Hysteroscopic Treatment Research Articles

Conservative surgical repair of placenta increta invading into uterine septum: case report

BackgroundThe prevalence of placenta accreta spectrum is on the rise, primarily as a consequence of an increasing number of Cesarean sections. Nevertheless, uterine anomalies, particularly uterine septum, pose a notable risk factor for its occurrence. While there are limited case reports documenting the association between uterine septum and placenta adherence, most of these cases have been linked to prior hysteroscopic treatment of the septum. Notably, this case represents the first-reported instance in which a uterine septum was preoperatively diagnosed in association with placenta increta adherent to it, and subsequently managed conservatively.Case presentationA 30-year-old pregnant Egyptian female patient, who had undergone two previous cesarean sections, was diagnosed with placenta increta and had an incomplete uterine septum. She was admitted to Elshatby University Hospital in December 2021. During her surgery, it was found that the placenta was adherent to right lower aspect of the septum, as well as the right anterior, lateral, and posterior uterine walls. A conservative surgical approach was scheduled and successfully performed, and 3 months later, an ultrasound examination revealed that the uterus had returned to its normal size, with no evidence of isthmocele or synechiae. The only abnormality noted was the presence of the septum.ConclusionUltrasound plays a crucial role in diagnosing placenta accreta and identifying any additional uterine abnormalities that may guide the planning of conservative treatment. Uterine septum represents a risk factor for placental adherence, as the placenta can indeed become adherent to it. Muscle defects may become apparent following placental separation and can often be effectively managed through the use of running sutures, obviating the need for resection of the affected portion.Trial registration clinicaltrials.gov, registered on 27 April 2021, registration number: NCT04866888, https://clinicaltrials.gov/ct2/show/NCT04866888.

12399 Exploring the Complexities of Hysteroscopic Treatment for Adenomyosis: Insights from a Case Series

12399 Exploring the Complexities of Hysteroscopic Treatment for Adenomyosis: Insights from a Case Series

Pain Severity During Hysteroscopy by GUBBINI System in Local Anesthesia: Covariance Analysis of Treatment and Effects, Including Patient Emotional State.

Pain accompanying medical procedures can be considered in the "mind-body" problem of accounting for and describing the relationship between mental and physical processes (psyche and soma). Background/Objectives: The purpose of this study is to evaluate the severity of pain among patients undergoing a minihysteroscopy procedure under local anesthesia using the "GUBBINI SYSTEM" (GUBBINI Mini Hystero-Resectoscope; Tontarra Medizintechnik, Tuttlingen, Germany) and to assess the association of various covariates with pain during the procedure, including patient emotional state. Methods: This study included 171 patients admitted to the Center for Hysteroscopy under Local Anesthesia at the Heliodor Święcicki Gynecological and Obstetrical Clinical Hospital of the Karol Marcinkowski Medical University in Poznań, Poland, for hysteroscopic treatment under local anesthesia (paracervical, using lignocaine). The Center for Hysteroscopy is the first certified "CENTER OF EXCELLENCE" of The International Society for Gynecologic Endoscopy (ISGE) in Poland. Results: A positive relationship was observed between alexithymia and its trait of difficulty identifying emotions and pain, as well as between perceived pain and one of the deficits of emotional processing-signs of unprocessed emotion. Conclusions: In conclusion, before the hysteroscopy, adequate information and counseling related to the procedure can effectively reduce the pain and anxiety levels of the women, and nurses can navigate this stressful process. Providing education and counseling to all women undergoing hysteroscopy, and explaining the procedure in detail, should be the preferred approach.

Hysteroscopic Treatment of Retained Products of Conception Using See and Treat Operative Office Hysteroscopy Without Anesthesia

Study ObjectiveTo evaluate clinical efficacy of office operative hysteroscopic treatment of retained products of conception (RPOC) without anesthesia. DesignA retrospective cohort study. SettingA tertiary care academic medical center between April 2019 to March 2023. PatientsA total of 175 patients with confirmed RPOC underwent see-and-treat operative office hysteroscopy without anesthesia in our outpatient clinic. InterventionsHysteroscopic removal of RPOC without anesthesia. Measurements and Main ResultsIn 163 cases, the removal of RPOC in the office was attempted, and in 155 cases (95.1%), complete removal of the RPOC, without complications was achieved, although it sometimes required a second procedure in clinic. In 12 cases, office operative hysteroscopy was not attempted, due to physician decision based on the appearance and vascularity of RPOC, or due to pain during the diagnostic hysteroscopy, or both.The average size of RPOC for patients treated in the clinic was 15± 8.4 mm (range 4-47mm).One hundred twenty-eight cases were performed using a Truclear Elite 6mm device, and 35 cases using a mini-Bettocchi 4.2mm device.Eighteen cases were unsuccessful on the first attempt; 12 underwent a second procedure in the clinic, which was completed in 10 (83.3%) cases.105 (71.4%) patients attended a follow-up hysteroscopy, eight of them (7.6%) required separation of adhesions that was performed in the clinic, and 8 patients were referred to a surgical procedure under anesthesia, due to persistent RPOC. ConclusionOperative office hysteroscopy is feasible and highly effective for patients with RPOC, with a total success rate of 95.1% complete evacuation in clinic. A follow-up hysteroscopy is important especially after treatment of large RPOC.

