Conventional Hysteroscopy Research Articles

Enhancing endometrial pathology detection: chromohysteroscopy vs. conventional hysteroscopy in infertility evaluation

BackgroundEndometrial pathology is a recognized contributor to infertility and recurrent implantation failure, but its detection during hysteroscopy, particularly in the absence of visible lesions, is challenging. Chromohysteroscopy, involving the use of methylene blue dye, has shown promise in improving diagnostic accuracy.MethodsThis interventional cross-sectional study compared the diagnostic accuracy of chromohysteroscopy and conventional hysteroscopy, using histopathology as the gold standard. A total of 100 consenting infertility patients were included, in a sequential step, hysteroscopy followed by chromohysteroscopy using methylene blue dye was performed to enhance the detection of subtle endometrial pathologies.ResultsAmong the 100 women who underwent diagnostic hysteroscopy, 76 exhibited normal findings, while 24 had abnormal findings. During chromohysteroscopy, 62 cases displayed a light staining pattern, and 38 cases exhibited dark staining. Histopathological analysis of biopsy tissue from the dark-stained areas revealed endometrial pathology in 84.2% (32/38) and normal endometrium in 15.8% (6/38) cases. In contrast, biopsies from the light-stained areas indicated abnormal endometrium in only 3.23% (2/62) cases, with the remaining 96.77% having a normal histology. Chromohysteroscopy demonstrated a significantly higher diagnostic accuracy (92%) for endometrial pathology compared to conventional hysteroscopy (58%). Notably, chromohysteroscopy’s sensitivity was 94.12%, and its specificity was 90.9%. The staining patterns observed during chromohysteroscopy correlated well with histological findings, highlighting its effectiveness in identifying structurally damaged endometrium.ConclusionChromohysteroscopy emerges as a valuable diagnostic tool for assessing endometrial pathology, especially in infertility cases. This technique offers superior accuracy compared to conventional hysteroscopy, providing clinicians with a more precise means of diagnosis and potential targeted treatments.

Retracted: Effect of Vaginoscopy versus Conventional Hysteroscopy on Pain, Complications, and Patient Satisfaction in Patients with Endometrial Polyps

Retracted: Effect of Vaginoscopy versus Conventional Hysteroscopy on Pain, Complications, and Patient Satisfaction in Patients with Endometrial Polyps

Effect of Vaginoscopy versus Conventional Hysteroscopy on Pain, Complications, and Patient Satisfaction in Patients with Endometrial Polyps.

Background Hysteroscopy is considered the gold standard for diagnosing intrauterine pathology. Traditional hysteroscopy requires the placement of a vaginal speculum and cervical forceps, which are large in diameter, causing discomfort and pain to the patient and even causing vagal reflexes. Aims To investigate the impact and clinical value of vaginoscopy versus conventional hysteroscopy on pain, complications, and patient satisfaction in patients with endometrial polyps and to analyse the advantages of clinical application of vaginoscopy examination. Materials and Methods One hundred and twenty-five patients with endometrial polyps treated in our hospital from May 2021 to December 2021 were selected for this study and divided into 52 cases in the hysteroscopy group and 73 cases in the vaginoscopy group according to the random remainder grouping method. Conventional hysteroscopy was used, and in the vaginoscopy group, vaginoscopy was performed. The impact of pain, complications, patient satisfaction, and clinical value of the two groups was observed and compared. Results The time taken for the examination varied between the different hysteroscopic methods, with the hysteroscopy group taking the longest time compared to the vaginoscopy group (P < 0.01). The VAS scores immediately after the examination and 30 minutes after the examination were both significantly higher in the hysteroscopy group than in the vaginoscopy group (P < 0.01). The difference in NPY, PGE2, and 5-HT after the pain-causing mediator intervention was significantly better in the vaginoscopy group than in the hysteroscopy group. The difference in the incidence of complications such as abortion syndrome, cervical laceration, uterine perforation, and haemorrhage after treatment was significantly lower in the vaginoscopy group than in the hysteroscopy group. In the vaginoscopy group, the satisfaction rate was 91% significantly higher than that of the hysteroscopy group (P < 0.05). Conclusion The vaginoscopy technique shortens the examination and treatment time, reduces patient pain, improves patient compliance, reduces the use of preintervention drugs and anaesthetics, and reduces complications.

