scholarly journals Advances in Outpatient Hysteroscopy

2021 ◽  
Author(s):  
Ayesha Ajmi
Keyword(s):  
Recovery Time ◽  
Uterine Cavity ◽  
Targeted Biopsy ◽  
High Definition ◽  
Endometrial Polyps ◽  
Technological Advances ◽  
Therapeutic Procedures ◽  
Outpatient Hysteroscopy ◽  
One Step ◽  
Bipolar Electrosurgery

Hysteroscopy is a gynaecological procedure that has developed into an important tool to identify endometrial abnormality. It offers direct examination of the uterine cavity and tubal ostia and offers the option of performing targeted biopsy of suspected lesions that can be missed by blind procedures. In a large number of cases, the intrauterine lesions can be diagnosed and treated at the same setting as one step approach (“see and treat”). For example, endometrial polyps can be identified and removed; intrauterine adhesions may be divided in the office owing to the practicability of operative saline hysteroscopy, vaginoscopic approach and the convenience of miniature hysteroscopes. There is decent evidence that hysteroscopy in the outpatient clinic setting is preferred by the patients, associated with low risk of complications, quicker recovery time and reduced cost. Technological advances have led to development of high definition miniature hysteroscopes without negotiating optical performance, and hence making hysteroscopy an ingenuous, safe and trusted office procedure. Recent advances such as bipolar electrosurgery, endometrial ablation devices, morcellators and tissue retrieval system has transformed the surgical technique. This modernization of hysteroscopy completely revolutionised the approach to the management of intrauterine pathologies, moving from a blind procedure under general anaesthesia to directly visualised procedure under no or local anaesthesia, offering diagnostic as well as therapeutic procedures that should be at the disposal of every modern gynaecologist.

Hysteroscopy

2020 ◽  
pp. 597-606
Author(s):  
O. A. O’Donovan ◽  
Peter J. O’Donovan
Keyword(s):  
Gold Standard ◽  
Uterine Cavity ◽  
Direct Visualization ◽  
Postmenopausal Bleeding ◽  
Endometrial Polyps ◽  
Current State ◽  
Technological Advances ◽  
Wide Range ◽  
Proper Training ◽  
Low Incidence

Hysteroscopy (direct endoscopic visualization) of the endometrial cavity is an exciting and rapidly developing field of gynaecological practice. The most dramatic advances have occurred during the last 20 years due to technological advances including miniaturization of equipment and improved optics. Hysteroscopy is used both diagnostically and therapeutically to treat a wide range of gynaecological problems (heavy menstrual bleeding, infertility, and postmenopausal bleeding). The most recent advances allow accurate direct visualization of the uterine cavity which provides a platform for targeted biopsies, safe removal of endometrial polyps, and treatment of fibroids, septa, and adhesions. Proper training has resulted in a low incidence of serious complications. The current consensus is that hysteroscopy provides a gold standard not only for evaluating and treating intrauterine pathology but also for allowing a minimalist approach which has resulted in improved patient outcomes. This chapter provides an overview of the current state of this exciting and evolving field.

scholarly journals Block of squid axon K channels by internally and externally applied barium ions.

1982 ◽  
Vol 80 (5) ◽  
pp. 663-682 ◽  
Author(s):  
C M Armstrong ◽  
R P Swenson ◽  
S R Taylor
Keyword(s):  
Time Constant ◽  
Recovery Time ◽  
Pulse Voltage ◽  
Squid Axon ◽  
Barium Ions ◽  
K Channels ◽  
Voltage Dependent ◽  
One Step ◽  
Dissociation Constant Kd ◽  
The Way

