Hysteroscopy Newsletter

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

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.

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

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

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