Office Operative Hysteroscopy for the Management of Retained Products of Conception

Study Objective Office operative hysteroscopy (See-and-treat) allows most women with abnormal ultrasound findings suspected for retained products of conception (RPOC) to avoid the added risks of anesthesia and the inconvenience of the operating room. The aim of this study is to compare office to conventional operative hysteroscopy for the treatment of RPOC. Design A retrospective cohort study from January 2018 to March 2019. Setting Single tertiary medical care center. Patients or Participants All women who underwent hysteroscopy due to RPOC during the study period. Interventions Data were collected from women's medical records. Primary outcome was defined as successful removal of all suspected RPOC. Data are presented as median and interquartile range. Measurements and Main Results During the study period, 229 women underwent hysteroscopy due to RPOC, of them 141 (61.57%) and 88 (38.43%) office and conventional operative hysteroscopy, respectively. No in-between group differences were observed in women's age, body mass index and parity. Time interval to hysteroscopy was longer [ 2.13 (1.55-2.78) vs. 1.63 (1.02-1.63) month; p=0.001], and maximal diameter of thesuspected finding was smaller for the office group compared to the conventional operative group [12.0 (8-20) vs. 20 (15-30) mm; p=0.001]. Positive finding rate on histho-pathology was higher for the operative group (76.1% vs. 61.0%; p=0.02). Additional analysis comparing success (n=111) to failure (n=30) of office operative hysteroscopy, revealed that maximal diameter ≤27.5 mm had significantly higher success rate (p=0.007). This finding was supported by logistic regression analysis that found maximal diameter of the suspected finding as the only parameter associated with success rate in office operative hysteroscopy (B=0.12; p=0.001). Conclusion Office operative hysteroscopy is a feasible treatment option for the removal of RPOC when maximal content dimeter is taken under consideration due to its association to success rate.

The Novel Application of Transvaginal Notes for Hysteroscopic Polypectomy and Cervicalmyomectomy

Study Objective To demonstrate the advantages of using transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for both hysteroscopic polypectomy and cervical myomectomy. Design Video presentation of the surgical procedure. Setting University hospital. Patients or Participants A sexually inactive patient with numerous comorbidities presented with irregular vaginal bleeding in the setting of worsening pelvic pain and bladder pressure for three year. Pelvic MRI showed multiple cervical fibroids and an endometrial polyp. Interventions After the patient was anesthetized, a narrow vagina with no visibility of the cervical os was detected. vNOTES hysteroscopic polypectomy and cervical myomectomy were determined to be more appropriate than conventional methods. A GelPOINT mini port was first placed in the vagina, which allowed for entrance into the uterine cavity. A Myosure hysteroscope and laparoscopic tenaculum were inserted through the port, and polyps in the uterine cavity were then removed. After polypectomy, a transverse incision was made on the anterior cervix through the same port for cervical myomectomy. The tenaculum was used to grab the fibroid and a harmonic scalpel was then applied for enucleation. V-loc was used to close the incision and reconstruct the cervical canal. After suturing, hysteroscopy was performed again to confirm normal anatomy. A Foley catheter was placed to prevent cervical stenosis. Measurements and Main Results Complete resection of cervical myoma and uterine polyp were performed, with postoperative relief of symptoms (i.e. bladder pressure). The surgery was 70 mins with Conclusion For patients with cervical polyps and/or myomas who cannot be operated by conventional methods, NOTES hysteroscopy and myomectomy may be an attractive option and lead to less surgical complications, reduced pain, and faster recovery.

