| 书目名称 | Practical Manual of Hysteroscopy | | 编辑 | Enlan Xia | | 视频video | | | 概述 | Tips in performing diagnostic and operative hysteroscopy.Advanced techniques of combined hysteroscopy with laparoscopy.Written by experts with extensive experience in the field | | 图书封面 |  | | 描述 | This book aims to provide readers with the latest information on application of hysteroscopy in diagnosis and treatment of gynaecological diseases. The first chapters systematically review current status, equipment and instruments, applied anatomy, preoperative treatment and anesthesia for hysteroscopic surgery. In the following chapters, details in aspect of hysteroscopy from diagnostic to hysteroscopic surgery are explained with clinical cases. After that, advanced techniques in hysteroscopy combined with laparoscopy and ultrasound monitoring hysteroscopic surgery are introduced with high-resolution illustrations. Written by experts with wealthy experience in the field, this book will be a valuable reference for gynecologists at hysteroscopy units, reproductive units, gynecological and oncological units.. | | 出版日期 | Book 2022 | | 关键词 | Hysteroscopy; Hysteroscopic myomectomy; Hysteroscopic endometrial polypectomy; Hysteroscopic diagnosis; | | 版次 | 1 | | doi | https://doi.org/10.1007/978-981-19-1332-7 | | isbn_softcover | 978-981-19-1334-1 | | isbn_ebook | 978-981-19-1332-7 | | copyright | Henan Science and Technology Press 2022 |
| 1 |
,History and Development of Hysteroscopy, |
Enlan Xia |
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Abstract
The history of hysteroscopy could be traced back to 150 years ago. Under the influence of low productivity, the hysteroscopic technique was developed very slowly. Until the twentieth century, it improved gradually, especially in recent 20 years, the evolution of operational hysteroscopy brought epoch-making revolution in the treatment of some gynecological diseases. The advances of hysteroscopic technique are owing to the contributions made by many innovators, whose years of continuous efforts innovated the means of diagnosis and treatment for today’s gynecologists and obstetricians. This chapter will describe several different historical periods, especially the important stages in which the uterine cavity could be revealed in front of us (Table 1.1).
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| 2 |
,Equipment and Instruments for Hysteroscopy, |
Xuegang Liu,Baoliang Lin,Yan Quan |
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Abstract
Since Pantaleoni applied the first hysteroscopy in 1869, with the help of candlelight and concave mirror on human living body and found cervical polyps in a woman with postmenopausal vaginal bleeding, quite a few scholars have committed to exploring the mystery of uterine cavity in the next 100 years. But due to the physiological and anatomical characteristics of uterus and the limitation of instruments and optical-electrical system, optimal results were hardly achieved. Until 1970s, with the emergence of fiber-optic devices, cold light sources, and modified uterine-distending method, the research and application of hysteroscopy regained attention and underwent rapid development.
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| 3 |
,Anatomy and Histology in Hysteroscopy, |
Enlan Xia |
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Abstract
The uterus is a hollow organ, inverted pear-shaped, and located in the center of the pelvis. It is made up of three parts, the fundus, the corpus, and the cervix. The narrow portion between the corpus and the cervix is called isthmus, and its upper portion is internal orifice of the uterus, that is, anatomical internal os; the lower portion is histological internal os, which marks the transition from the endometrium to the endocervix. The size and shape of the uterus may vary with age and fertility. The uterus of normal non-childbearing women measures 7–8 cm in length, 4–5 cm in width, and 2–3 cm in thickness. The volume of uterus increases in women after parturition. The proportion of the uterus to the cervix changes with age. At adolescence, the corpus is as long as the cervix; in women of child-bearing age, the length of the corpus is about twice that of the cervix; in postmenopausal women, the corpus and the cervix are equal in length.
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| 4 |
,Effects of Preoperative Medication for Hysteroscopy and Commonly Used Drugs in Gynecology on Endometrium, |
Xiaowu Huang |
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Abstract
During hysteroscopic surgery, particularly when the uterus is distended with distention medium, the endometrial shedding fragments are prone to block the sieve holes of hysteroscopic outer sheath, which may cause the blockage of return flow. Together with intraoperative bleeding, the operation view is hindered, which is not helpful for the operation to run smoothly. The preoperative administration of drugs can make endometrium thinner, and endometrial blood vessels decreased, thus achieve a good vision that facilitates the operation and shortens the operation time. Pretreatment with drugs was originally used for hysteroscopic endometrial ablation. In 2014, the French clinical guidelines indicated that, pretreatment with drugs may achieve a good vision, but cannot decrease the occurrence of complications, therefore it should not be considered as a routine use.