We have studied the interactions of Ba ion with K channels. Ba2+ blocks these channels when applied either internally or externally in millimolar concentrations. Periodic depolarizations enhance block with internal Ba2+, but diminish the block caused by external Ba2+. At rest, dissociation of Ba2+ from blocked channels is very slow, as ascertained by infrequent test pulses applied after washing Ba2+ form either inside or outside. The time constant for recovery from internal and external Ba2+ is the same. Frequent pulsing greatly shortens recovery time constant after washing away both Ba2+in and Ba2+out. Block by Ba2+ applied internally or externally is voltage dependent. Internal Ba2+ block behaves like a one-step reaction governed by a dissociation constant (Kd) that decreases e-fold/12 mV increase of pulse voltage: block deepens with more positive pulse voltage. For external Ba2+, Kd decreases e-fold/18 mV as holding potential is made more negative: block deepens with increasing negativity. Millimolar external concentrations of some cations can either lessen (K+) or enhance (NH+4, Cs+) block by external Ba2+. NH+4 apparently enhances block by slowing exist of Ba ions from the channels. Rb+ and Cs+ also slow clearing of Ba ions from channels. We think that (a) internally applied Ba2+ moves all the way through the channels, entering only when activation gates are open; (b) externally applied Ba2+ moves two-thirds of the way in, entering predominantly when activation gates are closed; (c) at a given voltage, Ba2+ occupies the same position in the channels whether it entered from inside or outside.

scholarly journals 3D Laparoscopic Monitors

2014 ◽  
Vol 5 ◽  
pp. MEI.S13342
Author(s):  
Francesca Destro ◽  
Noemi Cantone ◽  
Mario Lima
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Three Dimensional ◽  
Short Paper ◽  
High Definition ◽  
Recent Introduction ◽  
Technological Advances ◽  
New Surgery

Minimally invasive surgery (MIS) is a relatively new surgery comprising various procedures performed with special miniaturized instruments and imaging reproduction systems. Technological advances have made MIS an efficient, safe, and applicable tool for pediatric surgeons with unquestionable advantages. The recent introduction of three-dimensional (3D) high definition systems has been advocated in order to overcome some of the problems related to standard MIS visual limitations. This short paper recapitulates the necessity to minimize MIS visualization limitations and reports the characteristics of new laparoscopic 3D systems.

scholarly journals Hysteroscopic evaluation in infertility and abnormal uterine bleeding

2018 ◽  
Vol 7 (2) ◽  
pp. 612
Author(s):  
Navneet Kaur ◽  
Ruby Bhatia ◽  
Paramjit Kaur ◽  
Surinder K. Bhopal
Keyword(s):  
Endometrial Hyperplasia ◽  
Uterine Cavity ◽  
Invasive Procedure ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Therapeutic Modality ◽  
Secondary Infertility ◽  
Endometrial Polyps ◽  
Submucous Fibroid

Background: Hysteroscopy an endoscopic procedure for visualization of uterine cavity may be extensively used in both primary and secondary infertility and abnormal uterine bleeding for evaluating intrauterine pathology. The objectives of this study were to visualize and identity intrauterine pathology in both primary and secondary infertility and abnormal uterine bleeding (AUB) by hysteroscopic evaluation and to perform hysteroscopic guided therapeutic procedures like endometrial currettage, polypectomy, adhesiolysis.Methods: Hysteroscopic evaluation of uterine cavity for any intrauterine pathology in AUB and Infertility. Adhesiolysis, polypectomy, endometrial biopsy misplaced copper T removal were carried out under hysteroscopic vision.Results: Intrauterine synechia in 20.51%, Submucous fibroid in 5.13%, bicornuate uterus, endometrial hyperplasia and endometrial polyp were seen in 2.56% patient each were detected in infertility group while 81.95% cases with AUB had abnormal intrauterine pathology commonest being endometrial hyperplasia in 33.33% followed by endometrial polyps in 23.81% cases, submucous fibroid and misplaced copper T in 9.52% each and intrauterine synechia in 4.76% patient. Endometrial biopsy and polypectomy was done in 23.80% each with AUB, misplaced copper T removal in 9.52% and adhesiolysis in 4.76% patient with AUB.Conclusions: Hysteroscopy remains gold standard for evaluating intrauterine lesions in abnormal uterine bleeding and infertility. A safe, simple minimally invasive procedure not only diagnostic but therapeutic modality for adhesiolysis, endometrial biopsy/curettage, polypectomy, misplaced copper T removal under direct vision with minimal complication within reach of every Gynaecologist thereby reducing burden of major surgical intervention.

scholarly journals Multiple endometrial polyps in patient undergoing long-term gestagen therapy

2005 ◽  
Vol 133 (9-10) ◽  
pp. 438-440
Author(s):  
Milena Zamurovic ◽  
Pavle Srbinovic ◽  
Jovana Petrovic
Keyword(s):  
Progesterone Receptors ◽  
Uterine Cavity ◽  
Reproductive Period ◽  
Histopathological Analysis ◽  
Endometrial Polyps ◽  
Endometrial Cells ◽  
Gynecology And Obstetrics ◽  
Irregular Bleeding ◽  
Continuous Presence ◽  
Cell Genome

