BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children w...BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children with Robert’s uterus who was examined and treated by laparoscopy and hysteroscopy.Unlike the existing cases reported in the literature,this patient had a late onset of Robert’s uterus symptoms.Due to right tubal ectopic pregnancy 3 years previously,the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain.She was examined and treated by laparoscopy and hysteroscopy,and is completely asymptomatic at 5-year followup.CONCLUSION The typical obstructive Mullerian abnormality requires further surgery.Combined laparoscopy and hysteroscopy is an effective,minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.展开更多
Uterine arteriovenous malformations (UAVMs) are not common and are not well known. They are mainly manifested by hemorrhages that can be life-threatening. Their diagnosis is based mainly on ultrasound coupled with Dop...Uterine arteriovenous malformations (UAVMs) are not common and are not well known. They are mainly manifested by hemorrhages that can be life-threatening. Their diagnosis is based mainly on ultrasound coupled with Doppler flow, as well as pelvic magnetic resonance imaging and angiography. In the absence of a consensus, and based on our experience, we discuss the place of hysteroscopy in the therapeutic strategy of UAVM. We reported 3 cases of UAVM, and we performed a review of the literature concerning the diagnosis and treatment of this pathology. We finally collected the advantages of the embolization-hysteroscopy sequence. In fact, the data suggest that hysteroscopy is a feasible and safe alternative treatment modality for UAVM. We believe that the resection of UAVM can be done under optimal conditions with a reduced risk of bleeding. Hysteroscopy would allow for optimal evaluation of the uterine cavity after treatment as well as the possibility of applying an anti-adhesive gel. In addition, the combination of hysteroscopy and embolization would require less healing time and shorter follow-up than embolization alone. It could also reduce the number of patients lost to follow-up.展开更多
Generally, hysteroscopy is not appropriate for pregnant women without an indication. What if a patient undergoes hysteroscopy accidentally during the early gestational period? We here report a rare case of a woman who...Generally, hysteroscopy is not appropriate for pregnant women without an indication. What if a patient undergoes hysteroscopy accidentally during the early gestational period? We here report a rare case of a woman who continued pregnancy after a diagnostic hysteroscopy was performed in early pregnancy and delivered a healthy baby. The patient had a history of infertility and oligomenorrhea, probably due to a previous induced abortion. A hysteroscopy was performed after the end of her "menstruation" for assessment of her uterine cavity. Early pregnancy, instead of the expected intrauterine adhesions, was suspected, and the procedure was immediately ceased. Subsequent tests confirmed the diagnosis of pregnancy. She had a fullterm delivery by elective caesarean section. The success of this case was attributed to the use of vaginoscopic techniques in hysteroscopy and correct judgment and decision-making during the procedure. This case report provides some useful methods and experience that might be helpful when a similar situation occurs in clinical practice.展开更多
BACKGROUND Cervical pregnancy is increasing in morbidity,and a definite diagnosis in early stages is challenging due to its specific onset site.Surgery is the mainstay of treatment for cervical pregnancy,but it may re...BACKGROUND Cervical pregnancy is increasing in morbidity,and a definite diagnosis in early stages is challenging due to its specific onset site.Surgery is the mainstay of treatment for cervical pregnancy,but it may result in the loss of natural fertility.Therefore,it is a great challenge to pursue a safe and effective treatment for cervical pregnancy.CASE SUMMARY We report the case of a cervical pregnancy successfully treated by ultrasoundguided cervical-intramuscular lauromacrogol injection combined with hysteroscopy.A 23-year-old woman with minor irregular vaginal bleeding was admitted to our department with suspected ectopic pregnancy.Transvaginal ultrasound revealed a gestational sac(approximately 22 mm x 13 mm)situated in the cervical canal with a yolk sac and blood flow signals.No cardiac activity was detected.Serum beta progesterone was 17.06 ng/m L,and serum beta human chorionic gonadotropin(β-HCG)was 5077.0 IU/L.The patient was diagnosed with cervical pregnancy.She was treated by ultrasound-guided cervicalintramuscular injections of lauromacrogol(3 m L)in combination with aborting under hysteroscopic visualization.A gradual decrease inβ-HCG levels and normal ultrasound findings were observed.Postoperative pathologic examination showed the presence of villi and changes in the endometrium in the secretory phase.The patient was discharged on day 6,and herβ-HCG level was 0.67 m IU/m L after 1 wk.There was no statistical difference between baseline and 1-week postoperative data in terms of serum indices including liver function,renal function,and routine blood analysis after treatment.The patient subsequently became pregnant 2 mo later and no abnormalities were detected on routine screening during pregnancy.CONCLUSION Ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy may be effective and safe in the treatment of cervical pregnancy.展开更多
A 27-year-old patient was diagnosed by hysteroscopy with uterine diverticulum in pregnancy and admitted to the hospital. Under the guidance of hysteroscopy combined with methotrexate, the scraping of the uterus was do...A 27-year-old patient was diagnosed by hysteroscopy with uterine diverticulum in pregnancy and admitted to the hospital. Under the guidance of hysteroscopy combined with methotrexate, the scraping of the uterus was done and operation successfully completed. The management of this case showed that hysteroscopy was a kind of valuable approach to the diagnosis and treatment of uterine diverticulum and curettage of the uterus under hysteroscope combined with drug was a safe, effective and conservative treatment.展开更多
