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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

HYSTEROSCOPY DEVICES Polyp Snare

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The disponsable Hysteroscopic Polyp Snared (DHPS) is used to cut and coagulated polyps and fibroids for removal from the uterus under direct vision. The Duckbill shape of open snare allows enhanced control and capture of pedunculated uterine polyps.Main caracteristics are:

Snare and handle as a single unit

Disposable. Intended for one-time use

Can be used through the working channel of a rigid or flexible hysteroscope

Can be used with or without electrocautery

Handle accepts a 2 mm monopolar plug for connection to a power source

 

Curiosities: Amniotic sheet

amniotic-sheetIntrauterine synechiae is the presence of fibrous adhesions inside the uterine cavity. In over 90% of cases, uterine adhesions formation is caused by uterine curettage especially if performed during the postpartum period or surgical abortions. Uterine curettage performed during these periods can damage the lining of the endometrium, allowing myometrial areas to contact each other, forming intrauterine adhesions. Other less common causes include uterine surgery such as hysteroscopic myomectomy or metroplasty and infectious endometritis, that rarely produces adhesions except when caused by tuberculosis.

If a patient with uterine sinequia becomes pregnant, the intrauterine synechia gets rodeated by amnion, which is seen on ultrasound as a band inside the uterine cavity. These sonographic findings were originally described by Mahony who described 7 cases. They created the term “Amniotic sheet” to describe the image in a cross-sectional sinequia seen encompassed by the amnion. This image of an undulating band with an oval image at its free end, which is corresponding to the sinequia, has also been called “The sperm sign.”

 

Hysteroscopy Books Comprehensive Pocket Atlas of Hysteroscopy

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Comprehensive Pocket Atlas of Hysteroscopy is an essential resourceproviding basic techniques involved in diagnostic and operative hysteroscopy for practicing clinicians and students.

This informative and visually appealing guide also provides an overview of the common pathology captured by hundreds of actual uterine procedures. Each pathological finding is presented in a clear, high quality photograph. This manual serves as a quick reference with authoritative guidance and includes a CD-ROM that demonstrates real time procedures.

 

Did You Know…..?

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Endometrial Polyps: Should they always be removed?

The simplest answer to this clinical question would be a resounding yes. The concern is the possibility of malignancy located in the polyp. However, the presence of cancer cells in endometrial polyps is very rare. Dockerti Ferris in 1944 established diagnostic criteria for adenocarcinoma originated in an endometrial polyp. First, the carcinoma must be limited to a portion of the polyp, second, the base of the polyp should be free of cancer cells and third, the endometrium surrounding the base of the polyp should be normal.Endometrial polyp 2 copia.jpg

The recommended procedure is hysteroscopy polypectomy and the risk of encountering a malignant lesion should not be the only criteria to value when deciding to offer polypectomy. Therefore, several questions arise when considering a polypectomy:

1. What are the suggested clinical indications for endometrial polypectomy?

2. What is the rate of atypical endometrial hyperplasia and endometrial cancer in asymptomatic women with endometrial lining less than 4mm?

3. What is the incidence of atypical endometrial hyperplasia and endometrial cancer in patients with hysteroscopically benign appearing endometrial polyps?

4-Cost of hysteroscopy compared to expectant management

Read the full article http:www.hysteroscopy.info

Interview with… Stefano Bettocchi

stefano-bettocchi-2How did you developed the vaginoscopy approach?

The vaginoscopic approach was developed in ’92 as an answer to my experience abroad and to the need to overcome the shortage of anaesthetists we used to have; actually in those days we still had to access the operating theatres for the anaesthesia and due to the shortage of anaesthetists and the growing number of patients, we decided to find a way to hysteroscopy and finally strip down our patients’ discomfort. Back then, there were more and more nuns accessing our institute and this fact motivated us even more tofind a non-invasive access to the cervical canal.

