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Hysteroscopic examinations are becoming less and less painful - as a result of the hysteroscopist's skill and technical knowledge and the advent of technology, such as the improvement and reduction of the diameter of the optics, high-definition video systems, safe and effective means of stretching and new instruments - and are well tolerated by patients, which increases their acceptance and allows their therapeutic performance in an outpatient setting.

Conventional hysteroscopies continue to be performed in a surgical environment, for the treatment of more complex uterine disorders. However, some hysteroscopic surgeries can also be performed in the office.

Currently, there is a new concept called “see and treat”, where some pathologies, when diagnosed on an outpatient basis, are already treated during the exam itself. This concept innovated hysteroscopy, leading to a very large gain for all, as patients no longer need to leave their daily activities to perform a surgical procedure and the health care system costs less. However, such a concept should only be carried out by doctors well qualified with the technique.

Due to the still slow dissemination of hysteroscopy, as well as the little access to information, it is still natural for patients to arrive with a certain fear to perform the exam, either in the office or in the hospital. For that, I help in the formation of a new generation of able gynecologists, not only to perform hysteroscopy, but also to multiply it.

                                                                                                                               Thomas Moscovitz

 

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In the past 10 years, I have participated in the evolution of a large teaching public hospital in São Paulo (Brazil), Vila Nova Cachoeirinha Maternity Hospital. Since 2012 I have been part of a medical associate, first as a medical resident, then as a clinical practitioner of gynecological endoscopy unit. Initially, Vila Nova Cachoeirinha
Maternity Hospital was mainly an obstetric hospital, averaging 10,000 births per year.

Nowadays, it became a reference in gynecological endoscopy care and teaching in the city of São Paulo. The transition was slow and progressive. These efforts were led by Dr. Geraldo Nadai, gynecological endoscopy unit head physician in the hospital aforementioned, who made it possible acquire new equipments, increase the number of exams and surgeries, training medical residents to more complex procedures. Partnerships were made with world references in hysteroscopy, such as Luiz Cavalcanti (Brazil), Alfonso Arias (Venezuela) and Luca Mencaglia (Italy), and began to share their experience through courses and surgeries.

I invite all colleagues to participate April 30th, 2020, in the 12th Italian - Brazilian Gynecological Endoscopy Symposium at Vila Nova Cachoeirinha Maternity Hospital (Brazil). It will be a pleasure to welcome you to the Pre-Congress “Live Surgery” at Hospital Vila Nova Cachoeirinha Maternity Hospital and to share the experience of professors Luca, Arias, Attilio…


                                                                                                                               Thiago Guazelli

 

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I have been working at the Infertility Center in Tehran for the last 15 years and I have done numerous advanced hysteroscopy operations. Since hysteroscopy was introduced into my country 25 years ago, few doctors have been willing to perform hysteroscopy and there are even fewer experts in advanced hysteroscopy.

Unfortunately, the majority of the gynecologists prefer D+C for common problems like polyps and retained product of conception, which is a blind procedure with lots of complications. On occasion these aggressive curettages for RPOC end up in totally destroyed endometrium.

During the last 15 years in IVF center, I have encountered many patients with infertility, some of them in IVF cycles with a thin endometrium. Such patients are victims of aggressive curettage after miscarriage in which the basal layer of the endometrium has been destroyed and the endometrium will not respond to any dosage of estrogen. Why have they not undergone hysteroscopy?

The reason is most gynecologists prefer to stick to their old routines. I have thought a lot about this problem. I believe the less sophisticated the hysteroscopy device is and the fewer the complications, the more the gynecologist will show interest in this procedure, especially in common cases like polyps and RPOC.


                                                                                                                               Shahrzad Ansari

 

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The procedure takes place either in office or the OR. This is due to administrative and insurance coverage reasons, and not medically driven, which is baffling as much of the world executes it mainly to the office.

In the office, my goal is to erase patients’ conditioning to always undergo pain during their visits. Almost none of them arrive relaxed and trusting that this will be a relatively painless procedure, and this distrust is augmented by low socio-economic status. The reason, which is my personal view, and it’s an opinion that might not be generally shared, is that in my specialty there is a great deal of gynecologic violence towards the patient.

Despite all this, Gynecologic Endoscopy is moving forward in Dominican Republic. It has a heartening projection, more than laparoscopy, due to its easy application and a shorter learning curve. Two factors for this growth to continue are the installation of focus groups that facilitate the learning curve and bring down the costs for the equipment. Another element is the training of the upcoming generation of gynecologists that would become the driving force for the broad implementation of hysteroscopy in my country’s health system.

I definitely agree with Linda Bradley when she says “My hysteroscope is my stethoscope”.


                                                                                                                               Milcíades Albert F.

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Hysteroscopy has evolved from the invention of Leichleiter by Phillipe Bozzini in 1805 to the first hysteroscopy done by D C Pantaleoni in 1869 using the modified cystoscope with aid of Desormeaux’s endoscope. Laparoscopy in the mean time gained the upper hand as it is just another way to access the abdominal cavity. On the other hand uterine cavity is a virtual dark cavity and it required distention medium, light to be transmitted for better visualisation. As optic systems and distension media developed hysteroscopy became more and more feasible. Jacques Hamou in the late seventies and early eighties revolutionised the field of hysteroscopy. In the early 1990 Stefano Bettocchi introduced the miniature hysteroscope and then introduced the vaginoscopic technique making hysteroscopy feasible in outpatient setting.

The hard and passionate work of these and many other gynaecologists led to hysteroscopy spread its wings across the globe and thereby serve the patients. I consider my self lucky that I had the opportunity to learn office hysteroscopy from none other than my mentor Prof Stefano Bettocchi. I also worked and learnt a lot from Attilio Di Spiezio Sardo .In my days as resident we did not have the equipments in India to learn the art of hysteroscopy. The scene has now changed in India with nearly all gynaecologist  interested in hysteroscopy and  the seniors  willing to train them. Infact every Indian conference on Gynae laparoscopy is preceded by a  workshop on hysteroscopy. Truely as Linda Bradley says Hysteroscopy will be our stethoscope .

In The Global Congress of Hysteroscopy (2019) Prof Sergio, Prof Attilio and Luis gave a very good message of passion and friendship. Both the 2017 and 2019 Congress have led to great interaction among the hysteroscopists of the world and all have  been immensely benefited. I believe passion accompanied by thorough knowledge will make hysteroscopy safe for the patient. I firmly believe that counselling  the patient is the backbone of any surgical procedure ,more so in the case of Office Hysteroscopy.

                                                                                                        Milind Telang