Postmenopausal bleeding is a very common and alarming symptom accounting for 5 percent of all gynecological outpatients’ clinic attendances. This cross-section study was conducted in the Department of Obstetrics and ...Postmenopausal bleeding is a very common and alarming symptom accounting for 5 percent of all gynecological outpatients’ clinic attendances. This cross-section study was conducted in the Department of Obstetrics and Gynecology </span><span style="font-family:Verdana;">at University Hospitals and included 176 patients with perimenopausal bleeding </span><span style="font-family:Verdana;">who attended a patient clinic during the period from January 2017 to May 2019. All patients were subjected to transvaginal ultrasound, saline sonohysterography and out-patient endometrial sampling using pipelle;all the results were compared to histopathology obtained by hysteroscopic guided biopsy and/or hysterectomy. </span><b><span style="font-family:Verdana;">Result: </span></b><span style="font-family:Verdana;">In comparing the validity of TVS and SHG we found highly significant decrease in malignancy assessment in </span><span><span style="font-family:Verdana;">the TVS method compared to hysteroscopic-guided biopsy. According to the validity of pipelle in detection of malignant lesion, it was found to detect 80 cases out of 88 cases of malignancy with sensitivity 90.9%, specificity 100% and 95.45% accuracy with respect to histopathology by hysteroscopy guided biopsy and/or hysterectomy. Combination tests were done between SHG and pipelle and we found that the validity of combination tests in detecting malignancy improves the sensitivity and specificity in detection of malignancy sensitivity = 100% and specificity = 100% and this was found to be as an effective method in detection of malignancy. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> When SHG combined to outpatient endometrial sampling “pipelle”, the results were the same as hysteroscopy.展开更多
Objective: The purpose of this study was to evaluate the efficacy, safety, and benefits of hysteroscopic surgery in the treatment of dysfunctional uterine bleeding (DUB) or intrauterine lesions causing uterine bleedin...Objective: The purpose of this study was to evaluate the efficacy, safety, and benefits of hysteroscopic surgery in the treatment of dysfunctional uterine bleeding (DUB) or intrauterine lesions causing uterine bleeding. Methods: This study prospectively enrolled 100 patients who underwent operative hysteroscopy in tertiary referral university center because of uterine bleeding due to endometrial polyps or uterine submucosal leiomyomas diagnosed by transvaginal ultrasonogram. Indications for the operative hysteroscopies included abnormal uterine bleeding (AUB), ultrasound findings indicative of intrauterine lesions, and DUB. After operative hysteroscopic management, we inserted anti-adhesive solution, sodium hyaluronate and carboxymethyl cellulose into the uterine cavity. Results: Operative hysteroscopy was a successful procedure in 100 of 100 cases (100%) but it needed to be repeated in three cases with large uterine submucosal leiomyoma and after two endometrial polypectomy. Mean duration of the procedure was 23.2 minutes (range 5 - 67) and postoperative hospital stay was 7 hours (range 3 - 48). Most common indication was DUB (39%), submucosal leiomyoma was 21%, and endometrial polyp was 17%. There were five cases with postoperative uterine bleeding and none with fluid overload syndrome. During postoperative follow-up (3 - 28 months) the majority of patients (90/100, 90%) were free of symptoms. Conclusion: Hysteroscopic procedure is an effective and safe method for the management of benign intracavitary pathology or the treatment of dysfunctional uterine bleeding. Although sodium hyaluronate and carboxymethyl cellulose seems to be effective in the prevention of adhesion in uterine cavity, further study will be needed to prove the effectiveness of anti-adhesive solution.展开更多
Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding ...Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 - 49 yrs. 81.2% of patients have body mass index above 25 kg/m2. Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS);they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.展开更多
Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa...Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.展开更多
With an incidence of 0.005%,unscarred uterine rupture is extremely rare.It is difficult to diagnose uterine rupture because of the absence of characteristic clinical symptoms.Here,we report a rare case of a 31-year-ol...With an incidence of 0.005%,unscarred uterine rupture is extremely rare.It is difficult to diagnose uterine rupture because of the absence of characteristic clinical symptoms.Here,we report a rare case of a 31-year-old woman with a uterine rupture that was accurately diagnosed and repaired by laparoscopy and hysteroscopy on postpartum day 69.The patient recovered uneventfully and was discharged on postoperative day 4.Three months after surgery,pelvic magnetic resonance imaging was performed,which confirmed wound repair.In women with a stable condition,laparoscopy with hysteroscopy could be an alternative choice for the diagnosis and treatment of suspected uterine rupture;however,more substantial studies are needed to confirm this surgical approach.展开更多