HORMONAL STATUS OF PATIENTS AFTER HYSTEROSCOPIC MYOMECTOMY

Leiomyoma of the uterus is the most common tumor of women of reproductive age. Submucosal localization of myoma causes abnormal uterine bleeding, and also prevents the implementation of reproductive function. Hysteroscopic myomectomy is an option for organ-preserving surgical treatment of submucosal uterine myoma, but pregnancy after it remains a problem. The purpose of the study is to study the content of sex hormones in women after hysteroscopic treatment of submucous uterine myoma and the effect of the proposed preventive complex on it. Research material and methods – the concentration of reproductive hormones (prolactin, estradiol, progesterone, FSH, LH) was determined in the serum of 221 patients who underwent hysteroscopic myomectomy immediately after surgery and 3 months later. 121 women of the main group received within 3 months after the intervention a therapeutic complex of antiproliferative, anti-inflammatory and angioprotective action, 100 patients of the comparison group underwent only surgical intervention. The control group consisted of 100 healthy women of reproductive age. Results. In all patients who underwent hysteroscopic myomectomy, the main group and the comparison group, an increase in the level of estradiol (62.5 pg/ml and 60.3 pg/ ml against 40.7 pg/ml in the control group) and a decrease in progesterone (10, 3 nmol/l, 13.5 nmol/l and 23.9 nmol/l, respectively), most of the patients in the main group and the comparison group had hyperprolactinemia, as well as an increased ratio of LH/FSH. After 3 months of treatment in the main group, the normalization of all the indicated indicators was registered, in the comparison group the hormonal balance remained at the postoperative level. Conclusions: The hormonal status of patients who underwent hysteroscopic myomectomy is characterized by an increased content of prolactin and estradiol, a reduced concentration of progesterone and a disturbed ratio of gonadotropic hormones. Against the background of the proposed treatment complex, which is used in the postoperative period, a probable normalization of the concentration of prolactin, estradiol and progesterone, as well as the FSH/LH ratio, is observed.

Reproductive Outcomes After Hysteroscopic Adhesiolysis in Patients Experiencing Recurrent Pregnancy Loss and Intrauterine Adhesions

ObjectiveThis study aims to evaluate the reproductive outcomes after hysteroscopic adhesiolysis in patients experiencing recurrent pregnancy loss (RPL) combined with intrauterine adhesions (IUA). DesignSingle-center retrospective cohort study. SettingInternational referral hospital for women with IUA and RPL. PatientsBetween January 2018 and June 2022, a cohort of 64 women diagnosed with RPL and IUA were studied, with a follow-up period of at least one year after hysteroscopic adhesiolysis. InterventionsAll patients had a diagnosis of IUA from the diagnostic hysteroscopy and were treated with hysteroscopic adhesiolysis, utilizing intraoperative ultrasound monitoring as required. Main MeasurementsLive birth rate and menstrual pattern change (subjective assessment) after hysteroscopic adhesiolysis. ResultsIn our cohort, 59.38% (38/64) achieved pregnancy following hysteroscopic adhesiolysis, with 92.11% (35/38) conceiving within two years of the procedure. The miscarriage rate was recorded at 17.19% (11/64), and the live birth rate stood at 42.19% (27/64). Throughout the extended follow-up period, 64.06% (41/64) of the patients reported increased menstrual blood volume and improvements in menstrual patterns posthysteroscopic adhesiolysis. Univariate analysis indicated that being aged ≥35 years (p = .026), having a history of infertility (p = .003), the presence of moderate or severe IUA (p = .023), and experiencing menstrual improvements postsurgery (p = .001) were independent predictors of live birth. Multivariate analysis further identified that women with a history of infertility had a reduced chance of live birth following hysteroscopic adhesiolysis (p = .008), while those who reported menstrual pattern improvements postoperatively had an increased probability of achieving a live birth (p = .031). ConclusionsOur findings indicate that RPL and IUA patients without prior infertility and showing menstrual pattern improvement after hysteroscopic adhesiolysis, are more likely to achieve live births. Standardized hysteroscopic treatment, postoperative antiadhesion care, and early pregnancy planning are key to improving fertility outcomes in these patients.