Do you have any advice for the young physician who is starting out in the world of surgery?

First of all, I would suggest him to be passionate: passion can make the difference. The young physician should learn and listen to experts but, at the same time he should not be passive in the learning process. He should try to be innovative also when he is onlyvrepeating activities he has learned or seen from experts. This is my own story, I could have been a clone of my maestro, but I was always looking for new solutions in my reality. So, do respect your teaching experts, but always look for something new discovering and sometimes overcoming your limits!

 

Hysteroscopy Pictures: Endometrial Hyperplasia

Endometrial hyperplasia is an overgrowth of endometrial glands, with different shapes and sizes, which causes increased endometrial thickness. There is a higher proportion in the gland/stromal ratio than observed in normal endometrium. Under the spectrum of endometrial hyperplasia different pathologies that have the common feature of increasing endometrial thickness. Some of these injuries have virtually no malignant potential while others are clearly premalignant lesions. Tissue evaluation plays a key role in the diagnosis of this entity.

endometrial-hyperplasia

The diagnosis of endometrial hyperplasia should be suspected in women with heavy and frequent menstrual periods or in women with abnormal uterine bleeding, especially if they have risk factors such as anovulation, polycystic ovaries, obesity or taking estrogen therapy. Endometrial hyperplasia produces abnormal uterine bleeding in both premenopausal and postmenopausal patients being the cause of 10% of abnormal uterine bleeding and 15% of postmenopausal vaginal bleeding.

 

Hysteroscopic treatment of submucous cystic adenomyosis

Cystic Adenomyosis.JPGAdenomyosis is a benign condition characterized by the presence of endometrial glands and stroma invading the myometrium with the presence of hyperplasia and hypertrophy of the smooth muscle fibers. It occurs mostly in women between the fourth and fifth decade of life, associated risk factors are multiparity, previous uterine surgery and presence of endometriosis; and like the latter, it is also estrogen sensitive.

Two forms of presentation are described focal and diffuse. Focal adenomyosis may occur as a well circumscribed nodular lesion (adenomyoma), similar to an intramural fibroid or restricted to one uterine wall structure in the form of localized adenomyosis. By contrast, the diffuse form is one in which can affect the entire uterus without demarcated boundaries between invaded tissue and surrounding healthy myometrium.

With the use of modern improved imaging techniques, authors have described a growing number of cases in adolescents and young adult women with dysmenorrhea, emerging a new type of adenomyosis called “cystic”. At present, the diagnosis is mainly based on MRI, presenting as a cystic structure with an internal diameter ≥10 mm and hemorrhagic content surrounded by myometrial tissue. In a review of cystic adenomyosis, Brosens et al (2015) described three types (A, B, and C) with their respective subtypes, according to the location of the cyst and the complexity of the lesion

 www.hysteroscopy.info

The vision of Osama Shawki regarding the application of Office Hysteroscopy in modern gynaecology

Osdeen surgeon thumb upMy dear friends, we have to face the unpleasant fact that gynaecologists are amongst the least technologically adept of medical specialties. If we look at Ophthalmology, ENT or even our neighbours – Dentists; all have now recruited cutting edge optics to their standard practice.

Office gynaecology equipment is still the same ancient, antiques used for the past hundred years with a shiny new lamp and electronic chair added. We are also the only specialty still performing blind sampling. As reported in multiple statistics, 100% of urologists are performing cystoscopy compared to only 15% of gynaecologists performing hysteroscopy.

It is high time for a revision and reassessment in the practice of gynaecology. Office hysteroscopy uses a diameter less than that of the uterine sound and utilizes high definition optics making it the most beneficial modern technology in practice. In my personal opinion, the equipment is very affordable but there are major pitfalls in equipment design and technology, which diminish enthusiasm for the procedure.

Our mission is to spread out proper training and reconstruction of equipment design to provide optimal easy practice and make it a standard procedure in every gynaecologist’s office.

 

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