The Experts below are selected from a list of 465 Experts worldwide ranked by ideXlab platform

Bettocchi S - One of the best experts on this subject based on the ideXlab platform.

  • Clinical aspects of hysteroscopic diagnosis of atypical endometrial hyperplasia
    'Elsevier BV', 2014
    Co-Authors: Ceci O, Resta L, Indrizzi A, Ferrari C, Bettocchi S
    Abstract:

    We read with interest the article by Mittal et al [1], “Diagnostic criteria for distinguishing endometrial adenocarcinoma from endometrial complex atypical hyperplasia”. The article is noteworthy not only for diagnostic aspects but also for clinical repercussions. We report our clinical experience on the diagnostic accuracy of hysteroscopy with regard to atypical endometrial hyperplasia. All hysteroscopies were performed using a continuous-flow office Hysteroscope with a 5F working channel. The biopsy forceps has a diameter of 5F and jaws of 5 mm in length. The forceps features small teeth on both sides of the jaws to retain the obtained tissue. With the combination of this kind of forceps and adequate technique, a very large amount of biopsied endometrial tissue (mean, 5.7 mm2 measured in 2 dimensions on histologic section) was sampled [2]. We compared the hysteroscopic findings (including targeted biopsies) with the histologic findings obtained after hysterectomy. On the basis of histologic examination of endometrial biopsy during a period of 10 years, we had 29 cases of atypical endometrial hyperplasia. Of these, 14 cases (48.3%) were found to be endometrial carcinoma with atypical endometrial hyperplasia at the hysterectomy. All carcinomas were endometrioid carcinomas, except for 1 case of adenosquamous carcinoma. Endometrioid carcinomas were well differentiated except for 2 cases, which were poorly differentiated. The myometrial invasion was present in the inner third of the uterus in 2 cases of endometrioid carcinoma. In the 14 cases of endometrial carcinoma diagnosed by hysterectomy, the image-based diagnosis by hysteroscopy led to a suspicion of endometrial carcinoma. The biopsies did not confirm the suspicion but revealed an atypical endometrial hyperplasia. The problem may be due to the amount of the biopsy, even when properly executed, because it was performed in a targeted manner. In our clinical perspective, we appreciate all effort to establish morphological criteria in biopsies to distinguish endometrial adenocarcinoma from atypical endometrial hyperplasia. If there is any doubt and the operator has a suspicion of endometrial cancer, then we will definitely suggest the repetition of the biopsy: this is the peculiarity of hysteroscopy [3]. Other “blind” techniques of endometrial biopsy (dilatation and curettage, Novak, Vabra, Pipelle) cannot suggest any suspicion and, thereupon, cannot suggest any repetition of the biopsy

  • Hysteroscopy and menopause: past and future
    2005
    Co-Authors: Bettocchi S, Nappi L, Ceci O, Pontrelli G, Pinto L, Selvaggi L
    Abstract:

    Purpose of review The main aim in investigating post-menopausal women is to exclude endometrial cancer. The purpose of this review is to define up-to-date clinical guidelines for the management of all post-menopausal women (asymptomatic as well as symptomatic). Recent findings Thanks to improvements in both the technology and the technique, hysteroscopy has become a simple and painless procedure that can easily be performed in an office or outpatient setting without any particular discomfort for the patient. The new, easier procedure, well tolerated by patients, has excellent diagnostic and surgical accuracy. Assuming that office hysteroscopy could offer a better visualization of the uterine cavity without increasing patient discomfort if compared to ultrasound, various authors have recently proposed the use of hysteroscopy as a first-line procedure in the approach to the menopausal patient. This could be defined as a change in strategy that has yielded very interesting results in terms of a better understanding of the appearance of the uterine cavity and the clinical value of small intra-cavitary pathologies (and their related treatment), particularly in asymptomatic women. Summary Hysteroscopy can be considered a routine outpatient method providing immediate results and causing minimal discomfort, especially when performed with the vaginoscopic approach. This technique has ushered in a new era of very-low-cost hysteroscopy, because only the Hysteroscope is required in the outpatient procedure, with no need for additional instruments, medication, extra personnel or dedicated theatre. The time taken is comparable to that required for transvaginal sonography

