Effectiveness and appropriateness in the application of office hysteroscopy

Yen, Chih‐Feng; Chou, Hung-Hsueh; Wu, Hsien-Ming; Lee, Chyi‐Long; Chang, Ting‐Chang

doi:10.1016/j.jfma.2018.12.012

Cited by 38 publications

(39 citation statements)

References 85 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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“…Therefore, the negative predictive value of normal endometrial biopsy is low at 51%. Approximately 3% of endometrial cancer is missed because of blinded D&C ( 9 ). Some gynecologists used several types of hysteroscopic features of endometrial lesions for diagnosing malignancy, including irregularity of endometrial glands, polypoid pattern, uneven surface, and abnormal endometrial vessels ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

Usefulness of biopsy by office hysteroscopy for endometrial cancer: A case report

et al. 2020

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A diagnostic biopsy for endometrial cancer is performed via dilation and curettage (D&C). However, D&C may miss endometrial cancer lesions due to of its ‘blind’ approach. Hysteroscopy is a useful method that can be used to detect endometrial cancer lesions. In addition, office hysteroscopy is easy to be scheduled and does not require anesthesia. The patient was a 40-year-old woman with suspected endometrial cancer; however, it could not be diagnosed by D&C and biopsy using hysteroscopy during hospitalization. Office hysteroscopy during the proliferative phase indicated that the suspicious endometrial cancerous lesion was minimal at the isthmus of the uterus with atypical vessels and a white spot, for which biopsy was performed. Pathological diagnosis was endometrioid carcinoma with squamous differentiation, G1. Therefore, total laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy were performed. In this case, it was difficult to detect minimal lesion in the secretory phase because the endometrial thickness hid the endometrial cancer. It is easy to perform office hysteroscopy in the proliferative phase. This case indicated that office hysteroscopy is a useful method to diagnose and perform biopsy for minimal lesions.

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“…To minimize surgical incisions and surgical trauma is the goal of minimally invasive surgeons [4]. Based on the previous abundant experience of single-hole laparoscopic gynecological surgery, from April 2018 to March 2019, the endo-umbilical 5mm-mini-incision surgery had been successfully used to complete 15 cases of micro-single-hole laparoscopic hysteroscopic surgeries in the diagnosis and treatment of complex uterine diseases, and had achieved good results [5]. It is now reported.…”

Section: Introductionsmentioning

confidence: 99%

Application of Micro-single-hole Laparoscopy Combined with Hysteroscopy in Diagnosis and Treatment of Complex Uterine Cavity Diseases

Sun¹,

Chen²,

Chen³

et al. 2021

JGO

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Object: To investigate the feasibility and safety of hysteroscopic surgery for diagnosis and treatment of complex uterine cavity diseases under the monitor of 5mm-mini-incision micro-single-hole laparoscopic surgery. Methods: A retrospective analysis of 15 patients with complex uterine cavity diseases undergoing hysteroscopic surgery underwent 5mm-mini-incision micro-single-hole laparoscopic surgery was performed in the Department of Obstetrics and Gynecology, the Affiliated Changzhou NO. 2 People's Hospital of Nanjing Medical University from April 2018 to March 2019. Among them, 8 cases were intrauterine adhesion, 3 cases were uterine submucosal fibroid, 3 cases were uterine septum, 1 case was post-cesarean scar pregnancy, ages from 23 to 45 years old, BMI 17.65-25.48kg/m 2 . The operation was performed through a 5mm-mini-incision from the midline of the umbilicus. The 40/50 small abdominal retractor was used to expand the incision approach. A 3-mm small lens (A cystoscope or a hysteroscope was used for some patients) was placed into the single-port approach to perform the laparoscopic surgery; hysteroscopic surgery was performed by hysteroscopy through the cervix. Results: All the 15 patients were successfully operated. One patient with severe intrauterine adhesion had uterine perforation during operation. The uterus was repaired and sutured under micro-single-hole laparoscopy perfectly. No other channels were added during operation, and no laparotomy was performed. The operation time was 20-125 min, in which the surgical path establishment time was 5-10 min, the umbilical reconstruction time was 3-5 min; the intraoperative blood loss was 5-10 ml, and the postoperative hospital stay was 3-7 days. The postoperative umbilical incision healed well, and there was no surgical scar in the abdomen after surgery. No postoperative umbilical hernia and other serious complications occurred. Conclusion: Under the premise of mature umbilical single-port laparoscopy, it is safe and effective to use 5mm-mini-incision micro-single-hole laparoscopic surgery as a monitor during hysteroscopy for the diagnosis and treatment of complex uterine cavity diseases. It will achieve a better cosmetic result than traditional laparoscopy.

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Effectiveness and appropriateness in the application of office hysteroscopy

Cited by 38 publications

References 85 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

Usefulness of biopsy by office hysteroscopy for endometrial cancer: A case report

Application of Micro-single-hole Laparoscopy Combined with Hysteroscopy in Diagnosis and Treatment of Complex Uterine Cavity Diseases

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