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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

 

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Some of them are important because of the relevance of the society that organizes them, for example the last AAGL Global Congress in which gynecologists from all over the world meet to talk about minimally invasive surgery in the city of Las Vegas. Other meetings are organized by societies with a large number of members, as happened with the AICOG (All Indian Congress of Obstetrics and Gynecology) that was held this past January in Bengaluru. A mega congress that deals with oncology, maternal-fetal medicine, infertility, reproductive health, surgery and almost anything that has to do with gynecology. Other congresses are important for the interest and dedication of emerging societies, societies that bring together great professionals who have a common goal: to learn and improve.

Our congress has a bit of this last. If I had to answer the question what makes this congress special? I would need only two words: Passion and Friendship. The first and most important is thing is passion. There is something that we must never forget in life. We must never forget that we are doctors, that our main goal is to help. Help our patients to solve a problem, help them to conceive a pregnancy, help to improve the quality of life of those who need our help..... and also help our colleagues. We must put our passion in our work, in our training. Being a doctor is something that must be lived with passion. As Stefano said, "passion makes a difference".

The second thing is friendship. The international group of hysteroscopists is like a big family, in which friendship is always present. A group of friends who enjoy what they do, who LOVE hysteroscopy and who have fun doing their job.

The passion for what we do and the friendship that exists between us results in the magic of the Global Congress ... it can be seen all around.... you can feel it...
you can even catch it, and if you take the magic and carry it with you, you will become a great hysteroscopist and one of this little family. You will be one of us!!!!

                                                                                                         Luis Alonso

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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