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Presentation on theme: "LONG JOURNEY IN A SMALL WOUMB."— Presentation transcript:

Mounir M M Elhao, Ain Shams University. Cairo,Egypt.


3 Prof. Dr. Mounir M. F. El-Hao
25 March 2017 Prof. Dr. Mounir M. F. El-Hao

4 The crossing bridge to mysterious woumb.
25 March 2017 Prof. Dr. Mounir M. F. El-Hao

5 Prof. Dr. Mounir M. F. El-Hao
25 March 2017 Prof. Dr. Mounir M. F. El-Hao

6 Panoramic View,Tubal ostea.
25 March 2017 Prof. Dr. Mounir M. F. El-Hao

Secretory activity diagnosed by five criteria: Endometrial thickness. Vascularity. Prominence of glands. Surface roughness. Tubal ostea Appearance. Depending on the five criteria( sensitivity was 81.9 %) (Mounir Elhao et al,1992.)

8 Thickness. Vascularity. Surface glands These criteria were very sensitive.for diagnosis of ovulation.( sensitivity 90%) The practice of D&C in rarely needed.

9 Hysteroscopic Classification of IUS.
844 infertile women Fine adhesions.No menstrual disorders. Coarse adhesion,oligohypomenorrhoea. Dense adhesions,Tubular cavity. Complete Occlusion,amenorrhoea. Main causes Curettage,CS,Infections. TTT.Scissors,Diathermy knife. (Sammour,Elhao,Yehya & Saleh,March,1993)Paris

10 Major and Minor IUS. Correction of major degree of IUS (Grade 3& 4)
With the use of electro cautary needle under hysteroscopic guidance resulted into very poor pregnancy rates.(2cases only)Both of them resuted into missed abortion. Elhao,Lamii,Elnazer,& Hamza.MD Thesis(1996)

11 IUS. In 32 cases (43.2% ) G1&2 In 44 cases (56.8%) G 3&4
Recurrence of adhesions after surgical hysteroscopy was in almost 1/3 of cases.maily in G3&4,Mainly after puerpural sepsis. Now the use of scissors under office and routine hysteroscopy gives far more better results.(ongoing study .)

12 IUS.


14 Missed IUCDs. 50 cases of missed IUCDs threads,hysteroscopy was successful in extraction of 100%(20 cases) of IUCDs While D&C was successful in only 90 % of cases. Maged ,Elhao et al.1989.

15 Missed Threads if IUCDs,a new technique of hysteroscopic extraction.
New technique of Hysteroscopic extraction of IUCD,using the telescope oh the hysteroscope and a mini crocodile forceps.from 286 cases of missed threads,236 were found to be intrauterine,and were either successfully extracted (220cases) with diagnostic telescope and mini-crocodile forceps.or left in place after withdrawal of the threads(16 cases.) (Elhao,1990)

16 IUCD related AUB. 72 patient wearing IUCDs,41 cases complaining of irregular uterine bleeding.while 31 cases as controls. In the group of AUB 27 cases of the 41 cases had local pathplogy or abnormal position of IUCDs but only one case of the control had local pathological lesion. Elhao et al,1989

17 CS Scar. In 50 cases of previous CS there were Scar not detected 11
Fibrotic white band Granulation tissue Minute defect Large defect Cervicat scar What should we do? Yehya,Sammour,Elhao

18 The use of hysteroscopy in MFD.




22 Septum resection. 2-3 %of the population.
20% of repeated miscarriages. Since Edstrom in 1074,described hysteroscopic resection of uterine septum the technique was practiced Elhao,Sammour and Elgammal,MS thesis,(1993.) One of the most satisfactory procedures in hysteroscopic surgery and gynecology.

23 Hysteroscopic management of MFD for over 25 years..
First described by ELDSTROM in 1974 Hysteroscopic management of lateral fusion defects,septate,suseptate ,partial bicornuate and uterus bicollis with or without septate vagina was done since early eighties.obstetric performance wasmarkedly improved after this procedure. Electric Knife ,loop,or cold scissors. Unipola or bipolar diathermy. With or without anesthesia. Mounir Elhao,Sammour (several studies.)