Objective: To evaluate the role of chromohysteroscopy in improving diagnostic accuracy of endometrial biopsy in cases of AUB. Design: Cross sectional interventional study. Materials and Methods: This study was conduct...Objective: To evaluate the role of chromohysteroscopy in improving diagnostic accuracy of endometrial biopsy in cases of AUB. Design: Cross sectional interventional study. Materials and Methods: This study was conducted on 60 women with AUB in Dept. of Obst. & Gyne at King George Medical University, Lucknow over a period of one year. All cases underwent diagnostic hysteroscopy followed by chromohysteroscopy using 2% methylene blue dye. Hysteroscopic guided biopsy was taken from stained and unstained areas followed by an endometrial aspiration biopsy from whole uterine cavity. The histopathology results of three samples were compared and analyzed in relation with staining pattern and type of AUB. Data analysis was done on SPSS version 15 of windows 2007. Results: Out of 60 cases, 11cases were found to have non hormonal pathology after chromohysterosopic biopsy. Eight (72.72%) cases were diagnosed by stained endometrial tissue, one (9.09%) by unstained tissue and three (27.27%) by endometrial aspiration. The diagnostic ability of stained tissue biopsy was significantly higher (p = 0.006) than unstained biopsy and endometrial aspiration. Conclusion: Chromohysteroscopy is a simple and effective technique for diagnosing endometrial pathology in cases of AUB.展开更多
A 42 years old woman suffering from repeated events of intensive vaginal bleeding during the week off birth control pills was referred for diagnostic hysteroscopy. The patient underwent hysterohy drosonoscopy, a 3-ste...A 42 years old woman suffering from repeated events of intensive vaginal bleeding during the week off birth control pills was referred for diagnostic hysteroscopy. The patient underwent hysterohy drosonoscopy, a 3-step procedure, including a transvaginal ultrasound scan, a diagnostic hysteroscopy and immediate hydrosonography. A3 cmintramural myoma was detected by the ultrasound scan without impinging onto the uterine cavity as visualized by diagnostic hysteroscopy. However, continuous hydrosonographic evaluation of the uterus, performed immediately afterwards, unveiled a fibroid with a significant intracavitary portion. A falsely normal cavity could be appreciated by high pressured hysteroscopy, while during the gradual fall of the intracavitary pressure a significant lesion could be revealed encroaching into the lumen. In the absence of an agreed distention pressure range during hysteroscopy, an immediate hydrosonography may serve as an auxiliary tool to follow the uterine wall contour as distention pressure declines during the eventual escape of the distention fluid from the lumen. Uterine wall contour is heavily dependent on the distension pressure and guidelines for intrcavitary pressure during hysteroscopy are evidently needed.展开更多
Background: Overall, the use of antibiotics is increasing. We noticed different practices amongst different hospitals in their prophylactic use of antibiotics during operative hysteroscopy. This review investigates wh...Background: Overall, the use of antibiotics is increasing. We noticed different practices amongst different hospitals in their prophylactic use of antibiotics during operative hysteroscopy. This review investigates whether there is sufficient evidence to recommend antibiotic prophylaxis in operative hysteroscopy. Methods: We performed a systematic search in “Pubmed” using “hysteroscopy” and “antibiotic” and “prophylaxis” as search items. We found 16 hits of which 4 were suitable to include in our review. Findings: In an included Cochrane review no conclusion was drawn since no articles could be included. A prospective study by Nappi?et al.?[1]?support the recommendation of the American College of Obstetricians and Gynaecologists not to prescribe routinely antibiotic prophylaxis in cases of hysteroscopic surgery. Bhattacharya?et al. conducted a prospective study that was ended prematurely. They conclude that there is no convincing evidence that prophylactic antibiotics are of value in hysteroscopy. A review by Morrill?et al. yielded no new data. Conclusion: We did not find a significant increase in clinical relevant infectious symptoms after hysteroscopy in women treated with or without antibiotic prophylaxis, although data are insufficient to draw a definite conclusion. Therefore, we suggest a prospective study is mandatory on this topic.展开更多
Objective: To apply office hysteroscopy in assessment/management of patients with recurrent miscarriage, thus to/or not to recommend office hysteroscopy as a routine procedure in such cases. Study design: Retrospectiv...Objective: To apply office hysteroscopy in assessment/management of patients with recurrent miscarriage, thus to/or not to recommend office hysteroscopy as a routine procedure in such cases. Study design: Retrospective analysis. Setting: University hospital’s outpatient abortion clinic. Subjects & Methodology: Patients’ records during the period between March 2015 and January 2017 for subjects with at least 2 previous miscarriages, who had undergone office hysteroscopy were reviewed. Results: Cases with 2 previous miscarriages (n = 95) were assessed and compared with those with 3 or more miscarriages (n = 105). Abnormal uterine findings were diagnosed in 24.1% of the former, and 43.8% of the latter group. The prevalence of uterine lesions among cases with 2 recurrent miscarriages was 42.1%;meanwhile, for subjects with 3 or more consecutive miscarriages, it was 43.8%. Conclusion: In addition to safety profile, simplicity and outpatient basis of use, outpatient hysteroscopy in recurrent miscarriages would be an added-value to practitioners as a diagnostic and therapeutic tool.展开更多
