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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

Reliability of hysteroscopy combined with narrow band imaging (NBI) technology

nbi-hysteroscopy

Narrow-band imaging (NBI) or “optical narrowband filter” is a novel system of endoscopic visualization in real time which significantly improves visualization of the vascularity and the tissue surface, allowing better characterization of abnormal findings. Applies a technology based on narrowing of the white light spectrum commonly used endoscopically through a system of filters. Thus, this system allows two wavelengths (415nm blue light and 540nm green light) to reach the surface of the tissue and reflected back on a chip that captures the image. Both wavelengths correspond to peaks in the absorption spectrum of the oxidized hemoglobin light, fact that allows to appreciate more clearly the vascular network in tissue surface. Blue light penetrates tissues poorly (0’17mm) and as a result allows to see the superficial vascular networks, while green light penetrates deeper and shows sub-epithelial vessels. When both are combined you can observe an image of the tissue surface with high contrast.

 

Gynko Sheath

gynko

The new single-use sheath which makes diagnostic hysteroscopy of 3mm!

Made of medical polyurethane plastic, the new cover GYNKO provides the gynecologist a useful tool to perform diagnostic hysteroscopy of only 3mm.

GYNKO is compatible to the optical commonly used in hysteroscopy 0 and 30 degrees (Storz type) and incorporates a working channel for instruments up 7Fr in conjunction with a channel for irrigation and a protective cover for the camera.

GYNKO will allow to perform the biopsy of the endometrium as well as the removal of small polyps.

With this new system, you can multiply the hysteroscopic procedures without having to repeatedly sterilize the entire system.

Uterine Cervix

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The name cervix derives from the Latin word “Cervic” meaning “neck”. It represents the lower portion of the uterus and communicates the uterine cavity with the vagina. It has a cylindrical shape with a length of about 3 cm and a diameter of about 2 cm. The uterine cervix has an opening to the vagina called the “external os” (EO). In the area of division between the cervix and uterine body lies a fibromuscular area called the “internal os” (IO). The area located between EO and IO is called the “endocervical canal”, which has a fusiform shape and an oval cross section, the endocervial canal has a diameter ranging between 3 and 10 millimiters.

The normal development of the uterus involves some changes happening over the mullerian ducts to form the cervix, uterus, fallopian tubes and upper vagina through the processes of differentiation, migration, fusión and canalization

The cervix has an intravaginal portion (portio vaginalis) and a supravaginal portion that is usually larger. Structurally, the cervix is composed of 85% extracellular matrix and 15% smooth muscle tissue. The extracellular matrix is made mainly of collagen, elastin and proteoglycans cells of smooth muscle and fibroblasts, epithelial cells and blood vessels.

More in http://www.hysteroscopy.info

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Diagnosis and Treatment of Endocervical Lesions by Cervicoscopy (Dra. María Alejandra Brito Pérez)

endocervical-lesions

The endocervical canal is lined by columnar epithelium on a basement membrane. There are also endocervical glands, and its extension is influenced by age, parity and hormonal status. The Squamous Columnar Union (SCJ) is in constant change throughout the life of the woman, there is a constant transformation from columnar to squamous epithelium, which is known as squamous metaplasia. Lesions of the cervix can be produced by trauma (tears, holes or ulcerations), infection: such as those caused by sexually transmitted agents (Chlamydia trachomatis, Neisseria gonorrhea, Trichomonas, herpes virus, or HPV), and neoplasms, that can be benign represented by endocervical polyps or fibroids, endometriosis, or malignant.

For analysis of premalignant cervical lesions, we use the 2001 Bethesda System, which organizes cervical cells from normal to carcinoma in situ, both originated from squamous cells, and from the glandular epithelium. In 1975, for the first time, the possible association between HPV and cervical cancer was noted, and 8 years later Zur Hausen and then Walmoeers and Bosch demonstrated the possibility to isolate the virus from cervical biopsies.

Read the full article

http://www.hysteroscopy.info

Hysteroscopy Pictures: Uterine septum

uterine-septum

The septate uterus is the result of a failure in the process of resorption of the medial septum that can range from a minimal septum in the uterine fundus to a complete one dividing the uterine cavity completely or even asociating double cervix and vaginal septum. The proposed mechanism by which the uterine septum regresses is apoptosis, the presence of Blc-2 protein protects from apoptosis. The absence of Blc-2 in the embryonal uterine septum may indicate a lack of protection from apoptosis in this area. On the other hand different studies have allowed the identification of several genes that can be implicated in the development of uterine malformations

In an interesting study comparing the use of resectoscope to VersaPoint in 63 women for the treatment of septum (Resectoscope or Versapoint for hysteroscopic metroplasty. Int J Obstet Gynaecol 2008 Apr; 101 (1):39-42) Dr. Litta concludes that the VersaPoint system does not require cervical dilation, avoiding potential cervical incompetence, cervical lacerations and uterine perforation related to the dilation process. The use of VersaPoint is a safe alternative to the use of resectoscope, especially in nulligravid or patients with cervical stenosis.

 

Gubbini Mini Hystero-Resectoscope

gubbini

The Gubbini Mini Hystero-Resectoscope offers a multitude of options for non-invasive diagnostic and therapeutical Gynaecology. The Gubbini Mini Hystero-Resectoscope System allows both, hysteroscopy and resectoscopy with reduced diameter of the shaft. The 16 Fr. Mini-Resectoscope with continuous flow and optional 5 Fr. working channel provides the possibility of a rapid and gentle endoscopic therapy for a wide range of endo-uterine diseases. By way of introducing miniature loops which are shaped ideally to the given anatomical proportions, the strain to female patients could be clearly reduced. The miniature loops are presently offered in two different patterns – with and without high frequency current for coagulation. The loop without HF current is typically used for blunt preparation.

 

INTERVIEW WITH… Dr. Attilio Di Spiezio Sardo

attilio-di-spiezio-sardo-hysteroscopy

The limits of hysteroscopy are still far! Indeed there are many aspects of the uterine cavity which still need to be completely elucidated. I am thinking about endometrial receptivity, embryo implantation, uterine congenital anomalies, the progression from hyperplasia to carcinoma, the endocervical canal…. All the technological improvements which could help us to investigate and treat these and other unknown aspects/conditions of the uterine cavity will represent the “future” of hysteroscopy!

 Read the full interview at http://www.hysteroscopy.info

 

Brief Review: Techniques for in-office hysteroscopic myomectomy

 

laserIn recent years we are witnessing the emergence of different devices and surgical techniques for in office hysteroscopic treatment of submucosal fibroid. In many cases the procedure can be performed without any anesthesia, allowing the use of different types of energy through instrument of 4-5mm in diameter with a working channel of 5Fr such as VersapointR with bipolar energy or laser, and apply different techniques that allows even the excision deeper myomas. Still, currently 40% of the hysteroscopic myomectomy are carried out in the operating room.

Important aspects for performing in office myomectomy are:

– Availability of hysteroscopes with working channels of small diameter.

– Complexity of fibroid: size, intra-myometrial component, location, etc. (Lasmar classification)

– Hysteroscopist skill level and experience: myomas type G1-G2 need for complete resection in a short operative time that is only achieved by expert hysteroscopists

– Operating time: It is related to the size and location of the fibroid, the device used and the skill of hysteroscopist. Usually the operative time varies between 15 to 30 minutes.

– Patient ability to tolerate the procedure.

Full article: http://www.hysteroscopy.info

 

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