Comparison of Virtual Ultrasonographic Hysteroscopy with Conventional Hysteroscopy in the Workup of Patients Who Are Infertile

Study ObjectiveTo compare the tolerability and diagnostic accuracy of virtual ultrasonographic hysteroscopy (VUH) with that of conventional diagnostic outpatient hysteroscopy in the workup of patients who are infertile. DesignA single-center, retrospective cohort study. SettingDepartment of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery Unit of Sacred Heart Hospital Don Calabria in Negrar, Italy. PatientsA total of 120 consecutive women who underwent hysterosalpingosonography and subsequent VUH and conventional hysteroscopy for infertility evaluation were included. The inclusion criterion was infertility for at least 1 year, with evaluation in the early or intermediate follicular phase of the menstrual cycle. InterventionsAfter the placement of an intracervical catheter, a Ringer Lactate solution was injected into the uterine cavity and fallopian tubes, and a 3D volume was obtained. The ultrasound volume acquired was successively elaborated offline, and a VUH was performed. Subsequently, a variable amount of air was introduced into the uterine cavity, and the patency of the salpinges was evaluated. Measurements and Main ResultsThe VUH findings were compared with those of conventional hysteroscopy performed in the subsequent month. For the detection of endometrial pathology in the overall pool, the sensitivity and specificity of VUH in comparison with conventional hysteroscopy were 100% (95% confidence interval [CI], 84.6%–100%) and 100% (95% CI, 96.3%–100%), respectively. For the detection of uterine cavity pathology and uterine malformations in the overall pool, the sensitivities of VUH were 80% (95% CI, 28.4%–99.5%) and 100% (95% CI, 75.3%–100%), respectively, with specificities of 100% (95% CI, 96.8%–100%) and 100% (95% CI, 96.6%–100%), respectively, when compared with conventional hysteroscopy. The positive predictive values for endometrial pathology, uterine cavity alterations, and uterine malformations were 100% (95% CI, 84.6%–100%), 100% (95% CI, 39.8%–100%), and 100% (95% CI, 75.3%–100%), respectively, with a receiver operating characteristic area of 100%, 90% (95% CI, 70%–100%), and 100%, respectively. There were no cases of severe vasovagal reactions or other complications. Most patients (67%, 81 of 120 women) described the examination as “less painful than expected,” 25% (30 of 120 women) “just as expected,” and only 7% (9 of 120 women) as “more painful than expected.” ConclusionVUH was well tolerated and showed a high accuracy (100%) in the study of the uterine cavity when compared with conventional hysteroscopy.

Value of Ultrasonographic Guidance For Operative Hysteroscopy on the Safety and Outcome of the Procedure: Randomized Control Trial

Abstract Background Hysteroscopy is a minimally invasive intervention that can be used to diagnose and treat many intrauterine and endocervical problems. Hysteroscopic polypectomy, myomectomy are just a few of the commonly performed procedures. Hysteroscopy has nearly replaced standard D&amp;C for the management of abnormal uterine bleeding (AUB), as it allows for direct visualization and diagnosis of intrauterine abnormalities, and it often offers an opportunity for simultaneous treatment. Operative hysteroscopy is a safe procedure resulting in complication in 0.95-3% of cases. The most frequently observed complications include hemorrhage (2.4%), uterine perforation (1.5%), and cervical laceration (1-11%). Another rare complication is excessive fluid absorption with or without resultant hyponatremia. Can use of ultrasound guidance during operative hysteroscopy decrease the rate of the operative complication? Objective To assess the value of ultrasound guidance for operative hysteroscopy on decreasing the complication and improving the success rate of the procedure. Patients and Methods It is estimated that a sample size of 88 patients that were divided to 44 patients in the Ultrasound guidance group and 44 patients in the group that didn’t perform ultrasound. The patients were encountered from those presented at the gynecology clinic of the Ain Shams university hospital or those presented at ECDU with the inclusion criteria in the period between December 2017 to November 2018. The patients were approached to participate on study and a written informed consent was taken from all the patients. Results Comparative study between the 2 groups revealed; highly significant increase in success rate in ultrasound guided hysteroscopy (USH) group; compared to conventional hysteroscopy (CH) group; with highly significant statistical difference (p &amp;lt; 0.01) and non-significant difference as regards failure and complications rates (p &amp;gt; 0.05). Conclusion Our study found that ultrasound assistance for difficult hysteroscopy reported that ultrasound appears to be a safe and reliable method of assistance.