Objectives: To facilitate embryo transfer technique in cases with previous failed or difficult transfer using office hysteroscopy. Study Design: Case report of 3 cases of previous difficult embryo transfer (ET). Metho...Objectives: To facilitate embryo transfer technique in cases with previous failed or difficult transfer using office hysteroscopy. Study Design: Case report of 3 cases of previous difficult embryo transfer (ET). Methods: Hysteroscopic assisted insertion of cervical stent at the end of withdrawal bleeding in the stimulation cycle. This stent was used as a track for embryo transfer catheter. Results: One case cancelled before (embryo transfer) ET and the other 2 cases didn’t get pregnant in spite of easy embryo transfer. Conclusion: This hysteroscopic assisted ET technique may facilitate ET technique in cases with difficult embryo transfer due to deformed cervix.展开更多
From July 1991 to June 1996 169 cases of tubal infertility were treated by surgery combined laparoscopy and hysteroscopy. The Procedure include: Adhesiolysis of perisalpingoovaritis , dilation of fallopian tube, salpi...From July 1991 to June 1996 169 cases of tubal infertility were treated by surgery combined laparoscopy and hysteroscopy. The Procedure include: Adhesiolysis of perisalpingoovaritis , dilation of fallopian tube, salpingostomy, endometriosis cantery, enucleation and puncture of endometrioma, excision of Morgani cyst. Meanwhile hysteroscopic catheterization and hydrotubaation monitoring by laparoscopy.Result:135 cases were followed up. The mean follow-up time was 18.4 month.70 cases became pregnant (pregnant rate 51.8%). 67 of them had intrauterine Pregnancy and three cases were ectopic pregnancies. The surgery combined laparoscopy and hysteroscopy to treat tubal infertility is simple, effective, less-harmful and the patients had rapid recovery.展开更多
Objective:Rising cesarean section rates have led to an increase in cesarean scar defects.However,there is no consensus regarding the gold standard for treating cesarean scar defects.This study aims to compare the effi...Objective:Rising cesarean section rates have led to an increase in cesarean scar defects.However,there is no consensus regarding the gold standard for treating cesarean scar defects.This study aims to compare the efficacy of laparoscopy combined with hysteroscopy and hysteroscopy in treating cesarean scar defects.Methods:An electronic search of the MEDLINE,EMBASE,and Clinical Trials.gov databases was conducted in May 2020,utilizing combinations of relevant medical subject headings for“cesarean scar defect”,“laparoscope”,and“hysteroscope”.Reference lists of relevant articles and reviews were hand-searched for additional reports.Observed outcomes included menstruation after surgery,blood loss,operative time,and further fertility.Results:Eight studies with 467 patients were included.The menstruation duration after surgery for the laparoscopy combined with hysteroscopy group and hysteroscopy group was comparable.While the laparoscopy combined with hysteroscopy group trended to have less blood loss(mean difference 49.60,95%CI:42.12e57.09,p<0.05)and shorter operative time(mean difference 60.40,95%CI:53.33e67.48,p<0.05)compared to hysteroscopy group.And 26 out of 51 patients were able to achieve pregnancy for those choosing the laparoscopy combined with hysteroscopy.Conclusions:Patients with cesarean scar defect should choose the appropriate technique considering their age,residual myometrial thickness,desire for further fertility,and gynecological inflammation.The current study lacked evidence to prove that laparoscopy combined with hysteroscopy is superior to hysteroscopy.展开更多
Background Diagnostic hysteroscopy and directed biopsy has been widely used to evaluate abnormal uterine bleeding. We aimed to explore the value of hysteroscopy and directed biopsy in the diagnosis of endometrial carc...Background Diagnostic hysteroscopy and directed biopsy has been widely used to evaluate abnormal uterine bleeding. We aimed to explore the value of hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma.Methods Two hundred and eighty-seven patients with endometrial carcinoma who were treated in Beijing University People＇s Hospital, Beijing, China were distributed into 2 groups： Group A （90 patients） was examined using hysteroscopy and directed biopsy, and Group B （197 patients） was examined using fractional dilatation and curettage （D＆C）. The diagnostic veracity of the two methods, the rate of positive peritoneal cytology and the prognosis of the 2 groups were compared.Results In Group A, 97.8% （88/90） of patients were diagnosed pathologically before surgery; the rate was 88.8% （175/197） for Group B. The difference between the 2 groups was statistically significant （P ＜0.05）. The sensitivity,specificity, positive predictive value and negative predictive value for the two methods for detecting cervical involvement were 77.8%, 100%, 100% and 97.6% for Group Aand 65.3%, 92.6%, 74.4% and 90.0% for Group B, respectively. The positive peritoneal cytology rate was 5.6% （5/90） in Group A and 6.09% （12/197） in Group B. The difference was not statistically significant （P ＞0.05）. The 3-year and 5-year overall survival rates were 91.4% （33/36） and 82.4% （14/17） for Group A and 95.6% （87/91） and 86.7% （39/45） for Group B. There were no statistically significant differences between the two groups＇ survival rates （P ＞0.05）.Conclusion Compared with fractional D＆C, hysteroscopy and directed biopsy offered improved pathological diagnostic accuracy before surgery and discovered cervical involvement more precisely in endometrial carcinoma patients, but it did not increase the positive peritoneal cytology rate or affect the prognosis of these patients.展开更多
