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Endometritis
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Ettore Cicinelli, Rossana Cicinelli, Carla Mariaflavia Santarsiero, Amerigo Vitagliano
Hysteroscopy is a technique which must only be carried out by gynecologists and it allows a thorough exploration of the uterine cavity. Fluid hysteroscopy has been shown to be an effective technique to detect CE, based on the detection of the so-called subtle or small lesions (7). The most characteristic lesions are micropolyps that can be easily recognized by fluid hysteroscopy as small or subtle lesions floating on the endometrial surface. Recently, using a Delphi procedure, we have defined the main diagnostic criteria for CE using hysteroscopy, namely micropolyps, hyperemia, mucosal edema, hemorrhagic spots, and “strawberry” pattern, with high inter-observer agreement (36).
Hysteroscopic Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
A follow-up ultrasound was performed between 1 and 2 months after the procedure, and a second-look hysteroscopy was performed after 2 months. The mass reduction was 60 to 100% (myoma disappearance), and the mean volume reduction was 72%. All of the patients reported an improvement in bleeding pattern immediately after the procedure. There were no complications and it was well tolerated by the patients. We have probed the feasibility of this new technique that is differentiated from other techniques not only by the results but especially by the fact that it is performed in an office setting without anesthesia. We believe that it is going to be a prevailing technique for the treatment of SM myomas, breaking the limits of the size.
Fibroid Adhesions
Published in John C. Petrozza, Uterine Fibroids, 2020
Eleni Greenwood Jaswa, Evelyn Mok-Lin
Sequential hysteroscopies may have a role in prevention of adhesion reformation. Early intervention to remove filmy adhesions bluntly has been reported with good success [52,53]. Shorter interval hysteroscopy (i.e., 1 week after initial sharp dissection) compared to traditional 2-month follow-up is suggested to have superior outcomes [52]. Similarly, following hysteroscopic resection of multiple apposing submucosal myomas, a reduction of adhesion formation from 78% to 0% after the addition of 1–2 week follow-up hysteroscopy has been reported [12].
Clinical analysis of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in patients with cervical pregnancy
Published in International Journal of Hyperthermia, 2022
Yufu Huang, Xiaogang Zhu, Luying Wang, Mingzhu Ye, Min Xue, Xinliang Deng, Xin Sun
2 ± 1 days (range: 1–3 days) after HIFU treatment, the patients underwent the suction curettage under the HEOS hysteroscopic guidance (Sopro-comeg Company, Bordeaux, France). After 8 h of fasting, the patient was placed in the lithotomy position and was given intravenous general anesthesia. Then routine disinfection and draping were performed. After inserting the speculum into the vagina, the patient’s cervix was held in place with a clamp. A 0.9% saline (speed: 400 ml/min) was sent through the catheter into the uterus to cause dilation. To determine the depth and angle of the uterus and localize the gestational sac, a rigid hysteroscope with a diameter of 4.5 mm (Olympus) was inserted into the uterus. The cervix was widened by gradually increasing the size of the dilator to 7.5 mm. The 7 mm cavity suction tube was used to scrape and suction the placental contents in the cervix. Hysteroscope was used to check if any contents remained in the uterus. If any pregnancy residues were detected, a clamp was used under the guidance of a hysteroscope with an outer sheath (diameter: 6.5 mm) to remove the remaining tissue. If necessary, an electrosurgical resection was used to remove the residues after re-dilation of the uterus.
Office hysteroscopy: back to the future!
Published in Climacteric, 2020
J. N. Mak, A. Imran, S. Burnet
Hysteroscopy is a minimally invasive diagnostic and operative technique, most commonly offered to patients with abnormal uterine bleeding or infertility. In the patient with abnormal uterine bleeding, hysteroscopy (combined with histology) is the gold standard for diagnosing endometrial pathology4. Direct visualization of the endometrium and targeted biopsy of intrauterine, endometrial, or endocervical lesions have resulted in diagnostic accuracy for major endometrial pathology. Meta-analyses reveal high sensitivity and specificity values for diagnosis of endometrial cancer (82.6% and 99.7%), polyps (95.4% and 96.4%), and submucosal myomas (97.0% and 98.9%), and moderate accuracy for endometrial hyperplasia (75.2% and 91.5%), all of which are superior compared to other diagnostic modalities, such as transvaginal ultrasound, saline infusion sonography, and blind endometrial sampling4,5.
Pain management during diagnostic office hysteroscopy in postmenopausal women: a randomized study
Published in Climacteric, 2020
A. Samy, H. Nabil, A. M. Abdelhakim, M. E. Mahy, A. A. Abdel-Latif, A. A. Metwally
Although numerous pharmacological treatments have been studied for use in hysteroscopy, the results have been inconsistent, probably because of the visceral nature of the pain, resulting in wide variation in practice regarding the use of different pain-relieving agents such as oral analgesics or local anesthetics for pain relief during OH26. Moreover, contraindications and undesirable side effects as well as limitations when completing the procedure have sometimes also been reported. Non-pharmacological approaches to pain in hysteroscopy would represent a safe alternative that would avoid any undesirable effects and should be further studied27. A recent network meta-analysis by Ghamry et al.28 evaluated and ranked different pharmacological and non-pharmacological interventions for pain relief during OH. They found that the combination of intrauterine local anesthetics plus vaginal misoprostol was effective in reducing the pain during OH28. They also found that transcutaneous electrical nerve stimulation was the most effective non-pharmacological option for pain relief during OH followed by bladder distension. Other non-pharmacological interventions included pressure, heat, hypnosis, music, and stretching; however, they were not adequately studied and thus no firm conclusions could be based on their results27,28.