Comparison of the effect of traditional hysteroscopy and HEOS system hysteroscopy in the treatment of refractory intrauterine residual

Objective To compare the clinical effects of conventional hysteroscopy and HEOS hysteroscopy in the treatment of refractory intrauterine residuals. Methods From January 2017 to February 2019, 60 patients with refractory intrauterine pregnancy residuals admitted to the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were randomly selected.The patients were divided into traditional endoscopy group and HEOS system endoscope group according to the different operation method, with 30 cases in each group.The operation time, intraoperative blood loss, hospitalization cost, postoperative uterine adhesion rate, postoperative menstrual recovery time, postoperative recovery rate of endometrium at the first, second and third month after operation were compared between the two groups. Results The operation time of the conventional laparoscopic group was (24.38±3.16)min, which was longer than that of the HEOS system hysteroscopy group[(18.71±3.32)min](t=1.336, P=0.027). The intraoperative blood loss of the conventional laparoscopic group was (18.41±4.35)mL, which was higher than that of the HEOS system hysteroscopy group[(12.81±3.84)mL](t=1.853, P=0.031). The hospitalization cost of the conventional laparoscopic group was (7 461.87±344.92)CNY, which was more than that of the HEOS system hysteroscopy group[(6 743.19±298.52)CNY](t=0.037, P=0.040). In addition, the uterine adhesion rate in the traditional hysteroscopic group was 20.00%(6/30), which was higher than that in the HEOS system hysteroscopy group[6.67%(2/30)](χ2=2.308, P=0.029), and the postoperative menstrual recovery time in the traditional hysteroscopic group was (31.46±4.12)d, which was longer than that in the HEOS system hysteroscopy group[(26.18±3.72)d](t=1.730, P=0.026). At the first, second and third month after operation, the good endometrial recovery rates in the traditional laparoscopic group were 20.00%(6/30), 43.33%(13/30), 63.33%(19/30), respectively, which were lower than those in the HEOS system hysteroscopy group[46.67%(14/30), 70.00%(21/30), 93.33%(28/30)](χ2=4.800, 4.344, 7.954, P=0.028, 0.037, 0.005). Conclusion HEOS system endoscope in the treatment of refractory intrauterine residual has good effect and is worthy of promoting. Key words: Abortion, incomplete; Hysteroscopy; Cryosurgery; Electrosurgery; Tissue adhesions; Intrauterine residual

A Novel Robotic Endoscopic Device used for Operative Hysteroscopy

Video Objective To trial the use of a novel robotic endoscopic surgery platform for operative hysteroscopy. Setting A uterine tissue model with simulated polyps in various locations (Gynesim). Interventions The robotic endoscope is a surgical platform that simultaneously delivers two instruments that are 2-3mm in size using concentric tube technology. These instruments extend from the tip of a standard rigid endoscope outer sheath and are controlled robotically by an operator distant from the surgical field. In this pilot, a probe and monopolar needle were used to resect simulated endometrial polyps. Surgical principles of adequate exposure and traction and counter-traction are demonstrated. Conclusion The robotic endoscope platform may offer advantages over conventional hysteroscopy that could be useful for some applications. These advantages include: improved exposure, finer dissection capability, and use of two handed technique to allow traction and counter-traction. Further study regarding the safe, efficient, and cost-effective use of the robotic endoscope in gynecology is needed. To trial the use of a novel robotic endoscopic surgery platform for operative hysteroscopy. A uterine tissue model with simulated polyps in various locations (Gynesim). The robotic endoscope is a surgical platform that simultaneously delivers two instruments that are 2-3mm in size using concentric tube technology. These instruments extend from the tip of a standard rigid endoscope outer sheath and are controlled robotically by an operator distant from the surgical field. In this pilot, a probe and monopolar needle were used to resect simulated endometrial polyps. Surgical principles of adequate exposure and traction and counter-traction are demonstrated. The robotic endoscope platform may offer advantages over conventional hysteroscopy that could be useful for some applications. These advantages include: improved exposure, finer dissection capability, and use of two handed technique to allow traction and counter-traction. Further study regarding the safe, efficient, and cost-effective use of the robotic endoscope in gynecology is needed.

