Presentation on theme: "Mounir M M Elhao, Ain Shams University. Cairo,Egypt."— Presentation transcript:
Mounir M M Elhao, Ain Shams University. Cairo,Egypt.
2 January 2014Prof. Dr. Mounir M. F. El-Hao3
2 January 2014Prof. Dr. Mounir M. F. El-Hao4
2 January 2014Prof. Dr. Mounir M. F. El-Hao5
2 January 2014Prof. Dr. Mounir M. F. El-Hao6
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.)
Thickness. Vascularity. Surface glands These criteria were very sensitive.for diagnosis of ovulation.( sensitivity 90%) The practice of D&C in rarely needed.
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
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)
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.)
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.
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)
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
In 50 cases of previous CS there were Scar not detected 11 Fibrotic white band 16 Granulation tissue 13 Minute defect. 03 Large defect. 05 Cervicat scar 02 What should we do? Yehya,Sammour,Elhao
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.
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.)
2 January 2014Prof. Dr. Mounir M. F. El-Hao24 The most satisfactory results which were achieved by hysteroscopy.wether by electric knife or by scissors.By routine resectoscope or office.
2 January 2014Prof. Dr. Mounir M. F. El-Hao25
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),
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.
. 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.
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,
Abdelmaaboud,Faris MD thesis.(2007)
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.
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.
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.
Amer (2006 ).
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.
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.
Another instrument, however, has revolutionized the way office hysteroscopy. The compact operative hysteroscope is a complete system. It is only 5-mm in diameter, and does not require the use of a sheath, as it has three built in channels. Two small channels allow the inflow and egress of distending media, and the third, which is 5-F in diameter, allows the insertion of operative instruments. This eliminates the need to change sheaths, or start with a larger diameter operative sheath, when anticipating the need to remove polyps, cut adhesions, or do biopsies under direct vision.
The risks of diagnostic hysteroscopy are quite low. Infection is uncommon, as is perforation
WHY OFFICE HYSTEROSCOPY ? MOSTLY I am not at the mercy of an OR schedule.
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.
TECNIQUE using saline distension medium and a 5 mm continuous flow office hysteroscope (Bettocchi Office Hysteroscope size 5; Karl Storz GmbH & Co., Tuttlingen, Germany). The scope is based on a rod lens system with a diameter of 2.9 mm and a 30° view.
The continuous flow sheath has an oval profile and maximum 5 mm diameter with an incorporated 5 Fr. working channel; the mechanical instruments used were grasping forceps with teeth and scissors (Karl Storz GmbH & Co.).
Intrauterine pressure was maintained at a constant40-60 mmHg using an electronic pump for irrigation and aspiration (Endomat; Karl Storz GmbH & Co.).
Distribution of the hysteroscopic findings in examined women
Table (3): Indications of office hysteroscopy in four hundred cases examined.
Conclusion : Women treated with lidocaine spray had significantly less pain. Uterine cavity abnormality might be associated with a higher degree of pain during hysteroscopy D. SORIANO, MD, S. AJAJ, MD, T. CHUONG, MD, B. DEVAL, MD, A. FAUCONNIER, MD and E. DARAÏ, MD, PhD Karim…..Acetic Acid
. 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) Lindheim SRKavic SShulman SVSauer MV
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.