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| 5 |
,Application of High Frequency Electricity in Hysteroscopic Surgery and Its Thermal Effects on Tissues, |
Hua Duan |
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Abstract
In 1924, Wyeth first found that high power and high frequency (HF) damped waves were able to incise tissues, and then high frequency damped wave electrotome was developed and applied in surgery by Anderson et al. In 1928, Bovieh and Cushing developed a high frequency undamped wave electrotome, which laid the basic foundation of high frequency electricity in the surgical treatment. In recent years, high frequency electricity has been proved to be safe, efficient, easily handled, and manipulated, and has been widely used in hysteroscopic surgery and improved quickly.
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| 6 |
,Distention Medium in Hysteroscopy, |
Limin Feng |
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Abstract
Hysteroscopic examination and operation are effective methods for the diagnosis and treatment of the dysfunctional uterine bleeding and other benign lesions in the uterine cavity. The sufficient distention and clear visualization of the uterine cavity is one of the most important factors for examination and treatment, so an appropriate distention medium is necessary for either diagnostic or operative hysteroscopy. The most commonly used distension media include gaseous medium (CO.), low viscosity liquids (such as glycine, glucose, mannitol or sorbitol, and normal saline), and high viscosity liquids (such as dextran-70). However, due to the serious allergic reactions, the use of high viscosity liquids has already been prohibited. The procedures of hysteroscopic resection are performed under the continuous irrigating of distention media. It is done after the resectoscope being inserted into the uterine cavity through the cervical canal, with both the whole endometrial layer and 2–3 mm myometrial layer underlying the endometrium being resected so as to achieve the aim that the endometrium cannot regenerate. This operation is quite similar to transurethral resection of the prostate (TURP) in that a large amount of liquid distension medium (irrigating fluid) can be absorbed via the intraoperative open veins into the circulation. Furthermore, the uterus is different from the bladder in that the uterus is an organ with certain thickness and a hidden cavity which needs a very high distending pressure. What’s more, there is much richer blood supply in the uterine wall than in the bladder wall, so there will be more absorption of distention medium during hysteroscopic surgery than that during TURP, resulting in the syndrome of transurethral resection of the prostate (TURP syndrome). This syndrome leads to the occurrence of hyponatremia, and if not corrected immediately, it could further cause the damage to cardiovascular system, serious neurologic and mental abnormalities, and even death, which are serious complications of endoscopic electro-resection.
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| 7 |
,Anesthesia for Hysteroscopy, |
Handong Cai |
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Abstract
Hysteroscopy is a new technique for treatment of gynecological diseases which was developed in 1990s. It integrates optical fiber, photoelectricity, mini camera, image analysis, and imaging as a whole. When these high-tech instruments are in clinical use, due to its characteristic technique, adverse effects and severe complications may occur. Therefore, anesthetists must have sufficient knowledge related to this field and possess emergency treatment skills to deal with intraoperative accidents and complications.
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| 8 |
,Diagnostic Hysteroscopy, |
Enlan Xia,Dan Yu |
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Abstract
Diagnostic hysteroscopy can be used to directly investigate intrauterine lesions and localize them for biopsy, so it is more intuitive, accurate, and reliable than traditional diagnostic dilatation and curettage (D&C), hysterosalpingography (HSG), and ultrasonography. Hysteroscopy can reduce the rate of missed diagnosis, significantly improve the accuracy of diagnosis, and has been reputed to be the golden standard of modern diagnosis of intrauterine lesions. Dotto et al. classified the endometrial images under hysteroscope into five categories: normal endometrium, benign lesions, low-risk endometrial hyperplasia, high-risk endometrial hyperplasia, and endometrial cancer, which were highly consistent with the findings of endometrial biopsy. Clark et al. reviewed 65 articles and studied the accuracy of hysteroscopy in diagnosis of endometrial cancer and hyperplasia in women with abnormal uterine bleeding. They found that in all patients included, the pretest probability of endometrial cancer was 3.9%, which was increased to 71.8% by a positive result of hysteroscopy and was reduced to 0.6% by a negative result. Thus, it was considered that the accuracy of hysteroscopy for endometrial cancer was high, but was only applicable to endometrial disease. Agostini et al. made a review and analysis of 17 cases who were diagnosed pathologically to have endometrial atypical hyperplasia after hysteroscopic resection. One case was discovered to have endometrial adenocarcinoma, with the risk of 5.9% (1/17). Nowadays, diagnostic hysteroscopy has become a new and valuable gynecological diagnostic technique. Applications of micro-devices and non-invasive techniques have expanded the use of hysteroscopy from out-patient clinic to movable stations. Nagele et al. suggested that outpatient hysteroscopy had a high detection rate for intrauterine lesions and simple hysteroscopic surgeries could be performed at the same time. Therefore, just as D&C in the twentieth century, hysteroscopy has been considered as a routine method for diagnosis of intrauterine lesions in the twenty-first century.