Role of Chromohysteroscopy in Evaluation of Endometrial Pathology Using Methylene Blue Dye.

Chromohysteroscopy is expected to help in diagnosing subtle endometrial pathologies which could be missed on conventional hysteroscopy and also help in targeting biopsy from endometrium. To study staining pattern of endometrium in patients undergoing chromohysteroscopy andto evaluate and compare the histopathology of chromohysteroscopy-guided endometrial biopsy with conventional endometrial sampling. This was a cross-sectional study conducted during the period of 18 months in Department of Obstetrics and Gynaecology, ESI PGIMSR, New Delhi, India, from September 2016 to February 2018. Totally, 60 women with complaints of infertility, failed intrauterine insemination (IUI), recurrent spontaneous abortions (RSA), heavy menstrual bleeding (HMB), intermenstrual bleeding (IMB) and postmenopausal bleeding (PMB) meeting inclusion criteria were evaluated and enrolled in the study. In patients with normal looking endometrium on hysteroscopy, methylene blue dye was administered through the hysteroscopic inlet. Tissue samples were obtained from stained areas followed by blind endometrial sampling immediately. The results of chromohysteroscopy-guided biopsy from light- and dark-blue-stained areas and blind biopsy were compared. Mean age of the study group was 37 years, with mean BMI of 24 kg/m2. There were 24 cases of HMB, 9 of IMB, 7 of PMB, 15 of infertility, 2 of failed IUI and 3 with RSA. On chromohysteroscopy, 39(65%) cases showed light-stained endometrium (group I) and 21(35%) showed dark-stained endometrium (group II). Comparison was done between histopathology obtained through chromohysteroscopy and blind endometrial sampling. The diagnostic accuracy of chromohysteroscopy-guided endometrial biopsy in evaluation of endometrial pathology was 86.67% with sensitivity of 91.67%, specificity of 85.41%, PPV of 61.12% and NPV of 97.61% (P <0.001). Chromohysteroscopy was able to detect endometrial pathology which was missed on conventional hysteroscopy and detected more cases of endometrial pathology than blind endometrial sampling.

3D/Saline infusion Sono-hysterography versus conventional office hysteroscopy in uterine cavity evaluation prior to ICSI procedure

3D/Saline infusion Sono-hysterography versus conventional office hysteroscopy in uterine cavity evaluation prior to ICSI procedure

Using narrow-band imaging with conventional hysteroscopy increases the detection of chronic endometritis in abnormal uterine bleeding and postmenopausal bleeding.

A preliminary study was designed to evaluate whether a narrow-band imaging (NBI) endoscopic light source could detect chronic endometritis that was not identifiable with a white light hysteroscope. A total of 86 patients with endometrial pathology (71 abnormal uterine bleeding and 15 postmenopausal bleeding) were examined by NBI endoscopy and white light hysteroscopy between February 2010 and February 2011. The surgeon initially observed the uterine cavity using white light hysteroscopy and made a diagnostic impression, which was recorded. Subsequently, after pressing a button on the telescope, NBI was used to reevaluate the endometrial mucosa. The median age of the patients was 40 years (range: 30-60 years). Endometritis was diagnosed histologically. Six cases of abnormal uterine bleeding (6/71, 8.4%, 95% confidence interval [CI] 0.03-0.17) and one case of postmenopausal bleeding (1/15, 6%, 95%CI 0.01-0.29) were only diagnosed with chronic endometritis by NBI (7/86, 8.1%, 95%CI 0.04-0.15). Capillary patterns of the endometrium can be observed by NBI and this method can be used to assess chronic endometritis.

