledge and even
share their doubts with a
word-wide gynecological
community
This document summarizes an interview with Dr. Ivan Mazzon, head of the Endoscopic Centre "Arbor Vitae" in Rome, about his "cold loop" hysteroscopic myomectomy technique. Dr. Mazzon was the first to use the term "cold loop myomectomy" and his technique involves using mechanical loops instead of electrified loops to detach the intramural component of fibroids, avoiding thermal injury to tissues. The main advantages are preservation of tissues, elimination of perforation risk, reduced bleeding and adhesions. While initially known only in Italy, interest in the technique is growing internationally as Dr. Mazzon publishes on it in medical journals.
This document summarizes an interview with Dr. Amy Garcia regarding her approach to diagnosing and managing cesarean scar defects (CSDs). Some key points:
- Dr. Garcia prefers office hysteroscopy to initially diagnose CSDs due to her experience performing many diagnostic hysteroscopic procedures.
- For diagnosis, she uses a flexible 3mm hysteroscope for most patients and a 4mm flexible digital hysteroscope for parous patients.
- For asymptomatic patients, no intervention is needed. For symptomatic patients, she may recommend birth control or an IUS to reduce bleeding or hysteroscopic resection of the defect.
- For patients wanting future fertility, laparoscopic repair of the lower uterine
1) Anaesthesiology has a key role in patient safety for surgical procedures and other vulnerable situations. Around 230 million patients undergo anaesthesia yearly, with 7 million developing complications and 1 million dying.
2) Leaders in anaesthesiology societies agree that patients have a right to safe care. Key goals include endorsing international safety standards, educating patients, providing appropriate resources, improving education, and developing safe drugs and equipment.
3) Specific aims are that all institutions providing anaesthesia comply with monitoring standards, have safety protocols, comply with sedation standards, support the WHO checklist, collect safety data, and contribute to audits and reporting.
This document provides information about a book titled "Gland-Preserving Salivary Surgery: A Problem-Based Approach". It includes a foreword describing the development and importance of minimally invasive and gland-preserving treatments for salivary gland diseases. It also lists the editors of the book and their contributions to advancing techniques like sialendoscopy. The book provides a comprehensive overview of modern diagnostic and treatment methods for salivary gland disorders from experienced clinicians.
Cervical Cancer Prevention UPDATE ON H.P.V. vaccinationNavneet Upadhyay
Cervical cancer is caused by HPV infection and is a major public health problem in India. Screening through Pap smears and HPV testing can detect pre-cancerous lesions early when treatment is most effective. Vaccination helps prevent HPV infection and therefore reduces the risk of developing cervical cancer. While most cases can be treated if detected early, late stage cervical cancer has a poorer prognosis emphasizing the need for widespread screening programs in India.
Similar to Hysteroscopy newsletter vol 3 issue 1 english (20)
Hysteroscopy Newsletter is an opened forum to all professionals who want to contribute with their knowledge and even share their doubts with a word-wide gynecological
community
El síndrome de sobrecarga hídrica es una entidad poco frecuente causada por la ingesta excesiva de agua que puede provocar hiponatremia e hipoosmolaridad. Se presenta típicamente en personas que beben grandes cantidades de agua durante ejercicio físico o competiciones deportivas. La fisiopatología se debe a la dilución excesiva de los electrolitos en el plasma sanguíneo, especialmente del sodio. Los síntomas incluyen náuseas, vómitos, cefalea, confusión y
El documento describe un número de una revista dedicada a la histeroscopia. Incluye varios artículos sobre temas de histeroscopia como pólipos tubáricos, una entrevista con un experto en histeroscopia y una descripción del Primer Congreso Global sobre Histeroscopia. El documento también promueve un nuevo libro atlas sobre histeroscopia que contiene capítulos escritos por expertos de todo el mundo.
Hysteroscopy Newsletter
is an opened forum to all
professionals who want
to contribute with their
knowledge and even
share their doubts with a
word-wide gynecological
community
Hysteroscopy Newsletter
is an opened forum to all
professionals who want
to contribute with their
knowledge and even
share their doubts with a
word-wide gynecological
community
Este número de la revista incluye una entrevista con Giampietro Gubbini, experto en histeroscopia que ha desarrollado un miniresectoscopio de 16 Fr. que permite realizar procedimientos histeroscópicos sin necesidad de dilatación cervical. También contiene artículos sobre polipectomía histeroscópica con diferentes técnicas y sobre el síndrome de Asherman. Finalmente, anuncia un próximo congreso mundial de histeroscopia.
Un nuevo número de este Newsletter sobre histeroscopia. Entrevista con Stefano Bettocchi para saber más sobre el abordaje por vaginoscopia. Pólipos de endometrio, ¿deberían siempre ser extirpados?. ¿Sabes lo que es una sabana amniótica?. Las técnicas para la miomectomía in-office, Hidrosalpinx antes de la FIV y alguna información sobre el Global Congress on Hysteroscopy. Disfruta de este último número !!!
Nuevo numero de la revista Hysteroscopy Newsleter. ¿Quieres saber mas sobre la adenomiosis quística?. Entrevista con el Prof. Osama Shawki, Tamoxifeno e histeroscopia. Metrorragia postmenopausica
Nuevo número de la revista sobre histeroscopia. En este número se incluye una entrevista a Rudi Campo, expresidente de la ESGE, Se habla sobre la cirugía de los úteros dismórficos. Útero unicorne y mucho, mucho más
Hysteroscopy Newsletter, nuevo número disponible.
Recuerda que este es un foro abierto a todos los profesionales interesados en el estudio y difusión de la histeroscopia.