  • What does 'diagnostic hysteroscopy' mean today? The role of the new techniques.
    2003
    Co-Authors: Bettocchi S, Nappi L, Ceci O, Selvaggi L
    Abstract:

    Abstract PURPOSE OF REVIEW: Visual examination of the uterine cavity and contextual operative facilities have provided the gynecologist with the perfect 'diagnostic' tool, making it possible to examine the cavity and biopsy suspected areas under direct visualization. RECENT FINDINGS: The approach used to insert the scope, together with the diameter of the Hysteroscope and the distention of the uterine cavity, are of extreme importance in reducing patient discomfort to a minimum during an outpatient examination. The vaginoscopic approach (without speculum or tenaculum) has definitively eliminated patient discomfort related to the traditional approach to the uterus. One of the major problems for endoscopists is passing through the internal cervical os; the new generation of Hysteroscopes, with an oval profile and a total diameter between 4 and 5 mm, are strictly correlated to the anatomy of the cervical canal. Miniaturized instruments have enabled the physician not only to perform targeted hysteroscopic biopsies, but also to treat benign intrauterine pathologies, such as polyps and sinechiae, without any premedication or anesthesia. This has been defined as a 'see & treat' procedure: there is no longer a distinction between the diagnostic and operative procedures, but a single procedure in which the operative part is perfectly integrated in the diagnostic work-up. SUMMARY: Diagnostic hysteroscopy has long paid the price of being a purely visual method of investigation. Today, thanks to recent advances in instrumentation and to modified techniques related to the simultaneous use of the scope and of instruments, hysteroscopy is finally achieving the full accuracy that has been awaited for the last 20 years

  • Comparison of hysteroscopic and hysterectomy findings for assessing the diagnostic accuracy of office hysteroscopy.
    2002
    Co-Authors: Ceci O, Bettocchi S, Di Venere R, Pellegrino A, Impedovo L, Pansini N
    Abstract:

    Objective: To assess the diagnostic accuracy of office hysteroscopy by comparing the hysteroscopic findings with the histologic findings on the hysterectomy specimens. Design: Retrospective clinical study. Setting: University-affiliated hospital. Patient(s): Review of the hospital records of 443 patients who underwent office hysteroscopy and, within 2 months, hysterectomy. Intervention(s): We compared the hysteroscopic findings (including targeted biopsies) with the histologic findings that were obtained after hysterectomy. The results of this study were then compared with those of a previous study in which we examined the diagnostic accuracy of dilatation and curettage (D&C). Main Outcome Measure(s): We evaluated the diagnostic accuracy of office hysteroscopy. Result(s): When compared with the histologic diagnosis of the uterus, the hysteroscopic findings showed a diagnostic sensitivity of 98%, a specificity of 95%, a positive predictive value (PPV) of 96%, and a negative predictive value (NPV) of 98%. Hysteroscopy was found to have a greater diagnostic accuracy than D&C: the sensitivity and the NPV of the two diagnostic procedures were statistically different. Conclusion(s): Office hysteroscopy is confirmed as a powerful diagnostic tool, but targeted biopsies, performed with a small diameter operative Hysteroscope, must be performed in cases of suspect endometrium to confirm the image-based diagnosis

  • Hysteroscopic evaluation of menopausal patients with sonographically atrophic endometrium.
    'Elsevier BV', 2000
    Co-Authors: Marello F, Bettocchi S, Ceci O, Greco P, Vimercati A, Di Venere R, Loverro G
    Abstract:

    Study Objective. To assess the diagnostic and operative potential of hysteroscopy in postmenopausal patients selected by ultrasound criteria. Design. Prospective evaluation (Canadian Task Force classification II-2). Setting. Outpatient ultrasound and hysteroscopy department of a university-affiliate hospital. Patients. Two hundred twelve women with an endometrial thickness less than 4 mm on ultrasound and in menopause for at least 1 year. Interventions. Transvaginal ultrasound and office hysteroscopy, with eye-directed biopsy specimens obtained with a 5-mm, continuous-flow operative Hysteroscope, and performed without anesthesia. Measurements and Main Results. Only 13 (6%) patients were symptomatic (irregular bleeding). Hysteroscopic diagnosis of endometrial polyps in three women (23%) was confirmed by histology. In the remaining 199 (94%) asymptomatic patients with atrophic endometrium on ultrasound hysteroscopy showed an endometrial pathology in 10% (16 polyps, 4 submucous myomas); in one patient histologic evaluation disclosed focal adenocarcinoma in an endometrial polyp. Conclusion. Hysteroscopy allows a proper histologic diagnosis, even in asymptomatic postmenopausal women with atrophic endometrium on ultrasound

Attilio Di Spiezio Sardo - One of the best experts on this subject based on the ideXlab platform.

  • challenging the cervix strategies to overcome the anatomic impediments to hysteroscopy analysis of 31 052 office hysteroscopies
    Fertility and Sterility, 2016
    Co-Authors: Stefano Bettocchi, S Bramante, Giuseppe Bifulco, Marialuigia Spinelli, Oronzo Ceci, Fabiana Divina Fascilla, Attilio Di Spiezio Sardo
    Abstract:

    Objective To report our experience on 10,156 cases of cervical stenosis (CS) diagnosed at office hysteroscopy. Design Retrospective study. Setting Ambulatory clinics of diagnostic and operative hysteroscopy of two university teaching hospitals (Naples and Bari). Patient(s) A total of 31,052 patients undergoing office hysteroscopy. Intervention(s) All of the paper and electronic reports of the office hysteroscopies performed from January 1996 to September 2014 were reviewed. Hysteroscopies were classified as successful (i.e., when access to and visualization of the entire uterine cavity was possible during the same procedure), incomplete (i.e., when access to uterine cavity was possible, but the entire uterine cavity could not be examined), or failed (i.e., when access to uterine cavity was not possible). CS was classified on the basis of localization: stenosis of external cervical ostium (ECO; type I); stenosis of distal third of cervical channel and the internal cervical ostium (ICO; type II); stenosis of the ICO (type III), and combined stenosis of ECO and ICO (type IV). Main Outcome Measure(s) The success rate at overpassing CS (including both successful and incomplete hysteroscopies) was the primary outcome measure. Secondary outcome measures were frequency and localization of CS in fertile and postmenopausal women and the frequency of use of technical maneuvers and/or miniaturized mechanical or bipolar instruments to overcome them. Result(s) All hysteroscopies were performed with the use of a 5- or 4-mm rigid continuous-flow office operative Hysteroscope by operators with different levels of expertise. The hysteroscopy technique used was standardized between the two centers and among all of the surgeons throughout the years. An access to the uterine cavity with a complete evaluation of the whole endometrial surface was possible in 93.9% of cases (29,152 patients). The main reasons of the 1,320 (4.3%) incomplete and 580 (1.9%) failed hysteroscopies were pain and CS, respectively. CS was identified in 10,156 women (32.7% of all procedures) and was significantly more frequent in postmenopausal than in fertile women (70.1% vs. 29.9%), except for type I stenosis, which was more frequent in fertile than in postmenopausal women. Type IV CS (44.3%) was the most commonly detected. Overall, CS was managed successfully with minimal discomfort in 98.5% of cases with technical maneuvers and miniaturized mechanical and/or bipolar instruments. Adhesiolysis with the distal tip of the Hysteroscope by rotating the scope on the endocamera was the significantly more used strategy to overpass all types of CS (39.8% of cases), generally used in combination with miniaturized operative instruments (79.2%). Bipolar electrodes were more used in cases of type I and type IV stenosis (39.7%) compared with the other types of CS. Conclusion(s) CS and pain represent the main reasons for failed hysteroscopy. Recent technical and technologic innovations, together with increased operator experience and optimal pain management, have made it possible to overcome even severe CS with the use of office hysterosocpy, thus significantly reducing the rate of failed procedures and the need for operating room and general anesthesia.