Utilidad de la cromohisteroscopia en la evaluación del endometrio: Hospital de San José de Bogotá DC, Colombia. febrero - Octubre 2014

Objetivo: determinar el rendimiento operativo de la cromohisteroscopia (CHC) en la evaluación del endometrio en el Hospital de San José de Bogotá DC, Colombia, entre febrero y octubre 2014. Metodología: se incluyeron 97 mujeres adultas a quienes se aplicaron 5 cc de azul de metileno al 1% en la cavidad endometrial y por histeroscopia se determinó la presencia de manchas oscuras de donde se tomaron biopsias dirigidas (estándar de oro). Mediante una hoja excel y base de datos stata13® se calcularon las características operativas por medio de tablas de contingencia, se compararon la CHC y la histeroscopia convencional (HC) por medio de la prueba de McNemar y se evaluó la concordancia entre evaluadores y técnicas por medio del coeficiente kappa. Resultados: la principal indicación fue hemorragia uterina anormal (80,41%) realizada en premenopáusicas (78,35%) con edad alrededor de 45 años que presentaban sobrepeso. La microscopía detectó un caso de cáncer endometrial, uno de hiperplasia endometrial y cuatro de endometritis crónica. La sensibilidad y valor predictivo negativo de la CHC fue 100%, la especificidad 39,8% y el VPP 1,7% para cáncer e hiperplasia. Para endometritis la sensibilidad fue 50%, especificidad 38,9%, VPP 3,5% y VPN 94,6%. No hubo diferencias estadísticas entre CHC y la HC. El acuerdo entre evaluadores fue de 79,12% y entre técnicas de 54,64%. Conclusión: la CHC en hemorragia uterina anormal puede aportar un mayor rendimiento para el diagnóstico de patologías malignas y premalignas que la HC por el alto valor predictivo negativo encontrado. Abreviaturas: CHC, cromohisteroscopia; HC, histeroscopia convencional; HUA, hemorragia uterina anormal.

Is pain better tolerated with mini-hysteroscopy than with conventional device? A systematic review and meta-analysis

Hysteroscopy is an indispensable approach in gynecology. Miniaturization may reduce pain allowing office procedures without anesthesia. Our main objective is to determine if modifications in scope diameters have made office hysteroscopy less painful. Studies were sought with key words "hysteroscopy" and "pain" from available online sources. Time frame was from 2000 onward. Thirty-three articles were retrieved for detailed analysis. Prospective randomized trials, studying pain as main outcome in office hysteroscopy expressed in means, confidence intervals and SD, comparing office mini-hysteroscopy to conventional hysteroscopy. Studies or arms within a study where conscientious sedation, anesthesia or non-steroidal drugs were used were excluded. We analyzed data from eight studies (seven RCT) comparing mini-hysteroscopy with conventional scopes, involving a total of twenty-three hundred and twenty-two participants, of which nineteen hundred and eighty-six completed the intervention. A meta-analysis revealed a significant reduction pain score (MD: -3.64; 95% CI -5.16 to -2.12; test for overall effect p<0.00001) and available data support miniaturization decreases pain in outpatient hysteroscopy. Pain in office hysteroscopy is lower with mini-hysteroscopes.

Outpatient Hysteroscopic Polypectomy: Bipolar Energy System (Versapoint®) versus Mechanical Energy System (TRUCLEAR System®) - Preliminary Results

Hypothesis: The new hysteroscopic system with mechanical energy is an effective outpatient technique for diagnosis and treatment that has certain advantages over conventional hysteroscopy in the management of endometrial polyps. Objectives: Our primary objective was to assess the total duration of hysteroscopy and polypectomy performed in an outpatient setting comparing the new mechanical energy hysteroscopy to the bipolar energy system. Our secondary objective was to compare the level of safety of both hysteroscopic techniques using the procedure success rate, the need for subsequent referral to surgery, existing complications, and comfort experienced by the patient during the procedure. Patients and Methods: This randomized controlled trial included the first 90 patients with an ultrasound diagnosis of endometrial polyp (>1 cm) who underwent an outpatient diagnostic and operative hysteroscopy at the Igualada Hospital (Barcelona) and agreed to be included in the study by signing an informed consent. Results: We obtained a 91% success rate with the TRUCLEAR System® compared to a 69% success rate with the Versapoint® system. Total operating time was 6.36 min in the TRUCLEAR System group versus 10.82 min in the Versapoint system group (p < 0.05), with a polypectomy time of 3.06 and 7.91 min, respectively (p < 0.05). There were no significant differences between the two techniques when analyzing pain using the visual analogue scale. No complications were recorded for either technique. Conclusion: The mechanical energy system presents a significant decrease in the total duration of polypectomy and hysteroscopy when performed both by experienced staff and by staff in training, resulting in higher success rates without complications with respect to conventional hysteroscopy with bipolar energy.