Quinto número de la revista "Hysteroscopy newsletter" Primera revista internacional publicada en español e inglés sobre todo lo relacionado con el mundo de la histeroscopia
Cuarto número de la revista "Hysteroscopy newsletter" Primera revista internacional publicada en español e inglés sobre todo lo relacionado con el mundo de la histeroscopia
Tercer número de la revista "Hysteroscopy newsletter" Primera revista internacional publicada en español e inglés sobre todo lo relacionado con el mundo de la histeroscopia
1) El documento describe la evolución de la histeroscopia desde los años 90 con el desarrollo de ópticas miniaturizadas y histeroscopios quirúrgicos de 5 mm, lo que permitió procedimientos ambulatorios sin anestesia. 2) Gracias al uso de instrumentos mecánicos de 5 Fr y electrodos, se puede tratar una mayor patología intrauterina. 3) El número de ginecólogos que trata a pacientes de forma ambulatoria sigue siendo bajo, debido al costo del equipo y la necesidad de personal capacitado
Hysteroscopy Newsletter es un espacio de debate abierto a todos los profesionales que quieran aportar sus conocimientos e incluso sus dudas. Hysteroscopy Newsletter es una ventana abierta al mundo de la histeroscopia. En definitiva se trata de una publicación realizada por ginecólogos para ginecólogos.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Hysteroscopy newsletter vol 3 issue 1 english
1. +
www.hysteroscopy.info
1
INSIDE THIS ISSUEI
Welcome 1
Histeroscopy Pictures 2
Cervical Stump
Interview of the month 3
Alka Kumar
Brief Review 6
Endometrial cancer
Conundrums 11
Postmenopausal bleeding
Original Article 14
Progress in Hysteroscopy
Global Congress on 16
Hysteroscopy
Hysteroscopy Devices 18
RESECTR
Debate 20
Uniform report system
Ichnandy Arief Rachman
Jan-Feb 2017 | vol. 3 | issue 1
ndonesia is a big country, it’s the fourth populated country in the world and is number
fifteenth of the largest country in the world. We have roughly 70 Millions Female in
reproductive age, but less than 20 percent of our Gynecologist are competence in
Hysteroscopy and laparoscopy. So many colleagues of mine still doing blind D & C.
Our introduction with endoscopy start in the late 80’s when Prof Ichramsjah is coming
back from England (with Jeffcoate) and bring one Wisap full laparoscopic hysteroscopic
tower and instrument. And in early 90’s, Prof Jacob have opportunity to study in German
(with Kurt Semm) and also to Brussels (with Jacques Donnez). After his return to
Indonesia many Indonesian OG learn this technique for the first time from them. Since
then many Indonesian gyne went to Leuven (with Jacques Donnez) and some to Nashville
(with James Daniell) in the late 90’s.
It was not until the year 2000 when IGES (Indonesian Gynecology Endoscopy Society)
formed in Bali with the inniative from Prof Wachyu, Prof Duddy, Prof Hadibroto, dr Nadir
Chan (sponsored by Anastasia `Ussia and Koninckx Phillipe). But still gynecology
endoscopy is not in the Indonesian Obstrician Gynecologist program Curiculum until
2009. With so many Island to cover it’s quite difficult to introduce gynecology endoscopy
through out the nation. IGES first training center in the university hospital was conducted
by Prof Wachyu at first National Hospital, Raden Saleh Building – University of Indonesia.
Back then it’s more into hysteroscopy diagnostic and laparoscopy operative, the
development of operative hysteroscopy expand more in the private sector but not in the
university teaching hospital.
Second generation gyne endoscopist, emerged after the first IGES National Congress in
Jakarta in 2009. Have met famous names like Hugo Verhoeven, Hans Tinneberg etc
encourage most of us seeking scholarship abroad. With Scholarship from the Dutch
School of Gynecologie en pelvic surgery I was with Marlies Bongers and Andreas
Thurkow in Holland, while my other colleague Anggie with Sebastiaan Veersema, Herbert
went to Clermont Ferranc, Lucky went to KK Hospital and Ferdhi practically graduated
from Germany. Together all of us together with Prof Wachyu, Prof Jacoeb, dr Nadir etc
started to give basic office hysteroscopy and operative workshop on National Obstrician
Gynecology Meeting or IGES Congress.
Many of the new technique are do able, but regarding expense and cost it is still problem
to spread the technique during OG registar program. Among 12 `IGES training center we
have today, only 2 center at the teaching hospital who has complete facility for Office and
Operative Hysteroscopy (outpatient and theatre patient setting). One is at the private
patient sector on first National Hospital and the other one is at my center at the public
patient sector on The presidential Hospital – Indonesia Army Central Hospital Gatot
Soebroto.
As the Course Director for IGES Training Center at The
presidential Hospital – Indonesia Army Central Hospital and on
behalf of the IGES I look forward for the event in Barcelona this
May 2017. Many of us want to come there to learn and to share
our experience. See you in Barcelona !!
2. TEAM COODINATOR
SPAIN
L. Alonso
EDITORIAL COMMITTEE
SPAIN
E. Cayuela
L. Nieto
ITALY
G. Gubbini
A. S. Laganà
USA
J. Carugno
L. Bradley
MEXICO
J. Alanis-Fuentes
PORTUGAL
J. Metello
ARGENTINA
A. M. Gonzalez
VENEZUELA
J. Jimenez
SCIENTIFIC
COMMITTEE
A. Tinelli (Ita)
O. Shawki (Egy)
A. Úbeda (Spa)
A. Arias (Ven)
M. Rodrigo (Spa)
A. Di Spiezio Sardo (Ita)
E. de la Blanca (Spa)
A. Favilli (Ita)
M. Bigozzi (Arg)
S. Haimovich (Spa)
R. Lasmar (Bra)
A. Garcia (USA)
N. Malhotra (Ind)
J. Dotto (Arg)
I. Alkatout (Ger)
R. Manchanda (Ind)
M. Medvediev (Ukr)
M. Elessawy (Ger)
All rights reserved.
The responsibility of the signed
contributions is primarily of the authors
and does not necessarily reflect the views
of the editorial or scientific committees.
HYSTEROSCOPY
PICTURES
www.hysteroscopy.info
2
The debate about whether supracervical hysterectomy, when performed for benign
conditions, has benefits over a total hysterectomy, remains open. There are many
arguments both for and against performing a supracervical hysterectomy.
Among the different arguments presented, it is clearly demonstrated by different
studies that a supracervical hysterectomy involves shorter surgical time, associated
lower blood loss and faster postoperative recovery. It has also been argued that
preservation of the cervical stump has positive implications in the sexual response as
well as favors the support of the pelvic floor and urinary function, although the latter is
yet to be confirmed.
