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Office hysteroscopic surgery utilize 5 French channels to introduce several tools either mechanic or electric needles and tweezers. The biggest advantage of office surgery is the possibility to avoid general anaesthesia and to perform almost all procedures in an outpatient setting. The great advantage of 5 Fr operative tools may become in several casesa limit, when intrauterine pathology is too large and needs to switch to classic resectoscope.

Recently mechanic energy has been adopted by operative hysteroscopes, either on office base (Truclear) in with bigger tools needing anaesthesia (Intrauterine Bigatti Shaver IBS).The advantages of shavers/morcelators is the possibility to avoid the use of electric energy.The blunt tip reduces the possibility to perforate the uterine wall.

Where are we going? Every uterine pathology needs an accurate pre-surgery diagnostic setup. To avoid possibile complications it is important to evaluate vascular invasion of trophoblastic retained tissue or to measure the healthy tissue between myoma and external serosa. It is very useful too keep an ultrasound machine in the operative theatre in order to assure maximal safety of the procedure.

The future I imagine is an integration between operative tools and ultrasound in order to have a surgery which will be precise and safe. Iimagine an automatic or computer guided surgery which integratesthe pre-surgery diagnostic setup and the cutting element in order toguide the operator like an airplane landing in the fog.

 Marco Gergolet

A new Fascinating Issue

In early 1990 and onwards, several improvements were introduced. The major one, diameter of the scope was reduced to 2mm, by Bettochi without compromising the visibility and quality of work. The no touch technique did away with the speculum, the tenaculum, need for dilatation and operating theatre. Procedures could be carried out in the OPD, suddenly making it a hugely popular device to diagnose, plan further surgery and carry out a variety of extensive surgical procedures. The instrument has evolved from a diagnostic tool to one where treatment can be carried out, using isotonic solution and in a out patient setting.

 It is not possible to forecast when the procedure will reach its full potential or what the “potential” is. It is essential for both the scientists and doctors to strive to go that little further.

It is important that hysterocopists all over the world keep in touch with each other so that these latest improvements and advances can be shared and translated into benefits for the patient.


Rahul Manchanda & Prabha Manchanda

Enjoy Our Group

During the last few years the world of hysterscopy has revealed to be very active in improving its technique. All the new trends could be summarized in two main directions. The first big innovation, following the indications of Prof. Stefano Bettocchi, has been a reduction in size of all diagnostic and operative hysteroscopes in order to approach all patients in an office set up. In this respect the Trophy scope by Dr. Rudi Campo fulfilled this new trend. The Trophy scope with its small diameter can be used as diagnostic hysteroscope during office procedures and in case of operative necessity an additional operative sheet can be pushed into the uterine cavity allowing this option.  Another big attempt in miniaturizing hysteroscopic instruments is the Gubbini resectoscope. Thanks to its small diameter Dr. Giampietro Gubbini has shown the possibility to approach with the resectoscopic technique all major intrauterine pathologies in an office set up. This great innovation still can be listed into the attempt of miniaturization of all hysteroscopic equipment.

  The second main revolution in the world of hysteroscopy concerns the possibility to remove the tissue chips during operative procedures at the same time of their resection. This new philosophy in operative hysteroscopy is trying to find an alternative solution to conventional resectosopy in order to reduce all complication related to this technique. In this respect two main instruments has been created by Prof Mark Hans Emanuel and I.  Emanuel described a morcellation technique while I speak of the shaver technique. Despite their technical differences both instrument follow the same idea which is to remove the tissue while resecting it allowing always a good visualization and reducing the complication rate. Originally these two techniques were built for operative hysteroscopy but as the technique improves will also be used during office procedures.

Giuseppe Bigatti

Our Community is Growing

During an International Meeting, in autumn of 2015, it started a crazy idea, to bring together the largest group of hysteroscopists, for the first World Congress of Hysteroscopy. Discussing with Sergio Haimovich and Luis Alonso, I found a great light in their eyes: the clean light of the freedom of research and of the work without external pollution. I immediately shared their choice of being able to work free from any possible external influences. Moreover, from there, the great idea of Luis and Sergio to involve many foreign colleagues with the same our desire and wishes. We discussed on many “unthinkable until then” common projects, all-converging on up to the International Conference.

Thus, day by day, time after time, the wave of enthusiasm swept everything and everyone, free from constraints and scientific joints. All colleagues ready to run the great unconventional venture of world meeting on hysteroscopy, to upset the routine. Michael Stark said: What is the hardest thing in the world? The diamonds? NO, THE TRADITIONS. We have passed the tradition to maintain hysteroscopy as a niche in endoscopy congress, ready to upset this tradition and changing, with the expertise, the unwritten rule that hysteroscopy is the younger sister in the gynecological endoscopy. The hysteroscopy is a worldwide standard practice daily performed in each ambulatory, Hospital and Clinic, by worldwide hystero-community. Thus, it began the adventure of the Global Congress on Hysteroscopy, which involves many of us and dreams of opening a new era, promoted by a “Mad Hystero-Group”.

Andrea Tinelli

First Issue of 2017

Indonesia is a big country, it’s the fourth populated country in the world and is number fifteenth of the largest country in the world. We have roughly 70 Millions Female in reproductive age, but less than 20 percent of our Gynecologist are competence in Hysteroscopy and laparoscopy. So many colleagues of mine still doing blind D & C.

Our introduction with endoscopy start in the late 80’s when Prof Ichramsjah is coming back from England (with Jeffcoate) and bring one Wisap full laparoscopic hysteroscopic tower and instrument. And in early 90’s, Prof Jacob have opportunity to study in German (with Kurt Semm) and also to Brussels (with Jacques Donnez). After his return to Indonesia many Indonesian OG learn this technique for the first time from them. Since then many Indonesian gyne went to Leuven (with Jacques Donnez) and some to Nashville (with James Daniell) in the late 90’s.

As the Course Director for IGES Training Center at The presidential Hospital – Indonesia Army Central Hospital and on behalf of the IGES I look forward for the event in Barcelona this May 2017. Many of us want to come there to learn and to share our experience. See you in Barcelona !!


                                                                                     Ichnandy Arief Rachman