24 Prof. Dr. Mounir M. F. El-Hao
MFD. The most satisfactory results which were achieved by hysteroscopy.wether by electric knife or by scissors.By routine resectoscope or office. 25 March 2017 Prof. Dr. Mounir M. F. El-Hao

25 Prof. Dr. Mounir M. F. El-Hao
Septum. 25 March 2017 Prof. Dr. Mounir M. F. El-Hao

26 Routine hysteroscopy for patients with high risk of uterine malignancy.
On fifty patients with high risk for uterine malignancy,(Diabetic,hypertensive,,obese,infertile,low parity), The study concluded that a negative hysteroscopic finding was considerted conclusive of absence of uterine pathology Also the study concluded that panoramic hysteroscopy is a valid alternative of traditional D and C. (Sammour,Elhao,Eissa,Khalifa and Elmogazi. 1992),

27 Recurrent abnormal uterine bleeding.
Cases were 2 or more D&Cs were performed for irregular uterine bleeding.(33 patients.) Hysteroscopy revealed abnormal intracavitary pathology in 81.8 % of cases examined.(10 myomas,4 polyps, 11 hyperplasia,1 atrophy and cancer in 1 case.) Makhlouf and Elhao,1989.


29 Submucous fibroids.

30 Menorrhagia, infertility or recurrent pregnancy loss are frequently related to the presence of submucosal myomas and endometrial or cervical polyps . Traditionally, the resectoscope has played a major role in the resolution of these pathologies, forcing the hysteroscopist to use this large diameter instrument even in the presence of small lesions (Loffer, 1990; Corson and Brooks, 1991; Hallez, 1996; Porreca et al,, 1996; Bettocchi et al,, 1998). The results were excellent, but due to the size of the instruments and hence the need to dilate the cervical canal, the use of general anaesthesia and an operating room were generally required.

31 The use of Pour 8 (vasopressin analogue
The use of Pour 8 (vasopressin analogue.)prior to endometrial resection. Seems to have an important role during the procedure.Fluid absorption was less,bleeding was less and vision was better in the pour-8 group. Elhao,Fateen,Mostafa and Taha,MS degree.(1998). Elhao et al,

32 Acetic acid vaginal pessaries prior to hysteroscopy.
Abdelmaaboud,Faris MD thesis.(2007)

33 25 % Dextrose a safe and clear distension medium.
76 cases done with 25% dextrose for uterine distetion as a safe and clear medium,However in recent experience its seems unsafe due to operative procedure opening deep sinuses and intravasation of the fluid and causing hyperglycaemia. Elhao,1988.




37 Hysteroscopic catheterisation of the fallopian tube in proximal tubal block.
Patients infertile for at least one year with proven PTB by HSG and or Laparoscopy (witout evidence of other major explanation for their infertility.)were subjected to tubal cannulation.using one of many cannulation kits. The study showed recanalisation rate of 77.7% M Sabri,K Lamii and M Elhao,(MD thesis,1996.) Recently,with more experience,a trial on antichlamidial therapy for three month is worthwhile before cannulation.

38 With more experience.No Need For preoperative preparations.
Effect of preoperative GnRHa or Progestin on endoscopic endometrial resection. From october 1993 to october 1996.,80 patients prepared for endometrial resection .25 depot provera,25 GnRHa and 30 patients non treatment group. Conclusions were that progestins were cheaper and better than no treament but with more side effects….GnRHa gave better control of menorrhagia ,more effective reduction of endometrial thickness and reduction of uterine size ,less fluid absorption. Shalaby,Hussein,Elhoussiny and Elhao,(1998.) With more experience.No Need For preoperative preparations.



41 Amnion graft in severe IUS
Amer (2006 ).

42 O perative O ffice H ysteroscopy

43 In the last 10 years, technological improvements have led to the production of smaller diameter scopes. This has prompted the industry to develop sheaths which continue to have a final diameter of ~5 mm, includes the working channel and continuous flow features.

44 The most important requirement for successful hysteroscopy
is satisfactory distension of the uterus. While many different media have been used, recent advances in equipment have greatly simplified the use of saline for diagnostic and simple operative hysteroscopy.

45 Saline 0.9%.Best, Office, Bipolar. Glucose 5 %.
Glycene.Best operative Unipolar(<1000.) Hyskon.Not any more.(DIC.) Glucose 10 %,Hyperglycaemia.

46 CONCLUSIONS. Office hysteroscopy is a time-efficient and cost-effective procedure, made possible by the development of small instruments. Proper patient selection and training of office personnel are mandatory to minimize complications and maximize efficacy.

47 Distribution of the hysteroscopic findings in examined women



50 Pain stratification in 400 examined patients with office hysteroscopy.


52 CONCLUSION: Office hysteroscopy is a time-efficient and cost-effective procedure, made possible by the development of small instruments. Proper patient selection and training of office personnel are mandatory to minimize complications and maximize efficacy. Lindheim SR, Kavic S, Shulman SV, Sauer MV (2005)

53 CONCLUSIONS. Office hysteroscopy is a very practical tool for an office setting. Minor operative procedures are possible,using scissors or bipolar diathermy. All degrees of IUS arebetter treated with mini scissors and office hysteroscopy. Hysteroscopic endometrial resection and large myomas are in need for General anaesthesia and 9mm resectoscope.


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