It is clear that the main difference between one technique and the other lies in the
preservation of the cervical stump and in possible problems associated with it. These
include the development of cervical cancer in the remaining cervix that is estimated to
occur in less than 1% of patients. The other associated problem is persistent cyclic
menstrual bleeding after surgery, this happens between 0% and 25% of cases
according to the different series.
If you are interested in sharing your cases or have a hysteroscopy image that
you consider unique and want to share, send it to hysteronews@gmail.com
Superficial vaginal
endometriotic implant
Fibrous tissue / whitish
fibrous scar tissue
Detail of the cervical stump
Jan-Feb 2017 | vol. 3 | issue 1
3. 3
www.hysteroscopy.info
INTERVIEW WITH...
Consultant hysteroscopic surgeon and inventor. Two different
facets of her passion about hysteroscopy. Her main interest is in
the field of 'Fluid management Systems' for endoscopic surgery.
Alka Kumar
Director Women's Health
Centre, Vaishali Nagar
Consultant Hysteroscopic
Surgeon at Anil Nursing Home
Jaipur, India
How has hysteroscopy developed in India in the last years ?
In the last 20 years, hysteroscopy has grown much in India and
developed its own place. It seems now it is in a groove and has a niche
for itself. We are having dedicated hysteroscopy workshops, conferences
and congresses. Alongside there are a lot of young gynecologists who
have developed a great interest in the subject.
We have had new developments from our country in hysteroscopy as
fluid management systems and newer morcellators. There are many
publications in hysteroscopy from India amongst which we are on the
cover pages of reputed journals like Fertility & Sterility, JMIG and IJOG.
You’re an expert in hysteroscopy and TBC. Whats your reflection
about genital TBC?
Unlike the western countries endometrial TB is rampant in India with
newer cases emerging each day. It is one of the leading causes of
primary infertility, secondary infertility and asherman. Endometrial TB is
usually a continuation of abdominal TB with the tubes and ostia involved
in many cases. Genital TB often presents itself with no clinical features
other than infertility. The common sites of GTB are fallopian tubes 90-
100%, endometrium upto 50%, ovaries 10-30%, cervix vagina and vulva
are fairly uncommon. Hysteroscopy is a powerful tool in raising a strong
suspicion, and in diagnosing endometrial TB by evaluating endometrial
architecture and the appearances of the tubal ostia and finally confirming
the diagnosis by tests like DNA PCR and BACTEC for Acid Fast Bacili. A
detailed history especially related to TB is a must before taking up the
case for hysteroscopy. Disease pathology like adhesions need to be
corrected at the time of hysteroscopy. Severe cases of asherman
syndrome do not have a good prognosis in terms of achieving a
pregnancy even with ART procedures.
Once ATT is started it is very helpful to do a relook hysteroscopy after 6
months to see the efficacy of the chemotherapy and to evaluate the
endometrium regeneration.
”The common sites sites of GTB are fallopian tubes 90-100%,
endometrium upto 50%, ovaries 10-30%, cervix vagina
and vulva are fairly uncommon”
Flimsy adhesions with
attached granuloma
Bizarre endometrium
Jan-Feb 2017 | vol. 3 | issue 1
4. 4
www.hysteroscopy.info
Which are the hysteroscopic patterns of this disease ?
According to our data from 1992 to 2016 , we have encountered some specific hysteroscopic markers which
are common to cases of endometrial TB:
I) Bizzare endometrial character: where the endometrium loses its color, glands and starts to look dirty,
pale, white powdery nibbled, and has flimsy adhesions.
II) Granulomas or tubercles: They appear as small pale white irregular objects either on the endometrium
directly or attached to flimsy adhesion bands. The tubercles vary in size.
III) Adhesions: From flimsy adhesions to moderate to severe adhesion bands, and often when looked closely
these adhesions have tubercles /granulomas that look like whitish colored irregular deposits that are attached
on the adhesions. It is very important therefore to start doing hysteroscopy at very low flow rates so that the
deposits do not get washed away with continuous fluid irrigation.
IV) Tubal ostia: Tubal ostia are commonly involved in endometrial TB. The minor endosalpigean folds are
scarred, white, pale and usually devoid of the longitudionally arranged vascularity. The ostia usually do not
show the normal opening and closing physiological motion at lower intrauterine pressures. Flimsy large
adhesion bands may be seen surrounding the ostia. Sometimes the ostia are completely hidden behind
adhesions. Flimsy adhesions can also be seen in the intramural part of the ostia.
We know that you have a new hysteroscopy pump to monitor the real time rate of fluid intravasation.
Can you tell us some words about it and what’s your opinion about intrauterine pressure during
hysteroscopy ?
Our pump is based on a dual peristaltic pump patented technology. The pump continuously displays the real
time rate of fluid intravasation into the systemic circulation of the patient and it also displays the total fluid
deficit without any weight measurement. It is important to understand the differences between real time rate
of fluid intravasation and the total fluid as depicted in the table below:
” Intrauterine pressure during hysteroscopy is one of the
most important parameter in hysteroscopic surgery”
Jan-Feb 2017 | vol. 3 | issue 1
5. www.hysteroscopy.info
5
The pump gives a predictably constant visualization and desired mechanical distention at all points of time
during the surgery. The pump constantly displays the true intra uterine pressure at all points in surgery. Any
desired intrauterine pressure can be maintained for any desired uterine cavity flow rate since, pressure and
flow rate, are absolutely independent of each other. The pump helps in significantly reducing the learning
curve and increases the surgeon’s confidence.
Intrauterine pressure during hysteroscopy is one of the most important parameter in hysteroscopic surgery
because this parameter directly influences visualization, mechanical distension and fluid intravasation.
Intrauterine pressure has great significance in office hysteroscopy as it is directly related to the pain threshold
of the patient. Higher pressure may promote excess intravasation while lower pressure impairs visualization
and mechanical distension. Ideal intrauterine pressure will result in proper stable distension and visualization.
There will be predictable separation of the intrauterine walls, therefore resulting in lesser fluid absorptions.
How can we help to the promotion of the hysteroscopy ?
The youngsters should be encouraged to visit the OR and to assist the experienced surgeons. hands on
training with simulators should be undertaken as much as possible. Live operative workshops and
hysteroscopy conferences should be attended with full concentration by the learners.