Objective To introduce the procedures, preliminary experience, and advantages of operation using combination of hysteroscopy and laparoscopy. Methods Sixty five women underwent transcervical resection of endometri...Objective To introduce the procedures, preliminary experience, and advantages of operation using combination of hysteroscopy and laparoscopy. Methods Sixty five women underwent transcervical resection of endometrium (11), myoma (38), polyp (2), septa (9), adhesion (1) or foreign body (4). All had the indications for simultaneous laparoscopic monitoring and operation. They were first diagnosed laparoscopically to decide the type of laparoscopic operation. Then they were treated hysteroscopically and finally received laparoscopic operation. Results Laparoscopic examinations confirmed the original diagnoses, revealed the causes of pelvic pain in 8 patients, and detected ovarian cyst, endometriosis, and pelvic adhesion in 5. Two cases of uterine perforation were found by laparoscopic monitoring. Thirty laparoscopic operations included removal or puncture of ovarian cyst, lysis of adhesion, coagulation of endometriosis, Rubin's test, and partial salpingectomy. The postoperative course was smooth and the operative result was satisfactory. Conclusions Operations using combination of hysteroscopy and laparoscopy are safe and effective. They also reduce the pain, and save the time and money of patients. Laparoscopic monitoring may detect uterine perforation in time.展开更多
文摘BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children with Robert’s uterus who was examined and treated by laparoscopy and hysteroscopy.Unlike the existing cases reported in the literature,this patient had a late onset of Robert’s uterus symptoms.Due to right tubal ectopic pregnancy 3 years previously,the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain.She was examined and treated by laparoscopy and hysteroscopy,and is completely asymptomatic at 5-year followup.CONCLUSION The typical obstructive Mullerian abnormality requires further surgery.Combined laparoscopy and hysteroscopy is an effective,minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.
文摘Uterine arteriovenous malformations (UAVMs) are not common and are not well known. They are mainly manifested by hemorrhages that can be life-threatening. Their diagnosis is based mainly on ultrasound coupled with Doppler flow, as well as pelvic magnetic resonance imaging and angiography. In the absence of a consensus, and based on our experience, we discuss the place of hysteroscopy in the therapeutic strategy of UAVM. We reported 3 cases of UAVM, and we performed a review of the literature concerning the diagnosis and treatment of this pathology. We finally collected the advantages of the embolization-hysteroscopy sequence. In fact, the data suggest that hysteroscopy is a feasible and safe alternative treatment modality for UAVM. We believe that the resection of UAVM can be done under optimal conditions with a reduced risk of bleeding. Hysteroscopy would allow for optimal evaluation of the uterine cavity after treatment as well as the possibility of applying an anti-adhesive gel. In addition, the combination of hysteroscopy and embolization would require less healing time and shorter follow-up than embolization alone. It could also reduce the number of patients lost to follow-up.
文摘Generally, hysteroscopy is not appropriate for pregnant women without an indication. What if a patient undergoes hysteroscopy accidentally during the early gestational period? We here report a rare case of a woman who continued pregnancy after a diagnostic hysteroscopy was performed in early pregnancy and delivered a healthy baby. The patient had a history of infertility and oligomenorrhea, probably due to a previous induced abortion. A hysteroscopy was performed after the end of her "menstruation" for assessment of her uterine cavity. Early pregnancy, instead of the expected intrauterine adhesions, was suspected, and the procedure was immediately ceased. Subsequent tests confirmed the diagnosis of pregnancy. She had a fullterm delivery by elective caesarean section. The success of this case was attributed to the use of vaginoscopic techniques in hysteroscopy and correct judgment and decision-making during the procedure. This case report provides some useful methods and experience that might be helpful when a similar situation occurs in clinical practice.
文摘BACKGROUND Cervical pregnancy is increasing in morbidity,and a definite diagnosis in early stages is challenging due to its specific onset site.Surgery is the mainstay of treatment for cervical pregnancy,but it may result in the loss of natural fertility.Therefore,it is a great challenge to pursue a safe and effective treatment for cervical pregnancy.CASE SUMMARY We report the case of a cervical pregnancy successfully treated by ultrasoundguided cervical-intramuscular lauromacrogol injection combined with hysteroscopy.A 23-year-old woman with minor irregular vaginal bleeding was admitted to our department with suspected ectopic pregnancy.Transvaginal ultrasound revealed a gestational sac(approximately 22 mm x 13 mm)situated in the cervical canal with a yolk sac and blood flow signals.No cardiac activity was detected.Serum beta progesterone was 17.06 ng/m L,and serum beta human chorionic gonadotropin(β-HCG)was 5077.0 IU/L.The patient was diagnosed with cervical pregnancy.She was treated by ultrasound-guided cervicalintramuscular injections of lauromacrogol(3 m L)in combination with aborting under hysteroscopic visualization.A gradual decrease inβ-HCG levels and normal ultrasound findings were observed.Postoperative pathologic examination showed the presence of villi and changes in the endometrium in the secretory phase.The patient was discharged on day 6,and herβ-HCG level was 0.67 m IU/m L after 1 wk.There was no statistical difference between baseline and 1-week postoperative data in terms of serum indices including liver function,renal function,and routine blood analysis after treatment.The patient subsequently became pregnant 2 mo later and no abnormalities were detected on routine screening during pregnancy.CONCLUSION Ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy may be effective and safe in the treatment of cervical pregnancy.