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| 9 |
,Operative Hysteroscopy, |
Enlan Xia,Ning Ma,Xuebing Peng,Dan Yu,Jie Zheng |
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Abstract
Since the early 1970s, hysteroscopic operation has been introduced in clinical practice. At the very beginning, it was only used for tubal sterilization, which was achieved by electrothermal damage to the interstitial portion of the fallopian tube under direct vision of hysteroscope. Due to its low efficacy and higher risk, it was replaced gradually by other methods of treatment. Thereafter, along with the innovation of technology and constant improvement on operative instruments and energy source, the hysteroscopic operation has also been constantly improved in its safety and efficacy. At present, this minimally invasive approach of hysteroscopy is gradually replacing the traditional traumatic hysterectomy via . to treat various intrauterine and cervical diseases. Due to its minimal invasiveness and high efficacy, it is recognized as the model of minimally invasive operations.
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| 10 |
,Combined Hysteroscopy and Laparoscopy, |
Enlan Xia |
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Abstract
With the development and improvement of the endoscopic techniques and surgical instruments, the minimally invasive technique has also gained popularity in the gynecological field, and more and more gynecological patients can be treated with minimally invasive techniques. Compared with open surgery, endoscopic surgery has advantages of minimum trauma, less bleeding, less interference with organs, slight postoperative pain or discomfort, and quick recovery. At present, gynecological laparoscopic techniques have been widely used in China, and the treatment of pelvic benign lesions by laparoscopy has shown a tendency to replace the traditional open surgery. Although the development of hysteroscopy comes relatively late, it has been developed very rapidly, and surgical indications have been continuously extended. Moreover, the surgical procedures have been shifted from a simple diagnosis and treatment to complex surgical procedures, such as hysteroscopic resection of large sessile submucosal myomas and inward-protruding intramural myomas; complex surgery of metroplasty, like correction of uterine septum and lysis of severe intrauterine adhesions; hysteroscopic tubal cannulation; and gamete intra-fallopian transplantation transfer. Nevertheless, clinically there are still many intrauterine, intra-abdominal, and intrapelvic disorders requiring urgent concomitant diagnosis and treatment, such as evaluation and treatment of tubal and uterine factors in cases of infertility, concomitant surgery for intrauterine and intra-abdominal lesions, and the monitoring of difficult intrauterine operations. Therefore, combined hysteroscopy and laparoscopy will become a more effective method for clinical diagnosis and treatment.
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| 11 |
,Ultrasonography Monitoring During Hysteroscopic Surgery, |
Dan Zhang |
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Abstract
Operative hysteroscopy is a surgical procedure implemented using hysteroscopic resectoscope, which belongs to intrauterine gynecology and includes TCRE, TCRM, TCRS, TCRA, and TCRF using wire loop electrode, and EA using rollerball electrode.
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| 12 |
,Complications of Hysteroscopic Surgery, |
Enlan Xia,Rafael F. Valle,Xiaowu Huang,Dan Yu,Yuhuan Liu,Baoliang Lin |
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Abstract
Complications are defined as clinical incidents that occur and cause the surgery to be suspended of further treatment during operation and which requires a long time of monitoring and further laparoscopic investigation or surgery. In 2000, Propst et al. reported that in 925 cases of hysteroscopic surgery, the occurrence rate of operative complications was 2.7%. These complications involved uterine perforation, fluid overload (≥1 L), hyponatremia, hemorrhage (≥500 mL), bowel or bladder injury, difficulty in dilating the cervix, prolonged hospitalizations, etc. TCRM and TCRS had the greatest probability of complications with fluid overload the most frequent complication. TCRP and TCRE had the lowest probability of complications. Hysteroscopic operative complications, although rare, are serious. There are four kinds of major complications: (1) Hyponatremic encephalopathy, or TURP syndrome, is one of the most serious complications. It has been reported that premenopausal women are 26 times more likely to suffer neurologic sequelae from hyponatremia than postmenopausal women or men. These women will experience permanent brain damage, paralysis, and even death. To prevent this complication, premenopausal women could be transited to postmenopausal state prior to operation by using GnRH agonists in sufficient dosage and for a sufficient length of time to induce menopause. Carter reported on one healthy young woman who suffered irreversible neurological consequences from hyponatremia during a hysteroscopic resection of a small submucous myoma. (2) Uterine perforation (either with or without bowel injury). (3) Hemorrhage. (4) Infection. In addition, there may be air embolism which may cause sudden death. Therefore, to perform hysteroscopic operation safely, the surgeon must be fully aware of various complications and the ways for early detection and preventive treatment.