The experienced surgeons must preserve a data bank of their videos and still images. Unedited videos are
perhaps more useful than their edited versions. Such videos and images shall help the learners in enhancing
their skills, shortening the learning curve, and in understanding the complications and their management in a
better manner. Data from surgeries must be meticulously preserved and tabulated so that more and more
publications are accomplished. Unusual images, cases and any complication should be reported for the benefit
of all.
Do you have any advise for the young physician who is starting out in the world of surgery ?
For starting in hysteroscopy it is very important that the young surgeon pays as much attention to the physics
of the instruments and devices he will be using for both hysteroscopy in the office and the OR set up.
Hysteroscopy involves a lot of instrumentation and energy sources. Understanding these will not only make
hysteroscopy easier but also safer.
The uterus is a collapsed cavity and requires distension for separation of the walls. It is this distension that
allows proper visualization. Therefore the significance of proper distension and intrauterine pressure has to be
understood. It is advisable to use a good fluid management system.
Take baby steps – start with simple diagnostic office hysteroscopy and then go on to moderate and difficult
procedures. There is a specific place of resectoscopy in hysteroscopy and that should be kept in mind while
learning the procedure. Always keep the fluid intravasation and balance in your mind, even while doing
simple procedures and above all, be mindful in the operating seat.
” Take baby steps – start with simple diagnostic office hysteroscopy
and then go on to moderate and difficult procedures.”
Jan-Feb 2017 | vol. 3 | issue 1
6. www.hysteroscopy.info
6
Endometrial cancer is the most common gynecological cancer in developed countries and is the 5th most
frequent cancer affecting woman. The estimated frequency is 19.1 / 100,000 cases in the USA and Canada
and 15.6 / 100,000 in Europe.
It is usually associated with menopause, although up to 14% of cases are diagnosed in premenopausal
women and up to 5% of cases in patients under the age of 40 years. It is usually diagnosed in early stages and
with the tumor usually confined to the uterine cavity, which generally gives it a good prognosis
The main risk factor is continued unopposed exposure to elevated estrogen levels. Among the different
causes related to endometrial cancer are:
1- Obesity: is present in 40-50% of endometrial carcinomas in developed countries. Obese women are 2-4
times more likely to develop endometrial cancer than non-obese women.
2- Unopposed estrogen therapy (UET). The use of UET greatly increases the formation of endometrial
hyperplasia and endometrial carcinoma. This risk increases in relation to the dose and duration of the
exposure. The administration of progesterone during HRT eliminates the risk of both endometrial hyperplasia
and carcinoma.
3- Tamoxifen: It is a selective estrogen receptor modulator (SERM) that is commonly used as an adjuvant
hormone treatment in women with breast cancer. The use of tamoxifen is associated with a 2-5-fold increased
risk of developing endometrial pathology, including polyps and endometrial cancer.
4- Hereditary: Endometrial carcinoma may appear in the context of a Lynch II syndrome or hereditary
colorectal cancer not associated with polyposis (HNPCC). It is an autonomic dominant disorder with
incomplete penetrance. Women with HNPCC have a risk of about 50% developing endometrial cancer.
Since the work of Bokhman, endometrial cancer has been divided histologically into two types, type I and
type II.
Brief Review
Endometrial Cancer
Jan-Feb 2017 | vol. 3 | issue 1
7. www.hysteroscopy.info
7
Type I: It represents 80% of the total of cases of endometrial cancer and corresponds to endometrioid
adenocarcinoma, so named because it histologically mimics the normal endometrium. There are several
subtypes such as villoglandular, secretory and ciliated cells.
Type II: Represents 20% of the total of cases of endometrial canecr. There are different histological
subtypes, being the papillary serous the most aggressive with invasion both to the myometrium and intra-
vascular space with consequent poor prognosis. The remaining histological subtypes such as clear cell,
mucinous, among other are less frequent.
The main symptom of presentation is abnormal uterine bleeding in 90% of cases. Endometrial
carcinoma should be suspected in patients with postmenopausal vaginal bleeding, postmenopausal
pyometra, and perimenopausal patients with increased intermenstrual bleeding.
Diagnostic hysteroscopy with targeted biopsy is currently the ideal method for the diagnosis of
endometrial cancer, reaching a sensitivity of almost 100%.
Osamu Sugimoto (Sugimoto, O. (1975). Hysteroscopic diagnosis of endometrial carcinoma A report of
fifty-three cases examined at the Women's Clinic of Kyoto University Hospital, American Journal of
Obstetrics and Gynecology, 121 (1), 105- 113) highlighted the role of hysteroscopy in the diagnosis of
endometrial carcinoma as well as in the assessment of extension and cervical involvement.
Sugimoto defined four hysteroscopic patterns of endometrial adenocarcinoma
1-Polypoid: With polypoid and histologically well
differentiated growth. The surface has few atypical
blood vessels and is usually whitish-grayish.
2-Nodular: Solid appearance with very marked
atypical vascularization and the existence of atypical
vessels in zigzag on the surface of the tumor.
3-Papillomatosis: is the most commonly pattern
present in more than 50% of patients with endometrial
carcinoma. Although of a nodular appearance, the
detailed examination reveals a surface covered with
numerous tentacle-like projections. Each projection is
composed of a blood vessel covered with cancerous
tissue.
4-Diffuse Carcinoma: When the entire endometrial
cavity is affected. Usually, this pattern is associated
with poorly differentiated carcinoma. Cases of
metastatic carcinoma usually present this pattern.
Another important factor to consider in the hysteroscopic assessment of endometrial carcinoma is the
determination of the existence of cervical involvement. The hysteroscopy allows to easily identify the
internal cervical os, which offers a great precision in the assessment of the extension towards the cervical
canal.
Jan-Feb 2017 | vol. 3 | issue 1
8. www.hysteroscopy.info
8
Dr. Francisco Coloma established another hysteroscopic morphological classification of endometrial
cancer (Coloma, F., Costa, S., Bartret, FB, Diago, VJ, Payá, V., Rodenas, JJ & Aguilar, JG (2006).
Morphological-hysteroscopic examination of endometrial cancer. Progress of Obstetrics and Gynecology,
49 (10), 553-559.) Based on the observation of 272 cases of patients with endometrial cancer. The
authors defined three patterns (pseudohyperplastic, nodular and malignant polyp) and an advanced sub-
pattern that can affect any of the three patterns.