文摘A 27-year-old patient was diagnosed by hysteroscopy with uterine diverticulum in pregnancy and admitted to the hospital. Under the guidance of hysteroscopy combined with methotrexate, the scraping of the uterus was done and operation successfully completed. The management of this case showed that hysteroscopy was a kind of valuable approach to the diagnosis and treatment of uterine diverticulum and curettage of the uterus under hysteroscope combined with drug was a safe, effective and conservative treatment.
文摘Postmenopausal bleeding is a very common and alarming symptom accounting for 5 percent of all gynecological outpatients’ clinic attendances. This cross-section study was conducted in the Department of Obstetrics and Gynecology </span><span style="font-family:Verdana;">at University Hospitals and included 176 patients with perimenopausal bleeding </span><span style="font-family:Verdana;">who attended a patient clinic during the period from January 2017 to May 2019. All patients were subjected to transvaginal ultrasound, saline sonohysterography and out-patient endometrial sampling using pipelle;all the results were compared to histopathology obtained by hysteroscopic guided biopsy and/or hysterectomy. </span><b><span style="font-family:Verdana;">Result: </span></b><span style="font-family:Verdana;">In comparing the validity of TVS and SHG we found highly significant decrease in malignancy assessment in </span><span><span style="font-family:Verdana;">the TVS method compared to hysteroscopic-guided biopsy. According to the validity of pipelle in detection of malignant lesion, it was found to detect 80 cases out of 88 cases of malignancy with sensitivity 90.9%, specificity 100% and 95.45% accuracy with respect to histopathology by hysteroscopy guided biopsy and/or hysterectomy. Combination tests were done between SHG and pipelle and we found that the validity of combination tests in detecting malignancy improves the sensitivity and specificity in detection of malignancy sensitivity = 100% and specificity = 100% and this was found to be as an effective method in detection of malignancy. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> When SHG combined to outpatient endometrial sampling “pipelle”, the results were the same as hysteroscopy.
文摘Objective: The purpose of this study was to evaluate the efficacy, safety, and benefits of hysteroscopic surgery in the treatment of dysfunctional uterine bleeding (DUB) or intrauterine lesions causing uterine bleeding. Methods: This study prospectively enrolled 100 patients who underwent operative hysteroscopy in tertiary referral university center because of uterine bleeding due to endometrial polyps or uterine submucosal leiomyomas diagnosed by transvaginal ultrasonogram. Indications for the operative hysteroscopies included abnormal uterine bleeding (AUB), ultrasound findings indicative of intrauterine lesions, and DUB. After operative hysteroscopic management, we inserted anti-adhesive solution, sodium hyaluronate and carboxymethyl cellulose into the uterine cavity. Results: Operative hysteroscopy was a successful procedure in 100 of 100 cases (100%) but it needed to be repeated in three cases with large uterine submucosal leiomyoma and after two endometrial polypectomy. Mean duration of the procedure was 23.2 minutes (range 5 - 67) and postoperative hospital stay was 7 hours (range 3 - 48). Most common indication was DUB (39%), submucosal leiomyoma was 21%, and endometrial polyp was 17%. There were five cases with postoperative uterine bleeding and none with fluid overload syndrome. During postoperative follow-up (3 - 28 months) the majority of patients (90/100, 90%) were free of symptoms. Conclusion: Hysteroscopic procedure is an effective and safe method for the management of benign intracavitary pathology or the treatment of dysfunctional uterine bleeding. Although sodium hyaluronate and carboxymethyl cellulose seems to be effective in the prevention of adhesion in uterine cavity, further study will be needed to prove the effectiveness of anti-adhesive solution.
文摘Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 - 49 yrs. 81.2% of patients have body mass index above 25 kg/m2. Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS);they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.
文摘Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.
文摘With an incidence of 0.005%,unscarred uterine rupture is extremely rare.It is difficult to diagnose uterine rupture because of the absence of characteristic clinical symptoms.Here,we report a rare case of a 31-year-old woman with a uterine rupture that was accurately diagnosed and repaired by laparoscopy and hysteroscopy on postpartum day 69.The patient recovered uneventfully and was discharged on postoperative day 4.Three months after surgery,pelvic magnetic resonance imaging was performed,which confirmed wound repair.In women with a stable condition,laparoscopy with hysteroscopy could be an alternative choice for the diagnosis and treatment of suspected uterine rupture;however,more substantial studies are needed to confirm this surgical approach.