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| 13 |
,Hysteroscopy for Other Purposes, |
Jie Zheng,Enlan Xia |
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Abstract
Vaginoscopy is also named non-touch hysteroscopy, which applies hysteroscopic instruments and non-invasive techniques (such as no placement of speculum, no holding of cervix, no dilation of cervical canal, no probe of the length of uterus, distension of the cavity with low pressure, and use of mini instruments) to accomplish the hysteroscopic examination so as to reduce the pain and discomfort which are caused by traditional hysteroscopy such as placing the speculum and cervical forceps, using the scope with large diameter, and requiring local or general anesthesia. With the extensive use of office hysteroscopy, vaginoscopy has been gradually favored by both doctors and patients. The application of it cannot only replace the traditional hysteroscopy, but also favor the female infants, young girls, and unmarried women of child-bearing age because of no damage to the hymen.
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| 14 |
,Hysteroscopy Training, |
Enlan Xia,Xiaowu Huang |
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Abstract
Before widespread clinical application, any kind of diagnostic and treatment technique must involve a set of systematic learning methods to guide operators to understand and grasp its operating principles step by step. Through clinical practice, its application methods, operating skills, and safety are constantly improved and perfected. Therefore, systematic training is important for the completion and implementation of endoscopic training program, and all the gynecologists to be engaged in this program must be qualified in this planned standard training so as to achieve the expected level of expertise.
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| 15 |
,The Future of Hysteroscopy, |
Enlan Xia |
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Abstract
In the past 30 years, rapid development of hysteroscopic technique and great progress in its equipment have turned hysteroscopic examination and surgery into an effective means of diagnosis and treatment of intrauterine lesions for gynecologists. It can be foreseen that there is a great deal of hope for hysteroscopy. Not only the indications for hysteroscopic diagnosis and treatment are well established nowadays, but they have also been extended and have replaced some other operations performed by gynecologists, such as curettage, removal of uterine submucous myoma by hysterotomy and blind division of intrauterine adhesions, and so on. The main aspect for future research will be the new second generation endometrial ablation technique. The ideal second generation technique should be accomplished more easily, require less skills and less training, and can be done under local anesthesia, but its effect can be comparable to classic hysteroscopic surgery, which can be adapted to all intrauterine operations including fibroids, and there are fewer complications compared with TCRE and EA. There is still more need for analysis of randomized controlled trials on various endometrial ablation techniques as much as possible so as to evaluate its effectiveness and safety. If there is no solid credible evaluation, new technique and new equipment cannot be applied routinely in clinic and be introduced in the market. In the treatment of obstetric and gynecological diseases, the costly endometrial pretreatment with drugs has gradually given way to mechanical pretreatment for economic reasons.
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| 16 |
,Digital Storage and Application of Endoscopic Image, |
Baijiang He |
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Abstract
The storage and application of endoscopic image data had been problems difficult to resolve properly before the introduction of computer technology. In order to save a valuable picture on the monitor as a static image, it is unimaginable to directly face the monitor and shoot. Some endoscopic manufacturers developed special equipment for shooting the endoscopic images with optical camera. After being filmed and processed, photographs are created for preservation. The dynamic images can only be stored in video tape, CD, or DV (digital video cassette). The shortcomings of doing so are that there will be loss in video quality after being preserved for long term or being replicated for many times, and that it is not possible or difficult to effectively edit and modify freely without professional equipment. For example, if we would like to produce a short teaching video about endoscopic surgery, there was a need to edit the original video data, such as editing videos, adding captions, and putting both narration and music. Its completion not only requires professional equipment worth of hundreds of thousands of dollars in the television station or publishing house but also assistance of the professional and technical personnel.
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发表于 2025-3-21 19:22:53