1-Pseudohyperplastic: image similar to a "seaweed pattern", with individual papillae and vascularization
in each one of them. It is subdivided into focal, which appear as a plaque and diffuse, in which there is
extension of more than 50% of the endometrial surface.
2-Nodular: appears as compact nodules, attached to the endometrial wall. These nodules have aberrant
characteristic and atypical vascularization.
3-Malignant transformation of a polyp: endometrial polyps with signs of malignancy either total or
partial.
The three patterns represent an advanced sub-pattern with fibrin deposits and necrotic areas. In
addition, they frequently present with mucometra or pyometra.
It is interesting to note that in this study a comparison was made between the different hysteroscopic
patterns and the surgical stage of the disease. It was observed that the pseudohyperplastic pattern
without advanced signs is usually associated with earlier surgical stages, as is the case with the
malignant polypoid pattern. The nodular pattern without advanced features is usually associated with
intermediate stages Ib 54% and, finally, in the presence of an advanced sub-pattern, the surgical stage is
Ic or higher in 66% of cases, regardless of the initial pattern.
This same study correlated the hysteroscopic pattern with the
histological grade, noting that the pseudohyperplastic pattern is
usually associated with a well differentiated histological grade,
whereas a nodular pattern is usually associated with poorly
differentiated patterns.
Recently, Dr. Su Hsuan has published his observations on a
pattern called the "glomerular pattern" (Su, H., Pandey, D., Liu,
YY, CF, Wang, CJ, Huang, KG, & Lee, CL 2016) Pattern
Recognition to Prognosticate Endometrial Cancer: The Science
Behind the Art of Hysteroscopy-A Retrospective Study.
International Journal of Gynecological Cancer, 26 (4), 705-710).
The data presented in this study correlate this pattern with
tumors of high histological grade and with advanced disease.
It is necessary to unify these and other published
classifications to obtain a common classification, which will
serve as a basis for hysteroscopists and to correlate the
hysteroscopic image with the surgical and histological grade. It
is also necessary to establish a correct protocol for the
evaluation of endometrial cancer by hysteroscopy, taking into
account the images, directed biopsy and evaluation of the
possible involvement of the cervical canal.
Nodular pattern
Hysteroscopy Newsletter
Pseudohyperplastic pattern
Hysteroscopy Newsletter
Jan-Feb 2017 | vol. 3 | issue 1
9. www.hysteroscopy.info
9
Gel barriers have been proven to have a significant clinical effect
on IUA prevention (Level of evidence 1b)
The resectoscope was originally introduced into gynecologic
practice by Robert Neuwirth in 1978 for the excision of submucous
fibroids.
DID YOU KNOW...?
Jan-Feb 2017 | vol. 3 | issue 1
10. www.hysteroscopy.info
10
Answer to the previous issue:
Osseous metaplasia
Mastering the
Techniques in
Hysteroscopy
O. Shawki, S. Deshmukh
L. Alonso
Jaypee
Year 2017 774 pages
Includes Interactive DVD-ROM
This textbook is designed in such a
way that it gives complete knowledge
about the uterus, i.e. anatomy,
physiology, instruments and gadgets
and its applications along with the
current and recent advances in
hysteroscopy. There are many
sections in this book dedicated to
each problem, and various opinions
and methods to solve it by stalwarts in
hysteroscopy. It also includes the tips
and tricks to master hysteroscopy.
This book is blessed with many gifted
international as well as national
figures of India, who are specialized
in hysteroscopic surgeries.
Sometimes, when performing hysteroscopy, it is
important to pay attention to every corner of the
uterus, as Vasari stated «cerca trova», «he who
seeks finds»
WHAT'S YOUR
DIAGNOSIS?
Hysteroscopy Newsletter
Jan-Feb 2017 | vol. 3 | issue 1
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A recently published meta-analysis "The accuracy of endometrial sampling in women with postmenopausal
bleeding: a systematic review and meta-analysis" concludes that "In women with postmenopausal
bleeding, the sensitivity of endometrial sampling to detect endometrial cancer and especially atypical
hyperplasia and endometrial disease, including endometrial polyps, is lower than previously thought". How
do you manage postmenopausal bleeding? Do you yhink that Hysteroscopy has to be the first option after
the US? Is there still a place for a "Blind" Biopsy?
Hysteroscopy Conundrums
Postmenopausal Uterine Bleeding
Jan-Feb 2017 | vol. 3 | issue 1
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Hysteroscopy is a rapidly developing field of gynecologic practice, progressing from an inpatient to
an outpatient procedure. Today hysteroscopy is the gold standard for evaluation of the endometrial cavity
with more accuracy than blind methods, and gives the possibility to more accurately diagnose uterine
abnormalities in patients presenting with pre or postmenopausal uterine bleeding, intermenstrual spotting, or
infertility [1].
It took more than a hundred years since the first time hysteroscopy was performed in 1869 by D.C.
Pantaleoni. He used a device similar to a cystoscope. In 60-year-old woman it was found an endometrial
polyp, which probably caused uterine bleeding [2].
Subsequently technological part has been modified significantly with dramatic improvement of
examination conditions (preliminary removal of blood from the uterus, stretching of the walls of the uterus
with distention media). A new era came after the introduction into medical practice portable optics and optics
with rigid lens systems and later introduction of video camera, improvements of lighting possibilities.
The introduction of electrosurgery in hysteroscopy has created a new surgical areas unknown
before. Today a big number of surgical procedures are carried out by means of hysteroscopy avoiding
laparotomy and sometimes hysterectomy [3].
The advent of small-sized instrumentation with a final diameter of <5 mm turn hysteroscopy into a
safe and more comfortable intervention and permit it be performed as an office procedure without
anesthesia. In 1997, Bettocchi et al developed the “vaginoscopic approach” or “no-touch technique” for the
atramautic insertion of the hysteroscope into the external uterine orifice, without the aid of the speculum or
the tenaculum, introducing the scope directly into the vaginal canal. This method reduces patient discomfort
and allows the performance of endoscopic examination even in nulliparous patients or in postmenopausal
women who have severe vaginal atrophy or stenosis [4-8]. In fact, the miniaturization of the instruments
effectively reduces the difficulties both for the operator and for the patient, allowing even less skilled
gynecologists to perform office hysteroscopy. Moreover, it has been demonstrated that a smaller
hysteroscope size makes its introduction easier and less painful compared with conventional ones [3, 9, 10].