Endometrial polyps represent a limited focal, circumscribed overgrowth of the endometrium. Their aetiopathogenesis has not been completely explained yet. They are often found in perimenopausal women; during the reproductive period they are less common. We present the case of a 32-year-old patient, who came for a check-up to the Gynecology and Obstetrics Clinic "Narodni Front" because of irregular bleeding. The patient was subjected to hormonal linestrenol therapy, which she had administered herself, without further consultations with her gynecologist, during the previous 10 years. Complete diagnostic examinations were performed. Contrast sonohysterography enabled the visualization of multiple polyps inside the uterine cavity, which were confirmed by histopathological analysis of material obtained via explorative curettage. Histopathological material contained over 30 endometrial polyps. A control check-up after one month, as well as subsequent quarterly check-ups, resulted in normal findings. Analysis of the described case has indicated that the loss of sensitivity of progesterone receptors in endometrial cells is possible if there is a continuous presence of progesterone agonists in circulation, as is true of linestrenol in this case. The loss of sensitivity of progesterone receptors upsets normal hormonal activity during the secretory phase of the menstrual cycle, leading to copious, irregular bleeding. These changes may, however, have even deeper effects. More recent research shows that, if the agent causing the loss of sensitivity of the receptors is present in circulation over a longer time period, changes may also appear at the DNA molecular level, i.e. in the cell genome itself. This, in turn, may lead to the beginning of the process of oncogenesis and the formation of timorous tissue.

Benign disease of the uterus

2020 ◽  
pp. 609-624
Author(s):  
Sahana Gupta ◽  
Isaac Manyonda
Keyword(s):  
Focused Ultrasound ◽  
Treatment Options ◽  
Uterine Fibroids ◽  
Transvaginal Sonography ◽  
Benign Diseases ◽  
Endometrial Polyps ◽  
Focused Ultrasound Surgery ◽  
Effective Interventions ◽  
Outpatient Hysteroscopy ◽  
Dramatic Shift

The benign diseases of the uterus compromise endometrial polyps, adenomyosis, and uterine fibroids or leiomyomas. Polyps are often asymptomatic, or may cause intermenstrual bleeding, and recent technological developments allow for rapid diagnosis (transvaginal sonography) and treatment (outpatient hysteroscopy and polypectomy with or without local anaesthesia). Precious little progress has been made over the past few decades in the understanding of the pathophysiology of adenomyosis, or its effective management beyond hysterectomy. Until as recently as two decades ago, the only treatment options for fibroids were hysterectomy and myomectomy, but the advent of radiological interventions (uterine artery embolization and focused ultrasound surgery) has revolutionized uterine-preserving management options of fibroid disease, while the recent emergence of selective progesterone receptor modulators has, at long last, heralded effective medical therapy for fibroids. This rapid expansion in fertility-preserving treatments for fibroids could not have been more timely since in recent years there has been a dramatic shift in the demography of childbirth, with many women postponing childbirth to their late 30s and early 40s, when fibroids are more prevalent and more symptomatic. Parallel developments in assisted reproduction technology now allow women to achieve pregnancies at an age that was unthinkable three decades ago. Even when child bearing is not an issue, hysterectomy no longer need be the only effective treatment for the menstrual disturbance and other symptoms associated with benign diseases of the uterus—new minimally invasive procedures now allow for equally effective interventions that improve women’s quality of life.

scholarly journals Evaluation of safety and diagnostic performance for flexible hysteroscopy in 1591 outpatient cases

2020 ◽  
Vol 50 (10) ◽  
pp. 1157-1161
Author(s):  
Yusuke Kobayashi ◽  
Kosuke Tsuji ◽  
Kanako Nakamura ◽  
Shimpei Nagai ◽  
Takayuki Takahashi ◽  
...  
Keyword(s):  
Endometrial Hyperplasia ◽  
Malignant Tumors ◽  
Intrauterine Infection ◽  
Immunosuppressive Drug ◽  
Benign Tumors ◽  
Uterine Perforation ◽  
Endometrial Polyps ◽  
Outpatient Hysteroscopy ◽  
Clinical Background ◽  
Diagnostic Concordance