Is Hysteroscopic Metroplasty Advisable for U2bC2V1 Malformation?

A complete uterine septum, with a double cervix and vaginal septum, is a complex and rare congenital genital tract anomaly. The diagnosis is difficult and often challenging, requiring complex imaging investigations and diagnostic hysteroscopy. The benefit of hysteroscopic metroplasty for this uterine malformation is still the subject of dispute. However, the potential benefits of obtaining pregnancies and reducing the rate of abortions make this surgical method a desirable one. We present a series of three cases with U2bC2V1 malformation that were diagnosed via magnetic resonance imaging (MRI), in which hysteroscopic removal of the uterine septum and resection of the longitudinal vaginal septum were performed, with the preservation of the two cervixes. All patients became pregnant after the hysteroscopic intervention and reported an improvement in dyspareunia and dysmenorrhea.

The Role of Hysteroscopic Treatment in Cesarean Scar Pregnancy Management: An Advancement in Care

The Role of Hysteroscopic Treatment in Cesarean Scar Pregnancy Management: An Advancement in Care

Hysteroscopic Management of Symptomatic Cesarean Scar Diverticulum in Patients Undergoing Frozen-Thawed Embryo Transfer: Impact on Clinical Pregnancy Rates and Pregnancy Complications.

This retrospective cohort study aimed to compare the clinical outcomes of patients with cesarean scar defect (CSD) undergoing frozen embryo transfer (FET) with or without hysteroscopic repair surgery. The study included 82 patients, with 48 patients in surgical group A (undergoing CSD repair) and 34 patients in surgical group B (undergoing hysteroscopic treatment for other uterine lesions). The results showed that patients in group A had a larger CSD volume and a different shape compared to group B. However, there was no significant difference in clinical pregnancy rates between the two groups. Additionally, there were no differences in miscarriage, live birth, or preterm birth rates, and no complications such as scar pregnancy or placental abnormalities were observed in either group. These findings suggest that hysteroscopic treatment of CSD in symptomatic patients undergoing FET does not increase the risk of pregnancy complications and can lead to comparable clinical pregnancy rates with asymptomatic patients. Further studies with larger sample sizes are needed to confirm these results and evaluate long-term reproductive outcomes following CSD repair.

Reproductive and obstetrical outcomes after treatment of retained products of conception: hysteroscopic removal vs ultrasound-guided electric vacuum aspiration, a prospective follow-up study

BackgroundTraditionally, curettage is the most widely performed surgical intervention used to remove retained products of conception. However, hysteroscopic removal is increasingly performed as an alternative due to the potentially lower risk of intrauterine adhesions and higher rates of complete removal. Until recently, studies comparing curettage with hysteroscopic removal regarding reproductive and obstetric outcomes were limited, and data conflicting. ObjectiveTo study reproductive and obstetric outcomes in women wishing to conceive after removal of retained products of conception by hysteroscopy or ultrasound-guided electric vacuum aspiration. Study designProspective long-term follow-up study, conducted in three teaching hospitals and one university hospital. Patients were included from April 2015 until June 2022 for follow-up; either in a randomized controlled, non-blinded trial on the risk of intrauterine adhesions after removal of retained products of conception, or in a cohort alongside the randomized trial. Women with an ultrasonographic image suggestive for retained products of conception ranging from 1 to 4 cm were eligible. Surgical procedures in the randomized controlled trial consisted of hysteroscopic morcellation or ultrasound-guided electric vacuum aspiration, while in the cohort hysteroscopic treatment consisted of hysteroscopic morcellation or cold loop resection compared with ultrasound-guided electric vacuum aspiration. ResultsA total of 261 out of 305 patients (85.6%) were available for follow-up resulting in a cohort of 171 women after hysteroscopic removal and 90 women after removal of retained products of conception by ultrasound guided vacuum aspiration. Respectively, 92/171 (53.8%) women in the hysteroscopic removal group and 56/90 (62.2%) in the electric vacuum aspiration group wished to conceive (p=.192). Subsequent pregnancy rates were 88/91 (96.7%) after hysteroscopic removal and 52/56 (92.9%) after electric vacuum aspiration (p=.428). The live birth rate was 61/80 (76.3%) and 37/48 (77.1%) after hysteroscopic removal and electric vacuum aspiration, respectively (p=.914), with 8/88 (9.1%) pregnancies in the hysteroscopic removal group and 4/52 (7.7%) pregnancies in the electric vacuum aspiration group still ongoing at follow-up (p=1.00). The median time to conception was 8.2 weeks (interquartile range 5.0–17.2) in the hysteroscopic removal group and 6.9 weeks (interquartile range 5.0–12.1) in the electric vacuum aspiration group (p=.262). The overall placental complication rate was 13/80 (16.3%) in the hysteroscopic removal group and 11/48 (22.9%) in the electric vacuum aspiration group (p=.350). ConclusionHysteroscopic removal and ultrasound-guided electric vacuum aspiration of retained products of conception seem to have no significantly different effect on subsequent live birth rate, pregnancy rate, time to conception and pregnancy complications. Reproductive and obstetric outcomes after removal of retained products of conception are reassuring, albeit with a high risk of placental complications.