One of the small hysteroscopes is a thin 3.2-mm semi-rigid
mini-hysteroscope (Versascope, Ethicon Inc., Somerville, NJ, USA)
with a disposable sheath and 1.9-mm fibre optic (Alphascope).
Another one is CAMPO TROPHYSCOPE 2,9 mm thin with the
Office Continuous Flow Operative Sheath 4.4 mm, Karl Storz.
Innovative feature of the last one are sheaths with gliding
mechanism: primary approach to uterine cavity with 2.9 mm outer
diameter and than intraoperative changeover from single-flow to
continuous-flow and operating sheath. The operative procedure is
facilitated by 7- Fr or 5-Fr mechanical instruments, which is
compatible with a 5-Fr bipolar electrode [11].
Dramatic progress in Hysteroscopy
Mykhailo V. Medvediev, MD, PhD, ScD
Professor, Department of Obstetrics and Gynecology,
Dnepropetrovsk medical academy of Health Ministry of Ukraine
Original Article
Fig.1. Prof. Stefano Bettocchi, Italy
Jan-Feb 2017 | vol. 3 | issue 1
15. Additionally, to decreasing of scopes caliber there are new mechanical and bipolar instruments been
developed these days. Some data showed high efficacy and tolerability of new instruments for out-patient
operative hysteroscopy. In one study the outpatient polypectomy was associated with a success rate of 95%.
Other outcomes such as discomfort after the procedure, time away from home, analgesia requirements,
description and satisfaction of the procedure were all in favour of the outpatient setting. Further, patients in
the outpatient group recovered faster [12].
Recently even more portable devices of office
hysteroscopy have been introduced to the market. One of these
is EndoSee device (CooperSurgical, Trumbull, CT, USA). The
Endosee Hysteroscope is a lightweight, handheld, battery
operated portable system. It is used with a single-use
Disposable Diagnostic (Dx) Cannula with a camera and light
source at the distal end to illuminate the area for visualization
and image and video capture. The video signal is electronically
transferred to the main body of the hysteroscope via an
electrical connector. An LCD touch screen display monitor on
the hysteroscope is used for viewing [1].
At present, conventional hysteroscopic resection can be considered the gold standard procedure for
major hysteroscopic operations. Despite well-recognized advantages of resection, several problems, such as
fluid overload, uterine perforation due to electric current, lack of visualization and need of removal of
resected fragments resulting in a time-consuming procedure, thermal damage to endometrium with
permanent detrimental effects on future fertility and relatively long learning curve, remain still unsolved.
Invention of mechanical hysteroscopic morcellators has made a great improvement in management
polyps and myomas. Hysteroscopic morcellator was developed to reduce problems mentioned above and
decrease an operative time comparing with traditional approach. Hysteroscopic mechanical morcellation
allows removal of the tissue automatically during hysteroscopic resection and leads to a reduced operating
time. There is evidence that the learning curve for use of the hysteroscopic morcellator is shorter than for
conventional monopolar resectoscope in relative novices [11].
Hysteroscopy has become an important tool to evaluate
intrauterine pathology including endometrial polyp, submucous
myoma, intrauterine adhesions and uterine anomaly. In most
cases, the diagnosis and treatment of these lesions can be
performed in the office or outpatient setting without need for
anesthesia. Smaller, more portable systems are now able to
provide good views and with image storage facilities. As a
consequence, a single room can be used for various purposes,
providing more opportunity for the development of outpatient
facilities for ambulatory gynecology.
1.Connor, M., New technologies and innovations in hysteroscopy. Best Pract Res Clin Obstet Gynaecol, 2015. 29(7): p. 951-65.
2.Siegle, A.M., The early history of hysteroscopy. J Am Assoc Gynecol Laparosc, 1998. 5(4): p. 329-32.
3.Kogan, L., et al., Operative hysteroscopy for treatment of intrauterine pathologies does not interfere with later endometrial development in patients undergoing in vitro fertilization. Arch
Gynecol Obstet, 2016. 293(5): p. 1097-100.
4.Bettocchi, S. and L. Selvaggi, A vaginoscopic approach to reduce the pain of office hysteroscopy. J Am Assoc Gynecol Laparosc, 1997. 4(2): p. 255-8.
5.Cooper, N.A., et al., Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain. BJOG, 2010. 117(5): p. 532-9.
6.Lin, B.L., et al., The Fujinon diagnostic fiber optic hysteroscope. Experience with 1,503 patients. J Reprod Med, 1990. 35(7): p. 685-9.
7.Bettocchi, S., et al., Advanced operative office hysteroscopy without anaesthesia: analysis of 501 cases treated with a 5 Fr. bipolar electrode. Hum Reprod, 2002. 17(9): p. 2435-8.
8.Marciniak, A., et al., [Role of office hysteroscopy in the diagnosis and treatment of uterine pathology]. Pol Merkur Lekarski, 2015. 39(232): p. 251-3.
9.Campo, R., et al., Office mini-hysteroscopy. Hum Reprod Update, 1999. 5(1): p. 73-81.
10.Di Spiezio Sardo, A., et al., Ambulatory management of heavy menstrual bleeding. Womens Health (Lond), 2016. 12(1): p. 35-43.
11.Closon, F. and T. Tulandi, Future research and developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol, 2015. 29(7): p. 994-1000.
12.Marsh, F.A., L.J. Rogerson, and S.R. Duffy, A randomised controlled trial comparing outpatient versus daycase endometrial polypectomy. BJOG, 2006. 113(8): p. 896-901.
15
www.hysteroscopy.info
Fig. 2. CAMPO
TROPHYSCOPE 2.9 mm
with the Office Continuous
Flow Operative Sheath, Karl
Storz
Fig. 3. EndoSee device (CooperSurgical,
Trumbull, CT, USA)
Fig. 4. Intrauterine BIGATTI Shaver, Karl Storz
Jan-Feb 2017 | vol. 3 | issue 1
17. www.twitter.com/hysteronews
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Some Pictures
Meeting Friends at Nagpur. Focus on Hysteroscopy Congress
Jose "Tony" Carugno, Sushma Deshmukh, osama shawki,
Luis Alonso Pacheco & Sergio Haimovich. All will attend the next
Global Congress on Hysteroscopy. Are you going to miss it?