Surgical management of extrauterine mislocated intrauterine contraceptive devices and related risks

Our aim was to evaluate the value of surgery, mainly laparoscopy in the diagnosis of the location of extrauterine lost intrauterine devices (IUCDs) and their removal. The diagnosis and management of 18 patients with extrauterine lost IUCDs between 2007 and 2011, were recruited in this study. Women whose lost IUCDs were removed by conventional methods (D&C, etc.) and hysteroscopy, were excluded from the study. Laparoscopy was performed initially for the management of these cases. The location of the IUCDs and complications related with surgery were recorded. The results showed that the most common extrauterine localisation of the lost IUCDs was the omentum (n = 10, 55.6%). Overall, 17 laparoscopies and one cystoscopy were performed for IUCD removal. Out of two cases whose IUCD were located adjacent to the bowel, one case required a laparotomy for repair of the perforation site. It was concluded that lost IUCDs outside the uterine cavity can be managed by laparoscopy as a first choice. Since the most common extrauterine localisation of the lost IUCDs is the omentum, a thorough exploration of this area should be carried out initially.

Magnifying hysteroscopy with narrow-band imaging for visualization of endometrial lesions

⁎ Corresponding author at: 35 Shinanomachi, Shinjuku-ku, Tokyo 160–8582, Japan. Tel.: +81 333531211; fax: +81 333530249. E-mail address: kbanno@sc.itc.keio.ac.jp (K. Banno). Narrow-band imaging (NBI) is a novel endoscopic technique in which images of microvessels in the mucosal superficial layer and mucosal surface are enhanced by narrowing the spectral bands of the observation light. In NBI, the light spectrum is shifted to wavelengths of 415±30 nm and 540±30 nm to facilitate wavelength-induced changes in visibility. In digestive endoscopy, NBI has improved qualitative diagnosis and enabled more accurate detection of lesions [1]. In gynecology, the use of NBI has recently been reported for laparoscopic identification of peritoneal endometriosis, evaluation of vascular density in endometriosis, and diagnosis of endometrial lesions [2,3]. Via these applications, NBI has attracted attention owing to the clear visualization that can be achieved. The use of NBI for image enhancement has recently been applied to magnifying endoscopy for the evaluation of blood microvessels and surface microstructure in the digestive tract, with the goals of qualitative diagnosis and evaluation of invasion depth [4]. In gastrointestinal endoscopy, magnifying endoscopy using NBI is referred to as because a macroscopic observation is conducted. The latest techniques, which include endocytoscopy and endomicroscopy, enable direct observation of cells and cell nuclei, and are potential alternatives to histology via biopsy. The feasibility of applying NBI in magnifying hysteroscopy for the evaluation of surface microstructure and bloodmicrovessels in endometrial lesions was investigated at the Department of Obstetrics and Gynecology, Keio University Hospital, Tokyo, Japan, in August 2009. Magnifyinghysteroscopic images of endometrioid adenocarcinomawere taken via conventional hysteroscopy and NBI (Fig. 1). The images were taken using a charge-coupled device digital camera (OTV-S7ProH-HD12E; Olympus Medical Systems, Tokyo, Japan), a light source (VISERA Pro Xenon Light Source [CLV-S40Pro]; OlympusMedical Systems, Tokyo, Japan), and a video system/processor (VISERA Pro Video System Center [OTV-S7Pro]; OlympusMedical Systems, Tokyo, Japan) via a 2.9-mm/30 ° telescope at magnification×60 (HOPKINS II; Karl Storz, Tuttlingen, Germany). There were no special requirements or patient preparation for NBI, and observation with conventional white light and NBI was interchangeable at the touch of a button by the surgeon. Magnifying NBI hysteroscopy enables visualization of the microstructure and blood microvessels in an endometrial lesion as dark green with a clear contrast (Fig. 1). This visualization results in easier detection—compared with conventional white-light hysteroscopy—of an abnormal protruding lesion and atypical vessels. Preliminary experience indicates that this method may be a useful new imaging tool for supplementing endoscopic diagnosis of endometrial lesions and that it is likely to have a role in optical biopsy in the future.

