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From the time of Commander Pantaleoni in 1869 when he hysteroscopically used silver nitrate to cauterize a uterine haemorrhagic polyp, to the invention of the Hopkins rod-lens system and light source, hysteroscopy has seen a quantum leap in its practice and widespread availability. Miniature telescopes are now readily available ensuring that hysteroscopy can safely be performed in an office setting without anaesthesia, thanks to the pioneering effort of Professor Stefano Bettocchi. The various recent devices for operative hysteroscopy have also made for a seamless practice.

Africa is definitely not left behind in this great match towards placing hysteroscopy on a pedestal. I remember back in 2010 when I set up a private practice which I chose to call Gynescope (Gynaecology and endoscopy) primarily because of my passion for minimal access surgery, especially hysteroscopy. It can even be argued that the bulk of the patients requiring hysteroscopy services reside in Africa. A cursory look at some of the indications might attest to this. One of the commonest indications for hysteroscopy is uterine synechiae. Most African countries have restrictive abortion laws, leading to an unacceptably high unsafe abortion rates and its sequelae which includes synechiae. Uterine fibroids, another common indication for hysteroscopy, is known to be commoner among the black population. For these reasons, the average gynaecologist in Africa is very much interested in developing his/her hysteroscopy skills. This fact will surely be manifested during the forthcoming Global Congress on Hysteroscopy, where there will be a large African, albeit, Nigerian contingent.

                                                                                                             Jude Okohue

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Fortunately, today, things are very different; there is a generalized interest in hysteroscopy as a specialty, with unquestionable uses as a diagnostic and therapeutic tool, relatively easy to learn, with frequent updates and web based events, which allows to see a large number of surgical interventions, images, conferences, etc., easy access to equipment, and the generosity of those who teach this art and the incorporation of specific dedicated hysteroscopic rotations in training programs. This year, we will start a fellowship in gynecological laparoscopy in Colombia, the first program endorsed by the AAGL outside the United States and Canada, where I have the honor to be the professor of Hysteroscopy.

In my opinion, what differentiates hysteroscopists from other surgeons is the possibility to complete most of the procedures in the office, without anesthesia, without sedation, as Dr. Bettocchi described it; The most important challenge and the resounding success of Hysteroscopy will be when we routinely have all gynecologists perform diagnostic Hysteroscopy in the office and have Hysteroscopy centers of high complexity, with greater resources that handle cases with great complexity.

                                                                                                             Carlos Buitrago

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Since my early beginnings in this field, my view to spread hysteroscopy was to emphasize its “simple, safe and smart” characteristics of practice. At a certain level of simplicity and safety, hysteroscopy will overcome the challenges of culture and depates, and acquire an attitude similar to the ultrasound machines in our clinics, which we literally start to use before thinking of a real indication. With assistance of interested colleagues, we developed a basic training program (independent from laparoscopic training) oriented mainly towards role of hysteroscopy, widening its indications, office practice, from setting up a unit up to different hand-skills. We then started to look for “and develop” affordable devices that are suitable for office use. Few companies showed an interest in investing in this area, and today affordable hysteroscopic systems are available for the first time.

This work gained an excellent feedback, and now supporting tens of hysteroscopy units in many countries in the area. Many challenges are today overcomed, now patients are aware of procedure, its importance and simplicity. Gynecologists feel more relaxed to refer patients for hysteroscopy if they donot have facilities to perform it on their own. The procedure costs are now reasonable too. More sales for advanced resectoscopes and shavers are being recorded, more researches are being carried out and published, dedicated hysteroscopy units are now not rare and far. We are catching up.

Finally, I appreciate all help I am getting from the international community of scientists in this field and proud to be accepted as a junior member among you all. Much thanks goes to the great heroes behind connecting all interested gynecologists with each other.

                                                                                                    Mounir M Khalil

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Despite the widespread use of the Internet and the emergence of social networks, diagnostic and surgical hysteroscopy has not been widely used in Ukraine until 2006. Since 2006 there has been a more active development of hysteroscopy, which is connected to the organization of a number of regular conferences devoted to gynecologic endoscopic surgery, with the involvement of international experts. It was 2006 that, in my opinion, became the year of Ukraine for the rapid development of gynecological endoscopy and hysteroscopy in particular.

From 2006 to the present day, the spread of hysteroscopy has steadily increased. To date, many public and private centers have in their arsenal hysteroscopes and hysteroresectoscopes. Since 2012, bipolar hysteroresectoscopy has started to develop actively. Diode lasers have been widely used since 2013. After 2015, shavers appeared in some places. In 2018, the first systems using 3 mm laparoscopic instruments for performing intrauterine manipulation have appeared.

Despite the huge growth spurt that hysteroscopy has had in our country, the issues of training and acquiring new equipment remain urgent. However, all gynecologists understand the importance and benefits of hysteroscopy, which makes 100% incorporation of this technique into our practice a matter of time. I hope, and I am even confident that office hysteroscopy, intrauterine operations in outpatient settings, laser technologies, hysteroscopic embryoscopy and many other kinds of hysteroscopy will become a "stethoscope" of Ukrainian gynecologists in the next five years. Progress is inevitable.

                                                                                         Mykhailo Medvediev

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Morocco is a developing country with a population of over 34 million today . The country has been seriously challenged by the scarcity of healthcare human resources over the past few decades, and there are currently less than 2000 Obstetrician-Gynecologists in total, leading to an unacceptable level of pregnancy and childbirth related deaths and morbidities. Our predecessors focused on adressing this issue but neglected the development of the fields of Gynecologic surgery and Fertility management.

As a young professor in the early nineties; I found this situation unacceptable. So I decided to resign and along with a small group of passionate colleagues we created the Moroccan Society of Gynecological Endoscopy (SMEGYN) and organized our first workshop with the support of our French colleagues, mainly Pr. Leon Boubli from Marseille and Pr. Jean-luc Mergui from Paris. The next step was to further develop Laparoscopic surgery, in collaboration with Pr Jean Bernard Dubuisson and the renowned team of Clermont-Ferrand.

Up until now, we organized 20 congresses, 11 courses of Hysteroscopic Surgery currently delivered by an exclusively Moroccan team, with over 400 participants in total, and 9 courses of Laparoscopic Surgery . Currently hysteroscopy is spreading throughout all the country. Regarding the technical aspects, diagnostic hysteroscopy is provided in an office setting by vaginal approach without anesthesia and the large majority of surgical procedures are scheduled in the OR, using a resectoscope. Short procedures are performed under general anesthesia and laryngeal mask or rachianesthesia for very long procedures such as large myomas or severe synechiae.

                                                                                         Jamal Fikri