文摘Objective: To evaluate the role of chromohysteroscopy in improving diagnostic accuracy of endometrial biopsy in cases of AUB. Design: Cross sectional interventional study. Materials and Methods: This study was conducted on 60 women with AUB in Dept. of Obst. & Gyne at King George Medical University, Lucknow over a period of one year. All cases underwent diagnostic hysteroscopy followed by chromohysteroscopy using 2% methylene blue dye. Hysteroscopic guided biopsy was taken from stained and unstained areas followed by an endometrial aspiration biopsy from whole uterine cavity. The histopathology results of three samples were compared and analyzed in relation with staining pattern and type of AUB. Data analysis was done on SPSS version 15 of windows 2007. Results: Out of 60 cases, 11cases were found to have non hormonal pathology after chromohysterosopic biopsy. Eight (72.72%) cases were diagnosed by stained endometrial tissue, one (9.09%) by unstained tissue and three (27.27%) by endometrial aspiration. The diagnostic ability of stained tissue biopsy was significantly higher (p = 0.006) than unstained biopsy and endometrial aspiration. Conclusion: Chromohysteroscopy is a simple and effective technique for diagnosing endometrial pathology in cases of AUB.
文摘A 42 years old woman suffering from repeated events of intensive vaginal bleeding during the week off birth control pills was referred for diagnostic hysteroscopy. The patient underwent hysterohy drosonoscopy, a 3-step procedure, including a transvaginal ultrasound scan, a diagnostic hysteroscopy and immediate hydrosonography. A3 cmintramural myoma was detected by the ultrasound scan without impinging onto the uterine cavity as visualized by diagnostic hysteroscopy. However, continuous hydrosonographic evaluation of the uterus, performed immediately afterwards, unveiled a fibroid with a significant intracavitary portion. A falsely normal cavity could be appreciated by high pressured hysteroscopy, while during the gradual fall of the intracavitary pressure a significant lesion could be revealed encroaching into the lumen. In the absence of an agreed distention pressure range during hysteroscopy, an immediate hydrosonography may serve as an auxiliary tool to follow the uterine wall contour as distention pressure declines during the eventual escape of the distention fluid from the lumen. Uterine wall contour is heavily dependent on the distension pressure and guidelines for intrcavitary pressure during hysteroscopy are evidently needed.
文摘Background: Overall, the use of antibiotics is increasing. We noticed different practices amongst different hospitals in their prophylactic use of antibiotics during operative hysteroscopy. This review investigates whether there is sufficient evidence to recommend antibiotic prophylaxis in operative hysteroscopy. Methods: We performed a systematic search in “Pubmed” using “hysteroscopy” and “antibiotic” and “prophylaxis” as search items. We found 16 hits of which 4 were suitable to include in our review. Findings: In an included Cochrane review no conclusion was drawn since no articles could be included. A prospective study by Nappi?et al.?[1]?support the recommendation of the American College of Obstetricians and Gynaecologists not to prescribe routinely antibiotic prophylaxis in cases of hysteroscopic surgery. Bhattacharya?et al. conducted a prospective study that was ended prematurely. They conclude that there is no convincing evidence that prophylactic antibiotics are of value in hysteroscopy. A review by Morrill?et al. yielded no new data. Conclusion: We did not find a significant increase in clinical relevant infectious symptoms after hysteroscopy in women treated with or without antibiotic prophylaxis, although data are insufficient to draw a definite conclusion. Therefore, we suggest a prospective study is mandatory on this topic.
文摘Objective: To apply office hysteroscopy in assessment/management of patients with recurrent miscarriage, thus to/or not to recommend office hysteroscopy as a routine procedure in such cases. Study design: Retrospective analysis. Setting: University hospital’s outpatient abortion clinic. Subjects & Methodology: Patients’ records during the period between March 2015 and January 2017 for subjects with at least 2 previous miscarriages, who had undergone office hysteroscopy were reviewed. Results: Cases with 2 previous miscarriages (n = 95) were assessed and compared with those with 3 or more miscarriages (n = 105). Abnormal uterine findings were diagnosed in 24.1% of the former, and 43.8% of the latter group. The prevalence of uterine lesions among cases with 2 recurrent miscarriages was 42.1%;meanwhile, for subjects with 3 or more consecutive miscarriages, it was 43.8%. Conclusion: In addition to safety profile, simplicity and outpatient basis of use, outpatient hysteroscopy in recurrent miscarriages would be an added-value to practitioners as a diagnostic and therapeutic tool.
文摘Objectives: To facilitate embryo transfer technique in cases with previous failed or difficult transfer using office hysteroscopy. Study Design: Case report of 3 cases of previous difficult embryo transfer (ET). Methods: Hysteroscopic assisted insertion of cervical stent at the end of withdrawal bleeding in the stimulation cycle. This stent was used as a track for embryo transfer catheter. Results: One case cancelled before (embryo transfer) ET and the other 2 cases didn’t get pregnant in spite of easy embryo transfer. Conclusion: This hysteroscopic assisted ET technique may facilitate ET technique in cases with difficult embryo transfer due to deformed cervix.
