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Hysteroscopy has broadened our understanding of the pathology of the uterine cavity and endometrium, the intramural diseases and the physiology of the uterus. It accelerated our understanding of many areas such as the growth and regeneration of endometrium and the biology of endometrial stem cells. More specifically, treating myomas with hysteroscopy allows us to understand the histology and biological characteristics of the myometrium such as the distribution of blood vessels and the anatomy of the muscular layers, which helps surgeons minimize tissue damage during operations. We also have a better understanding of the biology of precancerous endometrial lesions and endometrial cancer. This may bring revolutionary changes in the treatment for local and early stage endometrial cancer in the future. Similar changes may also take place in treating intramural lesions such as adenomyosis..

To conclude, surgical hysteroscopy has already caused a revolution in the diagnosis and treatment of uterine intracavitary pathology. Advances in technology has made the surgeries of uterine cavity easier, safer and possible in the office settings. Advanced artificial intelligence, optical technology and ultrasonic technology will lead to more intelligent and efficient hysteroscopy, change the diagnostics and treatments of endometrial and uterine diseases, and bring about new perspectives to the related diseases.

Xiang Xue

One more issue, ready for you

Dear Friends, 
My mission, during the last 25 years has been innovation. To develop not only technology but also techniques in order to create procedures easier to be performed even by inexperienced gynecologists and less traumatic for the patients (do not forget: they are our mission!).
And innovation, in my opinion, is also to create new formulas in the field of teaching.
It is my pleasure to announce the first “All in one Event”. This is a new concept of Congress which includes different events covering different topics in the field of Ob./Gyn. 
I like to compare it to a good restaurant with a gourmet menu: you can take all of it, tasting the different flavors or, if you are not hungry, you pick only one dish, maybe the main course, or one of the entrées, or just the dessert… 
It will take a full working week, from Monday to Friday, and different aspects of our specialty will be covered: 
- UroGynecology and Pelvic Floor rehabilitation with a dedicate “Nurses’ point of view”
- Human Pelvic Anatomy trough the laparoscope, with live surgery from Tubingen (D)
- Hysteroscopy and Ultrasounds
- Advanced Obstetrics Ultrasound

 Stefano Bettocchi

A new fascinating Issue

  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

Enjoy our group

 

 

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

Our community is growing

 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. 

  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. 

Giuseppe Bigatti