Stefano Bettocchi, honorary member of the Global
Congress on Hysteroscopy with Franklin Loffer and
Alessandro Buda. APAGE and TAMIG 2016 Taipei
Jan-Feb 2017 | vol. 3 | issue 1
Prof. Jorge Enrique Dotto and Prof. Linda Bradley in the
latest AAGL congress, Orlando (Florida) Exchanging ideas
about the next Global Congress on Hysteroscopy
Dr. Jose Caruno (USA) Dr. Luis Alonso (SPA) , Dr. Sergio
Haimovich (SPA) and Milind Telang (IND).
Relaxing time in Nagpur
18. 18
www.hysteroscopy.info
DEVICES
HYSTEROSCOPY
RESECTR
High-performance disponsable tissue resector
Basic manual devices are cost-efective ans easy-to-use, but often lack speed, power, control, and effectiveness.
Electromechanical system may improve speed and power for certain cases, but require costly capital equipement,
complex set-up and expensive disponsables. Some electromechanical systems introduce new procedural risks that may
outweigh their benefit.
The RESECTR ia a single –use, non-powered, hand-held, and hand-manipulated system designed to combine the
benefits of basic manual devices and electromechanical powered systems.
Clinicians squeeze and release the handle with their fingers to actuate cutting speed and control. Improved control
means physicians can perform tissue resection based on what they see and feel during the procedure.
RESECTRs are 100% disponsable , ship “ready-to-use”, and do not require new capital equipement, complex set-up, or
service contacts to cut.The cost-effective RESECTR can also be used in a variety of clinical settings allowing
physicians to “see-ans-treat” lesions in the hospital, clinic, surgery centre or office.
A systematic review and meta-analysis of randomized controlled trials comparing hysteroscopic
morcellation with resectoscopy for patients with endometrial lesions
International Journal of Gynecology & Obstetrics, 2016.
Li, C., Dai, Z., Gong, Y., Xie, B., & Wang, B.
Four trials including 392 patients were analyzed. Successful removal of all endometrial lesions was more frequent with
hysteroscopic morcellation than conventional resectoscopy (odds ratio 4.49, 95% confidence interval [CI] 1.94–10.41;
P<0.001). Total operative time was also shorter with hysteroscopic morcellation (mean difference −4.94 minutes, 95% CI
−7.20 to −2.68; P<0.001). No significant differences in complications were found. Meta-analyses were not possible for
tolerability and learning curve. In one study, hysteroscopic morcellation was acceptable to more patients (P=0.009).
Conclusions: Hysteroscopic morcellation is associated with a higher operative success rate and a shorter operative time
among patients with endometrial lesions than is resectoscopy. More high-quality trials are required to validate these results.
http://www.resectr.com
Jan-Feb 2017 | vol. 3 | issue 1
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HIGHLIGHT ARTICLES
Published on different medias
BACKGROUND: Minimally invasive surgery is a major pillar of gynecological surgery. However, there are
very few training opportunities outside the operation theater (OR) due to the cost and equipment requirements
of organ simulators, virtual reality trainers (VRT) are promising tools to fill this gap.
METHODS: Experienced and inexperienced participants of a minimally invasive surgery course followed
the standardized HystSim™-VRT training program.
RESULTS: Performance of 39 Participants (15 inexperienced and 24 experienced) was evaluated in the
standardized hysteroscopic program HystSim™. Tasks included three rounds of both a polyp and a myoma
resection. Primary measurements were improvement in resection time, cumulative resection path length, and
distention media use.
CONCLUSION: The HystSim™-VRT is an effective tool to improve the psychomotor skills needed in
hysteroscopic surgery for experienced and inexperienced surgeons prior to OR exposure. Additional organ
models training is advisable for hysteroscopic haptic skills.
Evaluation of the HystSim™-virtual reality trainer: an essential additional tool to
train hysteroscopic skills outside the operation theater.
Neis F, Brucker S, Henes M, Taran FA, Hoffmann S, Wallwiener M, Schönfisch B, Ziegler N, Larbig A, De Wilde RL.
Surg Endosc. 2016 Nov;30(11):4954-4961.
BACKGROUND: In Australia, gynaecologists continue to investigate women with abnormal bleeding and
suspected intrauterine pathology with inpatient hysteroscopy despite some evidence in the literature that that
there is no difference in safety and outcome when compared to an outpatient procedure.
AIMS: This prospective study assessed the safety, effectiveness and acceptability of outpatient hysteroscopy
over 11 years at a tertiary hospital in Australia. Resource savings were then calculated.
MATERIALS AND METHODS: A prospective database was analysed from March 2003 to January 2014
(130 months, 990 women).
RESULTS: Successful hysteroscopic access was obtained in 94% of cases. Twenty-six percent of patients
required a second procedure, including 132 for endometrial polyps and 33 for submucosal fibroids that were
not able to be treated in the outpatient setting. On questioning, 88% of women would be happy to have the
procedure again. Factors affecting success were pre-procedure pain, menopausal status and previous vaginal
delivery. The difference between pain experienced versus pain expected was a major factor in patient
acceptability. A vasovagal episode occurred in 5% of cases.
CONCLUSION: Outpatient hysteroscopy was demonstrated to be safe, effective and acceptable to women.
Provision of an outpatient hysteroscopy service saves theatre time and approximately $1000 per case.
Improved techniques and technology will allow progression to a 'see and treat' service, providing further
savings. With budget constraints, increasing wait times for major procedures and concerns about trainee
surgical experience, an outpatient hysteroscopy service should be considered the 'gold standard' investigation
over hysteroscopy in theatre.
Is outpatient hysteroscopy the new gold standard? Results from an 11 year
prospective observational study.
Ma T, Readman E, Hicks L, Porter J, Cameron M, Ellett L, Mcilwaine K, Manwaring J, Maher P.