Flexible hysteroscopy with narrow band imaging (NBI) for endoscopic diagnosis of malignant endometrial lesions

Narrow band imaging (NBI) for detection of blood vessels and microstructures on the mucosal surface is used in gastrointestinal endoscopy since it can improve qualitative diagnosis and detection of lesion. However, there are no studies on flexible hysteroscopy using NBI. We performed flexible hysteroscopy with NBI for outpatients to investigate the sensitivity and specificity of endoscopic diagnosis of malignant endometrial lesions. Of patients who attended our hospital for suspected lesions in the uterine cavity between April 2009 and May 2010, 104 subjects underwent hysteroscopy with NBI, in addition to white light. Using the pathological diagnosis as the gold-standard, we evaluated the sensitivity and specificity of NBI hysteroscopy for detecting atypical endometrial hyperplasia (AEH) or carcinoma. The results were also compared with historical data (n=209) for conventional hysteroscopy using white light only in 2008. The sensitivities were 97.2% [95% confidence interval (95% CI): 90.3-99.7%] and 82.6% (95% CI: 74.4-89.0%) for NBI hysteroscopy and conventional hysteroscopy, respectively. The 95% CIs for the two methods did not overlap and the sensitivity of lesion detection was higher with NBI hysteroscopy. Specificities were comparable, 90.6% (95% CI: 75.0-98.0%) and 85.1% (95% CI: 76.3-91.6%) between the methods. NBI hysteroscopy has increased sensitivity for detection of atypical endometrial hyperplasia (AEH) or carcinoma. A comparison with historical data suggested that NBI may be useful for diagnosis of malignant endometrial lesions. As far as we are aware, this is the first evaluation of flexible hysteroscopy with NBI for diagnosis of malignant endometrial lesions.

Diagnostic performance of CT virtual hysteroscopy in 69 consecutive patients

OBJECTIVE: CT Virtual Hysteroscopy provides a complete, minimally invasive evaluation of the the uterine cavity based on bidimensional, tridimensional and endoscopic views. The objective of the presentation is to evaluate the diagnostic accuracy of CT virtual hysteroscopy (VH) for the detection of cervical and uterine pathology in comparison to the conventional hysteroscopy (H) considered as the gold standard method.

Narrow-Band Imaging in Diagnosis of Endometrial Cancer and Hyperplasia: A New Option?

Study Objective To estimate whether the use of narrow-band imaging (NBI) hysteroscopy increases concordance between visual identification and a histologic diagnosis of endometrial cancer and hyperplasia. Design Prospective study (Canadian Task Force classification: II-2). Setting Department of obstetrics and gynecology, University of Eastern Piedmont, Novara, Italy. Patients 209 consecutive patients with abnormal uterine bleeding. Interventions White-light hysteroscopy and NBI hysteroscopy followed by direct biopsy. Measurements and Main Results The sensitivity and specificity of conventional hysteroscopy in predicting a diagnosis of cancer and hyperplasia were, respectively, 84.21% (95% confidence interval [CI], 79.27–89.15) and 99.47% (95% CI, 98.49–100.0), and 64.86% (95% CI, 58.39–71.34) and 98.77% (95% CI, 97.27–100.0), and of NBI hysteroscopy were 94.74% (95% CI, 91.71–97.76) and 97.89% (95% CI, 95.95–99.84), and 78.38% (95% CI, 72.8–83.96) and 97.67% (95% CI, 96.63–99.72). The concordance of conventional and NBI hysteroscopy with the histopathologic findings (measured using the Cohen κ) was, respectively, 88.80% (95% CI, 86.2%–96.3%) and 91.78% (95% CI, 89.6%–98.2%), a difference of 2.98% (95% CI, 0–9) in favor of NBI. Conclusion Narrow-band imaging hysteroscopy can accurately predict a histologic diagnosis of endometrial cancer or hyperplasia.