文摘From July 1991 to June 1996 169 cases of tubal infertility were treated by surgery combined laparoscopy and hysteroscopy. The Procedure include: Adhesiolysis of perisalpingoovaritis , dilation of fallopian tube, salpingostomy, endometriosis cantery, enucleation and puncture of endometrioma, excision of Morgani cyst. Meanwhile hysteroscopic catheterization and hydrotubaation monitoring by laparoscopy.Result:135 cases were followed up. The mean follow-up time was 18.4 month.70 cases became pregnant (pregnant rate 51.8%). 67 of them had intrauterine Pregnancy and three cases were ectopic pregnancies. The surgery combined laparoscopy and hysteroscopy to treat tubal infertility is simple, effective, less-harmful and the patients had rapid recovery.
文摘Objective:Rising cesarean section rates have led to an increase in cesarean scar defects.However,there is no consensus regarding the gold standard for treating cesarean scar defects.This study aims to compare the efficacy of laparoscopy combined with hysteroscopy and hysteroscopy in treating cesarean scar defects.Methods:An electronic search of the MEDLINE,EMBASE,and Clinical Trials.gov databases was conducted in May 2020,utilizing combinations of relevant medical subject headings for“cesarean scar defect”,“laparoscope”,and“hysteroscope”.Reference lists of relevant articles and reviews were hand-searched for additional reports.Observed outcomes included menstruation after surgery,blood loss,operative time,and further fertility.Results:Eight studies with 467 patients were included.The menstruation duration after surgery for the laparoscopy combined with hysteroscopy group and hysteroscopy group was comparable.While the laparoscopy combined with hysteroscopy group trended to have less blood loss(mean difference 49.60,95%CI:42.12e57.09,p<0.05)and shorter operative time(mean difference 60.40,95%CI:53.33e67.48,p<0.05)compared to hysteroscopy group.And 26 out of 51 patients were able to achieve pregnancy for those choosing the laparoscopy combined with hysteroscopy.Conclusions:Patients with cesarean scar defect should choose the appropriate technique considering their age,residual myometrial thickness,desire for further fertility,and gynecological inflammation.The current study lacked evidence to prove that laparoscopy combined with hysteroscopy is superior to hysteroscopy.
文摘Background Diagnostic hysteroscopy and directed biopsy has been widely used to evaluate abnormal uterine bleeding. We aimed to explore the value of hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma.Methods Two hundred and eighty-seven patients with endometrial carcinoma who were treated in Beijing University People＇s Hospital, Beijing, China were distributed into 2 groups： Group A （90 patients） was examined using hysteroscopy and directed biopsy, and Group B （197 patients） was examined using fractional dilatation and curettage （D＆C）. The diagnostic veracity of the two methods, the rate of positive peritoneal cytology and the prognosis of the 2 groups were compared.Results In Group A, 97.8% （88/90） of patients were diagnosed pathologically before surgery; the rate was 88.8% （175/197） for Group B. The difference between the 2 groups was statistically significant （P ＜0.05）. The sensitivity,specificity, positive predictive value and negative predictive value for the two methods for detecting cervical involvement were 77.8%, 100%, 100% and 97.6% for Group Aand 65.3%, 92.6%, 74.4% and 90.0% for Group B, respectively. The positive peritoneal cytology rate was 5.6% （5/90） in Group A and 6.09% （12/197） in Group B. The difference was not statistically significant （P ＞0.05）. The 3-year and 5-year overall survival rates were 91.4% （33/36） and 82.4% （14/17） for Group A and 95.6% （87/91） and 86.7% （39/45） for Group B. There were no statistically significant differences between the two groups＇ survival rates （P ＞0.05）.Conclusion Compared with fractional D＆C, hysteroscopy and directed biopsy offered improved pathological diagnostic accuracy before surgery and discovered cervical involvement more precisely in endometrial carcinoma patients, but it did not increase the positive peritoneal cytology rate or affect the prognosis of these patients.
文摘Objective To introduce the procedures, preliminary experience, and advantages of operation using combination of hysteroscopy and laparoscopy. Methods Sixty five women underwent transcervical resection of endometrium (11), myoma (38), polyp (2), septa (9), adhesion (1) or foreign body (4). All had the indications for simultaneous laparoscopic monitoring and operation. They were first diagnosed laparoscopically to decide the type of laparoscopic operation. Then they were treated hysteroscopically and finally received laparoscopic operation. Results Laparoscopic examinations confirmed the original diagnoses, revealed the causes of pelvic pain in 8 patients, and detected ovarian cyst, endometriosis, and pelvic adhesion in 5. Two cases of uterine perforation were found by laparoscopic monitoring. Thirty laparoscopic operations included removal or puncture of ovarian cyst, lysis of adhesion, coagulation of endometriosis, Rubin's test, and partial salpingectomy. The postoperative course was smooth and the operative result was satisfactory. Conclusions Operations using combination of hysteroscopy and laparoscopy are safe and effective. They also reduce the pain, and save the time and money of patients. Laparoscopic monitoring may detect uterine perforation in time.