Aust N Z J Obstet Gynaecol. 2016 Nov 15. [Epub ahead of print]
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Debate
DIAGNOSTIC HYSTEROSCOPY. Uniform report system
Raquel Duarte
Gynecology Service Hospital Quironsalud Málaga. Spain
Outpatient hysteroscopy is an increasingly widespread diagnostic and therapeutic tool in gynecology. Its use
allows the study of the uterine cavity, with the objective of diagnosing and sometimes even treating
malformations, polyps, fibroids, endometrial alterations, among other conditions.
Every "surgical" procedure must be well documented in the operative report, to make clear the findings and
procedures that have been performed.
Regarding diagnostic hysteroscopy, the report not only describes the procedure, but will be used as
complementary evidence for a future approach to the patient's pathology. A detailed description of all
findings will aid in planning any needed subsequent procedure or to modify aspects of the treatment to be
performed.
In cases in which the gynecologist who
performs the hysteroscopy is not the same
who will perform any subsequent procedure,
a standardized and detailed report will guide
any subsequent provider. In current practice,
each hysteroscopist performs the diagnostic
report according to his/her criteria, leaving
some characteristics without enough detail
that may have an impact on a future
treatment.
In other areas of gynecology in which
diagnosis is based on imaging, as in
colposcopy, strict criteria and specific
nomenclature have been unified for each
type finding (1). Would it be necessary to
propose the same unification of criteria
when performing a hysteroscopic
examination? Will the creation of a standard
report in which all the aspects that can be
assessed during hysteroscopy are clear?
The answer is probably yes. Most hospitals are providing outpatient hysteroscopy services and these
hysteroscopic studies will be evaluated by other colleagues in consultation to establish proper diagnosis and
treatment.
The current technological advances allow us to perform the recording or taking pictures of the procedure,
which facilitates the later information in case it is needed. Even so, it will probably be much more efficient
and easier to manage a report with all the detailed information and using the same structure, facilitating to
find every aspect of the hysteroscopic procedure, including even a graphic outline of the findings.
Jan-Feb 2017 | vol. 3 | issue 1
Hysteroscopy Newsletter
21. During hysteroscopy, the following areas can be assessed: The vaginal walls, uterine cervix, cervical canal,
uterine cavity morphology and size, visualization of the tubal ostium, and the endometrium.
There is not much literature on making a standard or unified report of hysteroscopic findings. Only in
Colombia, in 1998, they created a report, similar to the one they use for laparoscopies (2). This article intends
to expose the necessity to create a unified hysteroscopy report and a proposal of the same is presented.
HYSTEROSCOPY REPORT:
Patients Name: Medical Record Number: Date of procedure:
Age:
Hysteroscopist:
Gynecological history:
Last Menstrual Period:
OCP: Yes No
Indication of the procedure:
Infertility
Abnormal uterine bleeding
Suspected Mullerian anomaly
Other:
Procedure lenght (minutes):
Equipment used:
Hysteroscope:
Distension Media: Saline Glycine
Analgesia: Yes No
Vaginoscopy: Normal Abnormal (Findings)
Cervix: Normal Abnormal (Findings)
Cervical canal: Open Stenotic: Yes No This report should have a
schematic drawing of the findings
Morfology and size of the uterine cavity:
Normal
Abnormal: septum tubular arcuate other (describe)
Endometrium: Atrophic Polypoid Irregular Proliferative Scratch Other
Visualization of bilateral tubal ostium:: Yes No (why):
Intrauterine Patology: No Yes (describe)
Endometrial biopsy: Yes No
Clinical Impression:
Complications: No Yes (describe)
21
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Hysteroscopy Newsletter
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As I am sitting in front of my laptop enjoying a nice cup of coffee, I can’t
believe that I am working on the first 2017 issue of Hysteroscopy Newsletter. Yes,
2016 is gone! What a great year. Our hysteroscopy “revolution” is growing bigger
like a small snowball that is rolling downhill in a cold winter mountain. By now, our
snowball is unstoppable, it is about to become an avalanche of good things.
I am opening my mail box and I found sitting in my inbox one e-mail that is
highlighted as “very important” from Dr Luis Alonso, who we all know was the one
who let the snowball roll out of his hands, this time he is asking me for a challenge.
His e-mail reads: “Tony, resume en una página lo que sucedió en histeroscopia en el
año 2016. Felices fiestas, Luis” (Tony, in one page describe what has happened to
hysteroscopy in 2016. Happy holidays, Luis) My first thought was… he has been
drinking too much wine with good aged cheese these days. How am I going to
resume the best year for hysteroscopy in only one page?
Let me start, first Hysteroscopy Newsletter has grown exponentially, now we
reach many countries, leaders from all around the world are eager to collaborate and
the hysteroscopic community await every issue to download a great amount of
unbiased information from our Newsletter. (We have no financial conflict to
disclose). Second, the first Global Congress on Hysteroscopy was born. This colossal
event that will take place in the beautiful city of Barcelona from May 2nd to 5th 2017
is going to be a guaranteed sellout. A great deal of well-known world leaders will get
together to deliver the most updated information on hysteroscopy. Come to see first-
hand what is going on with this “hysteroscopic revolution”, there will be plenty of
videos and I guarantee you will go back home with your bag full of new tips and
tricks to improve your current hysteroscopic skills. Your patients will thank you for
that! Lastly, we just came back from the great city of Nagpur, India where the
Hysteroscopy Carnival took place. Thumbs up for Dr Sushma Deshmukh in putting
up such a great event. Faculty from America, Europe, Africa and Asia got together to
share their knowledge and enjoy the warm welcoming of the host. On that event the
latest hysteroscopy book was launched “Mastering the techniques in hysteroscopy” a
must have. Also, Dr Osama Shawki gave a great inspirational Ted Talk, showing his
“magic of hysteroscopy” and challenging the audience to become better at his art. We
left the room knowing that we can also do the “magic” with the hysteroscope.
The new year is here; rest assure that Hysteroscopy Newsletter will continue
to grow exponentially. We are committed to bring this ongoing hysteroscopy
“revolution” to the next level and we want you to be part of it. We invite you to
submit your articles, pictures, comment and critiques to our journal. We will all grow
together!
Happy New year 2017
Dr Jose “Tony” Carugno
University of Miami. USA
www.medtube.net
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