  • Office vaginoscopic treatment of an isolated longitudinal vaginal septum: a case report.
    Journal of minimally invasive gynecology, 2007
    Co-Authors: Attilio Di Spiezio Sardo, Stefano Bettocchi, S Bramante, Giuseppe Bifulco, Maurizio Guida, Carmine Nappi
    Abstract:

    This case report describes a new treatment of an isolated longitudinal vaginal septum (LVS) by office operative vaginoscopy with a 4-mm rigid Hysteroscope in a 27-year-old virgin who reported leukorrhea and recurrent vaginal infections. This technique might represent an effective treatment of an LVS, mostly in patients with an intact hymen. This could allow the inclusion of vaginal lesions among the indications for office endoscopic procedures performed using operative Hysteroscopes.

Selvaggi L - One of the best experts on this subject based on the ideXlab platform.

  • Hysteroscopy and menopause: past and future
    2005
    Co-Authors: Bettocchi S, Nappi L, Ceci O, Pontrelli G, Pinto L, Selvaggi L
    Abstract:

    Purpose of review The main aim in investigating post-menopausal women is to exclude endometrial cancer. The purpose of this review is to define up-to-date clinical guidelines for the management of all post-menopausal women (asymptomatic as well as symptomatic). Recent findings Thanks to improvements in both the technology and the technique, hysteroscopy has become a simple and painless procedure that can easily be performed in an office or outpatient setting without any particular discomfort for the patient. The new, easier procedure, well tolerated by patients, has excellent diagnostic and surgical accuracy. Assuming that office hysteroscopy could offer a better visualization of the uterine cavity without increasing patient discomfort if compared to ultrasound, various authors have recently proposed the use of hysteroscopy as a first-line procedure in the approach to the menopausal patient. This could be defined as a change in strategy that has yielded very interesting results in terms of a better understanding of the appearance of the uterine cavity and the clinical value of small intra-cavitary pathologies (and their related treatment), particularly in asymptomatic women. Summary Hysteroscopy can be considered a routine outpatient method providing immediate results and causing minimal discomfort, especially when performed with the vaginoscopic approach. This technique has ushered in a new era of very-low-cost hysteroscopy, because only the Hysteroscope is required in the outpatient procedure, with no need for additional instruments, medication, extra personnel or dedicated theatre. The time taken is comparable to that required for transvaginal sonography

  • What does 'diagnostic hysteroscopy' mean today? The role of the new techniques.
    2003
    Co-Authors: Bettocchi S, Nappi L, Ceci O, Selvaggi L
    Abstract:

    Abstract PURPOSE OF REVIEW: Visual examination of the uterine cavity and contextual operative facilities have provided the gynecologist with the perfect 'diagnostic' tool, making it possible to examine the cavity and biopsy suspected areas under direct visualization. RECENT FINDINGS: The approach used to insert the scope, together with the diameter of the Hysteroscope and the distention of the uterine cavity, are of extreme importance in reducing patient discomfort to a minimum during an outpatient examination. The vaginoscopic approach (without speculum or tenaculum) has definitively eliminated patient discomfort related to the traditional approach to the uterus. One of the major problems for endoscopists is passing through the internal cervical os; the new generation of Hysteroscopes, with an oval profile and a total diameter between 4 and 5 mm, are strictly correlated to the anatomy of the cervical canal. Miniaturized instruments have enabled the physician not only to perform targeted hysteroscopic biopsies, but also to treat benign intrauterine pathologies, such as polyps and sinechiae, without any premedication or anesthesia. This has been defined as a 'see & treat' procedure: there is no longer a distinction between the diagnostic and operative procedures, but a single procedure in which the operative part is perfectly integrated in the diagnostic work-up. SUMMARY: Diagnostic hysteroscopy has long paid the price of being a purely visual method of investigation. Today, thanks to recent advances in instrumentation and to modified techniques related to the simultaneous use of the scope and of instruments, hysteroscopy is finally achieving the full accuracy that has been awaited for the last 20 years

