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The field of hysteroscopic surgery has seen many advances over the years, from improved optics, the flexible hysteroscope, the resectoscope, hysteroscopic morcellators and most recently, the 5-mm “mini”-resectoscope. The art of hysteroscopy never stops to amaze me. The ability to perform a complex surgical procedure inside of the uterine cavity, without incisions, in the outpatient setting is revolutionary. Add to this the ability to achieve this without a speculum, tenaculum or cervical dilation; i.e. the vaginoscopic approach.

This technique provides several advantages, including avoiding a false track, decreased risk of uterine or cervical perforation, and minimizing trauma to the cervix and endometrium, avoiding the bleeding and debris, hence providing excellent visualization. I feel privileged to practice in this golden age of hysteroscopy, particularly with the coming-together of amazing hysteroscopic surgeons through the innovative Hysteroscopy Newsletter, the Global Congress of Hysteroscopy and the many successful hysteroscopic summits and congresses organized throughout the globe.

 

Nash Moawad

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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

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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

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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

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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