Modern hysteroscopy for diagnosis and treatment (office hysteroscopy)
Epublication WebSurg.com, Feb 2015;15(02). URL: http://websurg.com/doi/lt03encampo010
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.