Hysteroscopy is the process of viewing and operating in the endometrial cavity from a transcervical approach. It is a minimally invasive intervention that can be used to diagnose and treat many intrauterine and endocervical problems. The first scientist to conduct light into the human body was Bozzini in 1805. The hysteroscope as we know it today is similar to the early cystoscope described and presented in 1877 by Nitze. The instruments and technique of endoscopy underwent advances by people such as Heineberg (1914), Rubin (1925), Mickulicz-Radecki (1927), and Norment (1949).Newer technique of Hysteroscopy have enabled us to perform procedures like submucous myomectomy, submucous Polypectomy, Intrauterine septal resection, and lot more which required open surgeries in past. Also hysteroscopy has proved as boon in field of Reproductive Medicine and enhancing IVF results.
In this chapter I am trying to cover, in the most practical way, how to optimize myomectomy results while performing Hysteroscopy.
|ESGE: Classification of submucous myomas|
|Type 0 Entirely within endometrial cavity No myometrial extension (pedunculated) (Fig.2) Type I <50% myometrial extension (sessile), 90-degree angle of myoma surface to uterine wall (Fig.3) < 90-degree angle of myoma surface to uterine wall Type II >50% myometrial extension (sessile) R90-degree angle of myoma surface to uterine wall Fig.4) > 90-degree angle of myoma surface to uterine wall|
|Modified from Wamsteker et al. Obstet Gynecol. 1993;82:736–740|
|Tips 1. Meticulous attention to intraoperative fluid balance is imperative, if fluid deficit more than 1 to 1.5 liters is detected, serum sodium is measured and hyponatremia, if present, should be treated. For every liter of electrolyte free fluid that is absorbed the sodium will go down approximately 10 mEq /lit. This helps surgeon to determine when to stop a case. If deficit is approximately 1500cc it is advisable to put in a Foley’s catheter and give diuretic. 2. Absorptionoflargevolumesofelectrolytefree,lowviscosity fluid especially with large myoma is the trigger of some systemic changes during the operation. Myomectomy of large myomas is liable to hyponatremia, hypo-osmolality, increased CVP, increased PT and aPTT and increased most of the cardio dynamic parameters. These changes deserve performing the procedure by an experienced hysteroscopic surgeon using a quick technique with least possible Glycine volume and minimal intrauterine pressure to achieve the goal of a safe minimal access surgery. 3. It is advisable not to remove big anterior and posterior fibroids in the same sitting to avoid intra-uterine adhesions/ synechie formations. 4. Type 0 myoma should never be dislodged at the base first, which is the most tempting thing to do. One should avoid this as removal of floating myoma from uterine cavity creates a great problem. 5. While resecting Type I and Type II myoma particular care is taken regarding the intra-uterine pressure. If pressure is very high, fibroids will be pushed deep into the wall making resection difficult and also it may increase the intravasation of fluid. To prevent this, minimal least pressure is kept that gives adequate distension and clear vision.|
....to Fulfill your Dreams
The Beginning of the Most Cutest Wonder and That is a BABY!