Figure 1 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
Hysterofiberscopic still images of complete resection of an endometrial polyp (EMP) under direct observation. (A) Xylocaine 1% was injected at a 12 o'clock direction from the portio to create a paracervical block. (B) EMP in the uterine cavity. (C) EMP magnified in the right uterine cavity. (D) Uterine fundus and left proximal tubal opening. (E) Right proximal tubal opening. (F) EMP about to be grasped with placental forceps. (G) EMP was grasped with placental forceps and about to be extracted. (H) Remaining EMP was grasped with placental forceps and about to be extracted to the lower part of the uterine cavity. (I) Remaining EMP was grasped with placental forceps and about to be extracted to the isthmus of the uterus. (J) Remaining EMP was grasped using placental forceps and is about to be extracted to the cervix under hysterofiberscopic guidance. (K) Uterine fundus and left proximal tubal opening after complete resection of the EMP. (L) After curettage, uterine cavity with air bubbles on the anterior wall.
Similar publications
Background and study aims Delayed bleeding is believed to occur less frequently after cold snare polypectomy (CSP), but this has not been validated in clinical trials. This study aimed to compare rates of delayed bleeding after CSP and hot snare polypectomy (HSP).
Patients and methods We conducted a multicenter, randomized controlled trial. Partici...
Colorectal cancer (CRC) is considered one of the most prevalent cancers among Iranian men and women (1). Colorectal polyps, known as precursors of CRCs, are of great importance. Surveillance, locating, and removal of colorectal polyps make them the most modifiable factor apart from other genetic and environmental factors leading to CRCs. Colorectal...
Although the diagnostic and therapeutic opportunities for superficial nonampullary duodenal epithelial tumors (SNADETs) have been increasing, the natural history and treatment outcomes remain unclear. Due to the anatomical characteristics of the duodenum, clinicians should be more sensitive to the occurrence of complications for tumors in the duode...
Background and study aims Cold polypectomy is becoming popular for treatment of colon polyps due to its safety and convenience, but there is still the problem of tumor remnants. Because linked color imaging (LCI) improves polyp visibility, cold polypectomy under LCI is anticipated to reduce the tumor remnant rate. Therefore, we investigated the use...
Citations
... In contrast, rigid hysteroscopy is widely applied in Europe to perform the 'see and treat' strategy, which means that the lesion is removed at the same time when the lesion is confirmed by such type of hysteroscopy. The main advantage of 'see and treat' hysteroscopy is that hospitalization is not required, but it has corresponding disadvantages, such as limited indication disease and failure to complete the operation if the pain is severe due to the lack of anesthesia (18)(19)(20)(21)(22). There were no cases of hysteroscopyrelated perforation occurred in our hospital because we used a flexible hysteroscope and also discussed the risk of perforation with multiple doctors by inspecting the uterine cavity during examination. ...
Background:
To date, only few large studies are available concerning the safety and diagnostic concordance rates of outpatient flexible hysteroscopy. In our institution, outpatient hysteroscopy has been routinely and educationally applied Kosuke Tsuji to intrauterine lesions; thus, we retrospectively investigated the institution's outpatient flexible hysteroscopy cases.
Methods:
A total of 1591 cases of outpatient flexible hysteroscopy conducted at our institution in 2012-2016 were retrospectively analyzed in terms of their clinical background, complications and diagnostic concordance rates.
Results:
A total of 1591 cases included 546 cases of benign tumors (317 endometrial polyps, 168 myomas and 61 endometrial hyperplasia), 361 cases of atypical endometrial hyperplasia, 571 cases of endometrial cancers and 113 cases of other diagnoses. No major complications, including uterine perforation, occurred. However, one patient (0.06%) was diagnosed with septic shock caused by intrauterine infection that required prolonged immunosuppressive drug administration. Meanwhile, 335 patients diagnosed with benign tumors through outpatient flexible hysteroscopy underwent operation, and the diagnostic concordance rate was 74.6% (250 cases). However, this rate included 14 cases (4.2%) diagnosed with malignant tumors postoperatively. In preoperative endometrial cancer cases, the sensitivity and specificity for cervical invasion diagnosis were 39.4 and 90.8%, respectively. In addition, only one patient manifested positive ascites cytology intraoperatively, possibly caused by outpatient hysteroscopy.
Conclusions:
Outpatient flexible hysteroscopy is highly safe, with a slight negligible effect on ascites cytology. However, the diagnosis should be determined by multidisciplinary approaches, as hysteroscopy alone can miss malignancy.
With the advances in miniature instruments, office hysteroscopy on conscious patients has been the standard to explore the intrauterine pathology, with the ability to perform some minor procedures concomitantly. Patients usually appreciate the efficient “see and treat” procedures with such minimal discomfort that exempt from the inconvenience of going into the operating room and the need for anesthesia. However, controversies exist in the appropriateness of its application in some clinical situations. Concerns include (1) the criteria for hysteroscopy applied in the vast number of patients suffering from abnormal uterine bleeding or subfertility, and (2) the frequency for repeated hysteroscopy on some kinds of patients, such as those of endometrial cancer with fertility-sparing treatment for monitoring the disease, or those of severe intrauterine adhesion who need adhesiolysis for subsequent conception, in whom the appropriate protocol of repeatedly applying hysteroscopy lacks consensus. This article reviews the literature to find the best available evidence on the effectiveness of office hysteroscopy in comparison with other clinical diagnostic tools, as well as the current opinions on such controversies in its application.