Clinical analysis of uterine parameters evaluated by preoperative magnetic resonance imaging in patients treated by hysteroscopic approach with previous cesarean scar defect-related abnormal uterine bleeding: a retrospective cohort study.

As the cesarean delivery rate continues to rise globally, the treatment of previous cesarean scar defects (PCSD) remains challenging. This study aimed to analyze the variables that may influence the clinical cure rate of patients with PCSD-related abnormal uterine bleeding (AUB) as determined by preoperative magnetic resonance imaging (MRI) following hysteroscopic therapy. Women who underwent hysteroscopic surgery for PCSD-related AUB at the Gynecology Department of Third Xiangya Hospital of Central South University from 2018 to 2022 were recruited to this retrospective cohort investigation. A total of 147 patients were enrolled in this study and underwent follow-up over 6 months. The significance of clinical characteristics linked to the clinical cure rate of AUB was examined by logistic regression. There were 64 clinically cured (43.5%) and 83 non-clinically cured (56.5%) patients in the study. There were no significant differences in the age, menstrual duration, gravidity, parity, number of cesarean sections, time since the previous cesarean section, uterus position, width, depth, and thickness of the remaining muscle layer of the defect by MRI T2-weighted images (T2WI) before hysteroscopic surgery between the 2 groups. MRI T2WI of the myometrial thickness adjacent to the defect [P=0.038, odds ratio (OR) =2.095, 95% confidence interval (CI): 1.047-4.261] and the distance from the defect to the external cervical os (P=0.021, OR =2.254, 95% CI: 1.136-4.540) before hysteroscopic surgery are risk factors for the clinical cure rate. The myometrial thickness adjacent to the defect and the distance from the defect to the external cervical os in preoperative MRI are risk factors for clinical cure rate in patients with PCSD-related AUB after hysteroscopic treatment, which is helpful for evaluating the prognosis of disease.

Effect of misoprostol before hysteroscopic polypectomy on Dilatation of the cervix and time of the procedure

Introduction: Using misoprostol (analog prostaglandins E1, PGE1) prior to hysteroscopic intervention to induce ripening of cervix was implemented in gynecological problems management as submucosal myoma, endometrial polyps.1,2 Aim of study: The aim was to assess the effect of using misoprostol on easy dilatation of the cervix and on reducing the time needed for dilatation of cervix and the overall time needed for the procedure Patients and methods: An observational cross sectional study was performed on women who were complaining from vaginal bleeding and diagnosed to have an endometrial polyp either received misoprostol or not prior to hysteroscopic myomectomy and were subjected to hysteroscopic polypectomy under general anesthesia. Results: the time needed for cervical dilatation was more in the control group who did not receive misoprostol (P value >0.001). Conclusion: The use of a regimen of 400 mcg vaginal misoprostol administered 6 hours before hysteroscopic polypectomy is a simple, safe and effective method of cervical priming to facilitate the procedure with less total operative time , less time needed for cervical dilatation and less complications (as cervical lacerations or false passage).

