Office Operative Hysteroscopy: An Update

Salazar, Christina; Isaacson, Keith

doi:10.1016/j.jmig.2017.08.009

Cited by 145 publications

(113 citation statements)

References 66 publications

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“…Early hysteroscopy after TCRA played a key role in the follow‐up and was used to explore fresh adhesions. As previously reported, it was possible to separate the adhesion tissues with the hysteroscope body or cold microscissors, which not only normalized the uterine architecture but also avoided ablation effects from use of an energy device …”

Section: Discussionmentioning

confidence: 91%

Effects of early second‐look hysteroscopy combined with intrauterine balloon dilatation on reproductive outcomes for women with intrauterine adhesions

Sun

Shi

Liang

et al. 2020

Intl J Gynecology & Obste

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Objective:To investigate the effect of early second-look office hysteroscopy combined with intrauterine balloon dilatation on prognosis and pregnancy rate for women with intrauterine adhesions. Methods:A retrospective analysis of 156 women diagnosed with intrauterine adhesions by hysteroscopy at Shenyang Women's and Children 's Hospital, China, from April 2017 to January 2019. The study women underwent intrauterine balloon dilatation 10 days after transcervical resection of adhesion (TCRA) and hysteroscopy 20 days after TCRA (n=81). The control women underwent hysteroscopy 3 months after TCRA (n=75).Estrogen and aspirin were routinely administered postoperatively to all women. Data, including American Fertility Society (AFS) scores assessed by hysteroscopy, endometrial thickness measured by ultrasound, and menstruation and pregnancy outcomes assessed by interview, were compared between the two groups. Results:The degree of intrauterine adhesions, menstrual status, and endometrial thickness were improved in both groups after TCRA. Greater improvement in AFS score, menstruation, and endometrial thickness was observed in the study group than in the control group. After follow-up, more women in the study group achieved pregnancy (48.1% vs 30.7%, P<0.05). Conclusion:Early second-look of hysteroscopy combined with intrauterine balloon dilatation after hysteroscopic TRCA might improve the prognosis and postoperative pregnancy rate for women with intrauterine adhesions. K E Y W O R D S Balloon dilatation; Early second-look; Intrauterine adhesion; Prognosis; Reproductive outcomes; Transcervical resection of adhesion 1 | INTRODUCTION Intrauterine adhesions (IUA), also known as Asherman syndrome, are a common cause of secondary infertility among women of childbearing age. Endometrial damage caused by intrauterine operations or infections are the major causes of IUA, which lead to partial or complete occlusion of the uterine cavity. 1 IUAs are often secondary to intrauterine operations such as dilation and curettage. 2 Most effected women have hypomenorrhea, amenorrhea, and periodic abdominal pain, but a few also have normal menstruation. 2,3 Due to the high rate of induced abortion in China, the incidence of IUA is also increasing. 4 The prevalence of IUA is reported to be approximately | 193 Sun ET AL.20% after induced abortion, but rises to 40% for women with multiple intrauterine operations. 5Hysteroscopy is the gold standard for clinical diagnosis and treatment of IUA, 6 and most confirmed cases are treated by transcervical resection of adhesion (TCRA). However, the recurrence rate is up to 62.5%. 7 Several methods have been reported for preventing IUA recurrence, such as hyaluronic acid gel, artificial cycle hormone therapy, intrauterine balloon, and intrauterine devices; however, the effects are still uncertain. 8 Therefore, it is important to find a standardized strategy for managing women with IUA after TCRA surgery. Xu et al. 9 reported that early second-look hysteroscopy after hysteroscopic adhesiolysis (within...

