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Rudi CAMPO

Leuven Institute for Fertility and Embryology
Leuven, Belgium
MD
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Modern hysteroscopy for diagnosis and treatment (office hysteroscopy)
Modern technology has brought diagnostic hysteroscopy as a mainstay of modern gynecologic practice. The ambulatory visualization of the uterine cavity has obvious major benefits for the patient and the diagnostic algorithms. However, it has not been generally implemented by the physicians for obvious drawbacks – it is painful, difficult to get good visualization, difficult to organize and to provide significant tissue for histology.
The new TROPHY hysteroscope is especially designed to counteract the abovementioned drawbacks providing physicians most innovative possibilities resulting in an all in one diagnostic procedure and the highest patient comfort. The most specific feature of this hysteroscope is that it can be loaded with accessory sheaths in an active and passive position providing the possibility of enlarging the visual procedure with endometrial sampling or surgical actions for pathological examination of the endometrium and myometrium without removing the instrument. Additionally, one can remove the hysteroscope and use the accessory sheet to introduce the Trophy D&C suction curette or the Endo-myometrial sampler. Histology from endometrium and myometrium is possible without the need of a speculum and even minor interventions such as polyp or myoma resection are possible in a one-stop procedure.
Magnetic Resonant Imaging (MRI) has demonstrated that the uterus can be separated in 3 important functional areas. For this reason, exploration of the uterus in the infertile patient should implement the evaluation of the endometrium, the junctional zone myometrium (JZ), and the outer myometrium.
MRI cannot be implemented as a screening examination but the combination of transvaginal ultrasound and office hysteroscopy provides a complete one-stop diagnostic and eventually therapeutic procedure.
In this way, myometrial disorders, uterine congenital malformations, endometrium pathologies, and the cervical canal pathway can be evaluated easily.
This lecture describes a modern ambulatory one-stop approach, by combining ultrasound, hysteroscopy and endomyometrial tissue sampling for diagnostic and therapeutic purposes. This one-stop approach opens a totally new and advanced dimension to the screening, diagnosis and treatment of uterine pathologies in the infertile patient.
Lecture
4 years ago
2153 views
84 likes
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24:50
Modern hysteroscopy for diagnosis and treatment (office hysteroscopy)
Modern technology has brought diagnostic hysteroscopy as a mainstay of modern gynecologic practice. The ambulatory visualization of the uterine cavity has obvious major benefits for the patient and the diagnostic algorithms. However, it has not been generally implemented by the physicians for obvious drawbacks – it is painful, difficult to get good visualization, difficult to organize and to provide significant tissue for histology.
The new TROPHY hysteroscope is especially designed to counteract the abovementioned drawbacks providing physicians most innovative possibilities resulting in an all in one diagnostic procedure and the highest patient comfort. The most specific feature of this hysteroscope is that it can be loaded with accessory sheaths in an active and passive position providing the possibility of enlarging the visual procedure with endometrial sampling or surgical actions for pathological examination of the endometrium and myometrium without removing the instrument. Additionally, one can remove the hysteroscope and use the accessory sheet to introduce the Trophy D&C suction curette or the Endo-myometrial sampler. Histology from endometrium and myometrium is possible without the need of a speculum and even minor interventions such as polyp or myoma resection are possible in a one-stop procedure.
Magnetic Resonant Imaging (MRI) has demonstrated that the uterus can be separated in 3 important functional areas. For this reason, exploration of the uterus in the infertile patient should implement the evaluation of the endometrium, the junctional zone myometrium (JZ), and the outer myometrium.
MRI cannot be implemented as a screening examination but the combination of transvaginal ultrasound and office hysteroscopy provides a complete one-stop diagnostic and eventually therapeutic procedure.
In this way, myometrial disorders, uterine congenital malformations, endometrium pathologies, and the cervical canal pathway can be evaluated easily.
This lecture describes a modern ambulatory one-stop approach, by combining ultrasound, hysteroscopy and endomyometrial tissue sampling for diagnostic and therapeutic purposes. This one-stop approach opens a totally new and advanced dimension to the screening, diagnosis and treatment of uterine pathologies in the infertile patient.
Hysteroscopic myomectomy and ART
Fibroids represent an extremely common benign uterine pathology, the incidence of which increases with age, and approximately 10% of women with infertility problems will present a myoma. The association between uterine myoma and infertility is still controversial. Evidence exists that subserosal myomas do not impair the pregnancy rate in IVF whereas submucous myomas significantly decrease the implantation rate. Unfortunately, the effect of intramural myomas upon reproduction outcomes remains unknown, and until now no adequate diagnostic and therapeutic guidelines have been established.
Magnetic resonance imaging (MRI) imaging has redefined the functional anatomy of the uterus. Contrarily to ultrasound, MRI demonstrates that the non-pregnant myometrium is not a homogeneous smooth muscle mass but consists of two different structural and functional entities. The myometrium adjacent to the endometrium is a different hormone-dependent uterine compartment called junctional zone (JZ) myometrium. It is a functionally important entity in reproduction and it is ontogenetically related to the endometrium. Submucosal fibroids originate from this JZ myometrium and differ from subserosal fibroids as they have less cytogenetic abnormalities, less expression of Sex Steroid Hormone receptors, and they are more responsive to GnRH analog treatment and provide fewer recurrences after surgery.
Despite the lack of randomized studies, the sharp decline in pregnancy rates in case of submucous myoma is quite convincing and it is based on the existing evidence that myomectomy should be performed prior to ART for junctional zone myomas which protrude into the uterine cavity.
We demonstrate the different modern techniques of hysteroscopic myomectomy, the new instrumentation, the tips and tricks, the possible complications and clinical outcome.
Lecture
4 years ago
2085 views
101 likes
0 comments
27:15
Hysteroscopic myomectomy and ART
Fibroids represent an extremely common benign uterine pathology, the incidence of which increases with age, and approximately 10% of women with infertility problems will present a myoma. The association between uterine myoma and infertility is still controversial. Evidence exists that subserosal myomas do not impair the pregnancy rate in IVF whereas submucous myomas significantly decrease the implantation rate. Unfortunately, the effect of intramural myomas upon reproduction outcomes remains unknown, and until now no adequate diagnostic and therapeutic guidelines have been established.
Magnetic resonance imaging (MRI) imaging has redefined the functional anatomy of the uterus. Contrarily to ultrasound, MRI demonstrates that the non-pregnant myometrium is not a homogeneous smooth muscle mass but consists of two different structural and functional entities. The myometrium adjacent to the endometrium is a different hormone-dependent uterine compartment called junctional zone (JZ) myometrium. It is a functionally important entity in reproduction and it is ontogenetically related to the endometrium. Submucosal fibroids originate from this JZ myometrium and differ from subserosal fibroids as they have less cytogenetic abnormalities, less expression of Sex Steroid Hormone receptors, and they are more responsive to GnRH analog treatment and provide fewer recurrences after surgery.
Despite the lack of randomized studies, the sharp decline in pregnancy rates in case of submucous myoma is quite convincing and it is based on the existing evidence that myomectomy should be performed prior to ART for junctional zone myomas which protrude into the uterine cavity.
We demonstrate the different modern techniques of hysteroscopic myomectomy, the new instrumentation, the tips and tricks, the possible complications and clinical outcome.