Review of Asherman syndrome and its hysteroscopic treatment outcomes: experience in a low-resource setting

BackgroundAsherman syndrome is one of the endometrial factors that influence a woman’s reproductive capacity. However, in our context, it needs to be well-documented. This study aimed to evaluate the clinical characteristics and hysteroscopic treatment outcomes of Asherman syndrome.MethodA retrospective follow-up study from January 1, 2019, to December 31, 2022, was conducted on cases of Asherman syndrome after hysteroscopic adhesiolysis at St.Paul’s Hospital in Addis Ababa, Ethiopia. Clinical data were collected via telephone survey and checklist. Epidata-4.2 and SPSS-26 were employed for data entry and analysis, respectively.ResultA total of 177 study participants were included in the final analysis. The mean patient age was 31 years (range: 21–39) at the initial presentation, and 32.3 years (range: 22–40) during the phone interview. The majority of the patients (97.7%) had infertility, followed by menstrual abnormalities (73.5%). Among them, nearly half (47.5%) had severe, 38.4% had moderate, and 14.1% had mild Asherman syndrome. The review identified no factor for 51.4% of the participants. Endometrial tuberculosis affected 42 patients (23.7%). It was also the most frequent factor in both moderate and severe cases of Asherman syndrome. Only 14.7% of patients reported menstrual correction. Overall, 11% of women conceived. Nine patients miscarried, three delivered viable babies, and six were still pregnant. The overall rate of adhesion reformation was 36.2%. Four individuals had complications (3 uterine perforations and one fluid overload) making a complication rate of 2.3%.ConclusionOur study revealed that severe forms of Asherman syndrome, which are marked by amenorrhea and infertility, were more common, leading to incredibly low rates of conception and the resumption of regular menstruation, as well as high recurrence rates. A high index of suspicion for Asherman syndrome, quick and sensitive diagnostic testing, and the development of a special algorithm to identify endometrial tuberculosis are therefore essential. Future multi-centered studies should focus on adhesion preventive techniques.

A retrospective cohort study to examine factors affecting live birth following hysteroscopic treatment of intrauterine adhesions

To evaluate independent factors that affect the chance of live birth following hysteroscopic adhesiolysis in patients with intrauterine adhesions (IUAs). Retrospective cohort study SETTING: Hysteroscopic center of Fuxing Hospital in Beijing, China. Patients diagnosed with Asherman syndrome between June, 2020, and February, 2022. Hysteroscopic adhesiolysis followed by second look hysteroscopy to assess outcome and follow-up for a year. Live birth rate without the use of assisted reproductive technologies at 12 months follow-up. (s): Of the 544 women included in the cohort, the pregnancy rate at the end of one year follow-up was 47.6% (95%CI 45.5%-49.7%) and the live birth rate was 41.0% (95%CI 38.9%-43.1%). Stepwise multiple logistic regression analysis identified 3 independent predictors of live birth in decreasing order of significance: increase in menstrual flow after surgery (OR 3.69, 95%CI 1.77-8.21), postoperative endometrial thickness in the mid-luteal phase (OR 1.53, 95%CI 1.31-1.80), and the severity of recurred adhesion at second-look hysteroscopy (OR 0.62, 95%CI 0.50-0.76). Among subjects with good independent prognostic factors, namely, increased menstrual flow after surgery, postoperative endometrial thickness in the mid luteal phase greater than 6mm, no or minimal recurrence of adhesions at second-look hysteroscopy, the live birth rate was 69.0% (95%CI 65.4%-72.6%). On the other hand, in women (n=26) without any of the three good prognostic factors, none had a successful live birth (0%). (s): Overall, the live birth rate following treatment of Asherman syndrome was 41.0%. The prognosis is dependent on three outcome measures following surgery, namely, improvement in menstrual flow, post-operative endometrial thickness and minimal degree of recurrent adhesions at second-look hysteroscopy.

A case of exaggerated placental site treated with hysteroscopy

Exaggerated placental site (EPS) is a benign lesion that can occur in association with term pregnancy, ectopic pregnancy, molar pregnancy, intrauterine fetal death or miscarriage. The characteristics of EPS are described in several case reports and have been reported after major surgery such as hysterectomy. We describe the hysteroscopic characteristic of EPS associated with a spontaneous miscarriage. Hysteroscopic inspection of the uterine cavity revealed copious tissue with increased vascularization without signs of invasion. No cleavage was visualized between material and myometrium could be established during the resection procedure. 40 days after hysteroscopy the patient became pregnant. The pregnancy proceeded without complications and during the cesarean section no residual placenta-related abnormal site appearance was noted on inspection of the uterine wall. The hysteroscopic treatment could be considered feasible to preserve future fertility in young women in cases of suspect non-malignant trophoblastic disease.