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Section: Discussionmentioning

confidence: 91%

Effects of early second‐look hysteroscopy combined with intrauterine balloon dilatation on reproductive outcomes for women with intrauterine adhesions

Sun

Shi

Liang

et al. 2020

Intl J Gynecology & Obste

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“…Viable intrauterine pregnancy is a contraindication for hysteroscopy[ 1 ]. The procedure may cause infections or lead to abortion.…”

Section: Discussionmentioning

confidence: 99%

“…It can reduce the pain caused by use of a speculum and cervix dilation, which may induce a miscarriage. Vaginoscopy is now recommended as a standard technique for outpatient hysteroscopy[ 1 ].…”

Section: Discussionmentioning

confidence: 99%

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Live birth after hysteroscopy performed inadvertently during early pregnancy: A case report and review of literature

Zhao

Feng

2018

WJCC

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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 full-term 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.

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“…Hysteroscopy is a minimally invasive procedure considered as the gold standard for the evaluation and treatment of intrauterine diseases [1]. Currently available, small-diameter scopes have permitted the performance of in-office hysteroscopic procedures, allowing non-traumatic insertion into the cervix, a vaginoscopy technique [2].…”

Section: Introductionmentioning

confidence: 99%

The Development and Psychometric Validation of A Low-Cost Anthropomorphic 3D-Printout Simulator for Training Basic Skills Applicable to Office-Based Hysteroscopy

Panazzolo

Grando

Volpato

et al. 2020

Preprint

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Background Hysteroscopy training requires the development of specific psychomotor skills. Few validated low-cost models exist in hysteroscopy. The main objective of this study is to determine face, content and construct validity of a simulator designed for training basic hysteroscopy skills applied to office-based hysteroscopy.Methods Twenty-five hysteroscopy experts and 30 gynecology residents participated in this prospective observational study. The simulator consisted of three color-textured, silicone-coated anthropomorphic 3-dimensional (3-D) printout uterine models inside a box. Each uterine model in the simulator was designed to developed one of the following basic hysteroscopic skills: hysteroscopic navigation, direct biopsy, and foreign body removal. Participants performed five video-recorded simulation attempts on each model. Procedure-specific checklists were used to rate performance.Results Median scores (25th – 75th percentiles; p-value) 4 (3–4; p < 0.001) and surgical experience associated to the simulated procedures 4 (3–4; p < 0.001) indicated positive perceptions as to the realism of the internal cavity of the simulator. Median scores of 4 (3–4; p < 0.001) were assigned to the realism and utility of the tasks performed in the simulator for enhancing novice training in hysteroscopy. Expert performance scores were significantly higher and task completion times were significantly lower than those of novices in the navigation exercise (F(1,53) = 56.66; p < 0.001), the directed biopsy exercise (F(1,53) = 22.45; p < 0.001), and the foreign body removal exercise (F(1,53) = 58.51; p < 0.001). Novices´ performance improved on all three exercises: navigation exercise (F(1,53) = 182.44; p < 0.001); directed endometrial biopsy (F(1,53) = 110.53; p < 0.001); and foreign body removal (F(1,53) = 58.62; p < 0.001). Experts´ task completion times were significantly lower when compared to that of novices in the five attempts (p < 0,001) of the exercises: navigation (F(1,48) = 25.46; p < 0.001); directed biopsy (F(1,46) = 31.20; p < 0.001); and foreign body removal (F(1,50) = 69.8; p < 0.001). Novices´ task completion times diminished significantly throughout the sequence of exercises.Conclusions The low-cost simulator designed for the acquisition of basic skills in hysteroscopy demonstrated face, content and construct validity.

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Office Operative Hysteroscopy: An Update

Cited by 145 publications

References 66 publications

Effects of early second‐look hysteroscopy combined with intrauterine balloon dilatation on reproductive outcomes for women with intrauterine adhesions

Effects of early second‐look hysteroscopy combined with intrauterine balloon dilatation on reproductive outcomes for women with intrauterine adhesions

Live birth after hysteroscopy performed inadvertently during early pregnancy: A case report and review of literature

The Development and Psychometric Validation of A Low-Cost Anthropomorphic 3D-Printout Simulator for Training Basic Skills Applicable to Office-Based Hysteroscopy

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