Abstract Background To date, only few large studies are available concerning the safety and diagnostic concordance rates of outpatient flexible hysteroscopy. In our institution, outpatient hysteroscopy has been routinely and educationally applied Kosuke Tsuji to intrauterine lesions; thus, we retrospectively investigated the institution’s outpatient flexible hysteroscopy cases. Methods A total of 1591 cases of outpatient flexible hysteroscopy conducted at our institution in 2012–2016 were retrospectively analyzed in terms of their clinical background, complications and diagnostic concordance rates. Results A total of 1591 cases included 546 cases of benign tumors (317 endometrial polyps, 168 myomas and 61 endometrial hyperplasia), 361 cases of atypical endometrial hyperplasia, 571 cases of endometrial cancers and 113 cases of other diagnoses. No major complications, including uterine perforation, occurred. However, one patient (0.06%) was diagnosed with septic shock caused by intrauterine infection that required prolonged immunosuppressive drug administration. Meanwhile, 335 patients diagnosed with benign tumors through outpatient flexible hysteroscopy underwent operation, and the diagnostic concordance rate was 74.6% (250 cases). However, this rate included 14 cases (4.2%) diagnosed with malignant tumors postoperatively. In preoperative endometrial cancer cases, the sensitivity and specificity for cervical invasion diagnosis were 39.4 and 90.8%, respectively. In addition, only one patient manifested positive ascites cytology intraoperatively, possibly caused by outpatient hysteroscopy. Conclusions Outpatient flexible hysteroscopy is highly safe, with a slight negligible effect on ascites cytology. However, the diagnosis should be determined by multidisciplinary approaches, as hysteroscopy alone can miss malignancy.

scholarly journals Endometrial polyps: Pathogenesis, sequelae and treatment

2019 ◽  
Vol 7 ◽  
pp. 205031211984824 ◽  
Author(s):  
Njume Peter Nijkang ◽  
Lyndal Anderson ◽  
Robert Markham ◽  
Frank Manconi
Keyword(s):  
Postmenopausal Women ◽  
Uterine Cavity ◽  
Reproductive Age ◽  
Endometrial Polyps ◽  
Asymptomatic Women

Endometrial polyps are overgrowths of endometrial glands that typically protrude into the uterine cavity. Endometrial polyps are benign in nature and affect both reproductive age and postmenopausal women. Although endometrial polyps are relatively common and may be accompanied by abnormally heavy bleeding at menstruation. In asymptomatic women, endometrial polyps may regress spontaneously, in symptomatic women endometrial polyps can be treated safely and efficiently with hysteroscopic excision.

scholarly journals Hysteroscopic polypectomy versus expectant management in endometrial polyps in asymptomatic infertile women: a meta-analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 3096
Author(s):  
Tauane Bahia Modesto ◽  
Amanda Tamiris Barbosa Dias ◽  
Sofia Andrade De Oliveira
Keyword(s):  
Pregnancy Rate ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Uterine Cavity ◽  
Expectant Management ◽  
Implantation Rate ◽  
Endometrial Polyp ◽  
Structural Abnormality ◽  
Endometrial Polyps ◽  
Intrauterine Abnormalities

Background: Endometrial polyp is a hyperplastic structural abnormality of the uterine cavity and is one of the most commonly found intrauterine abnormalities. The endometrial polyp is mostly asymptomatic and sometimes diagnosed only during infertility investigation. The influence of endometrial polyps on female infertility is not completely understood, however, due to the possibility of endometrial polyps influencing fertility, their removal is usually performed in women undergoing infertility treatment.Methods: This meta-analysis was performed through an electronic search using MEDLINE, PubMed in October 2017, bringing together the terms of interest in order to select studies that would compare polypectomy and expectant management for endometrial polyps in sub fertile women. Four articles were selected according to the inclusion and non-inclusion criteria.Results: Five variables were collected from the selected articles to be compiled and analyzed (rate of live births per transferred embryo, chemical pregnancy rate, spontaneous abortion rate, implantation rate and clinical pregnancy rate), none of which showed any difference statistically significant in conduct.Conclusions: The data concluded that there is no statistical significance between expectant management and polypectomy.

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