Шеечная беременность. Отдаленные результаты органосберегающего гистероскопического лечения

Cervical pregnancy is a rare type of ectopic pregnancy, with an incidence of 1% in relation to other types of ectopic pregnancy and one case per 18,000 of all pregnancies. Objective. To study the long-term outcomes of the treatment of patients with cervical pregnancy who underwent operative hysteroscopy with fertility preservation. Patients and methods. This prospective and retrospective open-label clinical study included 46 patients with cervical pregnancy. Patients were divided into two groups: the retrospective group (n = 29) and the prospective group (n = 17). In all cases, treatment was performed by operative hysteroscopy. Results. After hysteroscopic treatment, an intended pregnancy occurred in all women who did not use contraceptive methods. The rate of natural pregnancy was 41.3% and the rate of pregnancy following ART was 32.6% (at baseline, 36.9% of patients had ectopic pregnancy after ART procedures). A total of 39.1% of patients gave birth; no cases of ante-, intra-, or postnatal fetal death were registered during labor. The cesarean section rate was 51.8%. Conclusion. Operative hysteroscopy should be considered as the method of choice in the treatment of patients with cervical pregnancy with gestational age up to 7 weeks (in case of advanced pregnancy – up to 8 weeks), chorion localization within ½ cervical muscle thickness and absence of severe bleeding with signs of hemorrhagic shock. Key words: cervical pregnancy, operative hysteroscopy, reproductive outcomes

Comprehensive Analysis of Factors Influencing Endometrial Polyps Incidence and Evaluation of Hysteroscopy Treatment Efficacy

Objective: To analyze the factors related to the incidence of endometrial polyps and assess the value of hysteroscopic treatment. Methods: Fifty women with endometrial polyps admitted to the gynecology department of Xinghua People’s Hospital between January 2020 and June 2021 participated in the study. They were categorized into two groups using numerical expressions, and their uteri were analyzed. Causes and related factors of endometrial polyps were assessed. The study included 25 patients undergoing dilation and curettage (control group) and 25 patients undergoing hysteroscopy (observation group). Clinical surgical indicators, endometrial indicators, adverse reactions, and recurrence rates were compared between the two groups. Results: The observation group exhibited lower intraoperative and postoperative bleeding volumes, as well as significantly shorter operation time and hospitalization time compared to the control group (P < 0.05). The incidence rate of adverse reactions was 4.0% in the observation group, significantly lower than the 24.0% in the control group (P < 0.05). After 1 year of follow-up, the recurrence rate in the observation group was 4.0%, considerably lower than the 20.0% in the control group (P < 0.05). Conclusion: Endometrial polyps have various causes, including endometritis and long-term use of contraceptive pills use. Hysteroscopic treatment proves effective, with minimal adverse reactions and a low recurrence rate, making it a commendable surgical option for promotion.

Hysteroscopic Treatment of Retained Products of Conception Using See and Treat Hysteroscopy without Anesthesia

Hysteroscopic Treatment of Retained Products of Conception Using See and Treat Hysteroscopy without Anesthesia

See and treat hysteroscopy. Future challenges and new prospective

Rapid development of technology, which has been achieved over the last decade, has helped decisively in the investigation and treatment planning of pathological conditions in the field of endoscopy and more specifically of hysteroscopic gynecological procedure. Through endless efforts in the wider medical field, hysteroscopic access of the endocervix and at the same time of the endometrial cavity was established both on a diagnostic and invasive level as an integral tool of gynecological surgery, revealing great sensitivity but also great specificity. Hysteroscopic intervention provides the possibility of direct visual imaging of endocervix and endometrial cavity and directly optically guided biopsies for histological confirmation. Globally, performance of hysteroscopy at the level of an outpatient clinic (office hysteroscopy) has a success rate of 98% and is considered a more valid method compared to diagnostic curettage. Design of increasingly flexible and smaller diameter endoscopic tools achieved the possibility of reviewing the endometrial cavity at the level of an outpatient office (office hysteroscopy), without analgesia. A study included cases of patients in whom both diagnostic and therapeutic approach were performed. Our study is focused on specific cases involving hysteroscopic procedures performed at the level of an outpatient clinic as part of an initial diagnostic examination and concurrently as part of an invasive treatment result. As culmination of all above was established hysteroscopic diagnosis and treatment in one session. (See and Treat Hysteroscopy). The aforementioned led to the development of hysteroscopic diagnosis and treatment in the context of See and Treat Hysteroscopy.

A Case of Hysteroscopic Treatment of Cystic Adenomyosis

A Case of Hysteroscopic Treatment of Cystic Adenomyosis