  • Uterine cavity assessment in infertile women: comparison of transvaginal sonography and hysteroscopy
    'Elsevier BV', 2001
    Co-Authors: Loverro G, Nappi L, Vimercati A, Vicino M., Carriero C., Selvaggi L
    Abstract:

    Objectives: To evaluate the diagnostic accuracy of transvaginal sonography (TVs) in detecting uterine cavity abnormalities in infertile patients, with reference to hysteroscopy as the gold standard method. Study Design: At the Institute of Obstetrics and Gynaecology. University of Bari, 134 infertile women were investigated with both TVs and hysteroscopy. In all cases endometrial biopsy was performed. Sensitivity, specificity, and positive and negative predictive values were calculated for TVs, considering hysteroscopic diagnosis as the gold standard. Statistical analysis was performed by using McNemar test. Results: There was one failed insertion of Hysteroscope. Hysteroscopy diagnosed pathological findings in 58 out of 133 cases (44%). TVs was in agreement with 50 of the 58 (86%) of the pathological findings diagnosed at hysteroscopy. As a test for the detection of uterine cavity abnormalities. TVs in comparison with hysteroscopy had 84.5% sensitivity and 98.7% specificity. 98.0% positive predictive value and 89.2% negative predictive value. Conclusions: TVs is able to dia,pose polyps, septum and submucous fibroids with quite significant accuracy, while hysteroscopy is indicated for their confirmation and removal. Thus, hysteroscopy provides both diagnostic and therapeutic capabilities. but TVs permits to proceed directly to operative hysteroscopy avoiding the need for a separate diagnostic procedure. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved

  • The role of contact hysteroscopy
    'Elsevier BV', 1996
    Co-Authors: Bettocchi S, Loverro G, Pansini N, Selvaggi L
    Abstract:

    Contact hysteroscopy has been replaced by a new technique based on the use of a special Hysteroscope. The instrument was designed to study the squamocolumnar junction and the lesions of the portion. A new technique, endometrial dating, uses the Hamou Hysteroscope to study endometrial physiology. We improved endometrial dating and discovered a new pattern, the pseudofunctional dysvascular endometrium (PFDE), that seemed to pertain to uterine bleeding. We also studied the PFDE syndrome in the presence of dysfunctional uterine bleeding. In this study we reviewed the three procedures and assessed their results. We conclude that contact microhysteroscopy is a reliable diagnostic procedure, and should be considered part of diagnostic hysteroscopy, not an independent technique

  • Anatomic Impediments to the Performance of Hysteroscopy
    1996
    Co-Authors: Bettocchi Stefano, Pansini N, Porreca Mr, Selvaggi L
    Abstract:

    Infertility and menorrhagia in menopausal women are the most frequent indications for hysteroscopy. Often, however, the procedure turns out to be difficult or impossible due to stenosis and reduction in the size of the cervical canal. With the availability of more and more atraumatic endoscopic instrumentations and improvements in the technique, hysteroscopy can be performed in all women, whatever the obstacle. In our 5-year experience of 1500 hysteroscopies, we often found anatomic conditions that, besides being obstacles to performing the examination, increased patient discomfort. With the office Hysteroscope with a 5F operative sheath one can rapidly overcome the obstacles and complete the examination without discomfort to the patient

Torella M - One of the best experts on this subject based on the ideXlab platform.

  • Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with "unfavorable" cervix
    'Edizioni Minerva Medica', 2017
    Co-Authors: De Franciscis P, Grauso F, Em Messalli, Mt Schettino, Calagna G, Perino A, Colacurci N, Torella M
    Abstract:

    BACKGROUND: The aim of this study was to compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix.METHODS: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm Hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisfaction were assessed with a Visual Analogue Scale (VAS).RESULTS: Operative time was significantly longer in group A than in group B (18.3 +/- 7.4 vs. 11.3 +/- 5.2 minutes), the cumulative complication rate and the need of postoperative analgesics were higher in group A than in group B. VAS of surgical difficulty and surgeon's satisfaction were higher in group B than in group A.CONCLUSIONS: The small-diameter hysteroscopy is a safe and effective approach for endometrial polyp up to 4 cm in patients with unfavorable cervical canal at risk of cervical injury.BACKGROUND: To compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix. METHODS: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm Hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisfaction were assessed with a visual analogue scale. RESULTS: Operative time was significantly longer in group A than in group B (18.3±7.4 vs 11.3±5.2 minutes), the cumulative complication rate and the need of post-operative analgesics were higher in group A than in group B. Visual analogue scale of surgical difficulty and surgeon's satisfaction were higher in group B than in group A. CONCLUSIONS: The small-diameter hysteroscopy is a safe and effective approach for endometrial polyp up to 4 cm in patients with unfavorable cervical canal at risk of cervical injury

  • Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with "unfavorable" cervix
    'Edizioni Minerva Medica', 2017
    Co-Authors: De Franciscis P, Grauso F, Calagna G, Perino A, Colacurci N, Messalli E., Schettino M., Torella M
    Abstract:

    Backgeound: The aim of this study was to compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix. Methods: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm Hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisfaction were assessed with a Visual Analogue Scale (VAS). Results: Operative time was significantly longer in group A than in group B (18.3\ub17.4 vs. 11.3\ub15.2 minutes), the cumulative complication rate and the need of postoperative analgesics were higher in group Athan in group B. VAS of surgical difficulty and surgeon's satisfaction were higher in group B than in group A. Conclusions: The small-diameter hysteroscopy is a safe and effective approach for endometrial polyp up to 4 cm in patients with unfavorable cervical canal at risk of cervical injury

  • Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with "unfavorable" cervix
    'Edizioni Minerva Medica', 2017
    Co-Authors: De Franciscis P, Grauso F, Calagna G, Perino A, Colacurci N, Messalli E., Schettino M., Torella M
    Abstract:

    Backgeound: The aim of this study was to compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix. Methods: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm Hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisfaction were assessed with a Visual Analogue Scale (VAS). Results: Operative time was significantly longer in group A than in group B (18.3\ub17.4 vs. 11.3\ub15.2 minutes), the cumulative complication rate and the need of postoperative analgesics were higher in group Athan in group B. VAS of surgical difficulty and surgeon's satisfaction were higher in group B than in group A. Conclusions: The small-diameter hysteroscopy is a safe and effective approach for endometrial polyp up to 4 cm in patients with unfavorable cervical canal at risk of cervical injury

De Franciscis P - One of the best experts on this subject based on the ideXlab platform.

  • Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with "unfavorable" cervix
    'Edizioni Minerva Medica', 2017
    Co-Authors: De Franciscis P, Grauso F, Em Messalli, Mt Schettino, Calagna G, Perino A, Colacurci N, Torella M
    Abstract:

    BACKGROUND: The aim of this study was to compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix.METHODS: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm Hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisfaction were assessed with a Visual Analogue Scale (VAS).RESULTS: Operative time was significantly longer in group A than in group B (18.3 +/- 7.4 vs. 11.3 +/- 5.2 minutes), the cumulative complication rate and the need of postoperative analgesics were higher in group A than in group B. VAS of surgical difficulty and surgeon's satisfaction were higher in group B than in group A.CONCLUSIONS: The small-diameter hysteroscopy is a safe and effective approach for endometrial polyp up to 4 cm in patients with unfavorable cervical canal at risk of cervical injury.BACKGROUND: To compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix. METHODS: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm Hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisfaction were assessed with a visual analogue scale. RESULTS: Operative time was significantly longer in group A than in group B (18.3±7.4 vs 11.3±5.2 minutes), the cumulative complication rate and the need of post-operative analgesics were higher in group A than in group B. Visual analogue scale of surgical difficulty and surgeon's satisfaction were higher in group B than in group A. CONCLUSIONS: The small-diameter hysteroscopy is a safe and effective approach for endometrial polyp up to 4 cm in patients with unfavorable cervical canal at risk of cervical injury

  • Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with "unfavorable" cervix
    'Edizioni Minerva Medica', 2017
    Co-Authors: De Franciscis P, Grauso F, Calagna G, Perino A, Colacurci N, Messalli E., Schettino M., Torella M
    Abstract:

    Backgeound: The aim of this study was to compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix. Methods: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm Hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisfaction were assessed with a Visual Analogue Scale (VAS). Results: Operative time was significantly longer in group A than in group B (18.3\ub17.4 vs. 11.3\ub15.2 minutes), the cumulative complication rate and the need of postoperative analgesics were higher in group Athan in group B. VAS of surgical difficulty and surgeon's satisfaction were higher in group B than in group A. Conclusions: The small-diameter hysteroscopy is a safe and effective approach for endometrial polyp up to 4 cm in patients with unfavorable cervical canal at risk of cervical injury

  • Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with "unfavorable" cervix
    'Edizioni Minerva Medica', 2017
    Co-Authors: De Franciscis P, Grauso F, Calagna G, Perino A, Colacurci N, Messalli E., Schettino M., Torella M
    Abstract:

    Backgeound: The aim of this study was to compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix. Methods: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm Hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisfaction were assessed with a Visual Analogue Scale (VAS). Results: Operative time was significantly longer in group A than in group B (18.3\ub17.4 vs. 11.3\ub15.2 minutes), the cumulative complication rate and the need of postoperative analgesics were higher in group Athan in group B. VAS of surgical difficulty and surgeon's satisfaction were higher in group B than in group A. Conclusions: The small-diameter hysteroscopy is a safe and effective approach for endometrial polyp up to 4 cm in patients with unfavorable cervical canal at risk of cervical injury

  • Small-diameter hysteroscopy with Versapoint versus resectoscopy with a unipolar knife for the treatment of septate uterus: a prospective randomized study.
    'Elsevier BV', 2007
    Co-Authors: Colacurci N, De Franciscis P, Perino A, Mollo A, Litta Pietro Salvatore, Cobellis L, De Placido G.
    Abstract:

    Study objective To compare 2 procedures for metroplasty: resectoscopy with monopolar knife versus small-diameter hysteroscopy fitted with a Versapoint device. Design Prospective randomized study (Canadian Task Force classification I). Setting Endoscopic gynecology units at tertiary care university hospitals. Patients One hundred-sixty patients with septate uterus and a history of recurrent abortion or primary infertility undergoing hysteroscopic metroplasty from 2001 to 2005. Interventions Hysteroscopic resection of the uterine septum performed with either a 26F resectoscope with unipolar knife (80 women, group A) or a 5-mm diameter Hysteroscope with Versapoint device (80 women, group B). All patients were managed expectantly, with follow-up lasting 1 year. Measurements and main results Operative parameters (operative time, fluid absorption, complications, need for second intervention) and reproductive outcome parameters (pregnancy, abortion, term and preterm delivery, modality of delivery, cervical cerclage) were measured. Operative time and fluid absorption were significantly greater in group A than in group B (23.4 \ub1 5.7 vs 16.9 \ub1 4.7 minutes and 486.4 \ub1 170.0 vs 222.1 \ub1 104.9 mL, respectively). The cumulative complication rate was significantly lower in group B than in group A. No difference in any of the reproductive parameters was observed between the 2 groups: pregnancy and delivery rates were 70% and 81.6% in group A vs 76.9% and 84% in group B. Nine women (18.4%) from group B and 8 women (16%) from group B experienced spontaneous abortions. Most patients (54/82) delivered by cesarean section without differences according to the hysteroscopic technique used for metroplasty (65% in group A vs 67.7% in group B) or to the gestational age (65.1% of term and 68.7% of preterm deliveries). Conclusions Small-diameter hysteroscopy with bipolar electrode for the incision of uterine septum is as effective as resectoscopy with unipolar electrode regarding reproductive outcome and is associated with shorter operating time and lower complication rate. Keywords Hysteroscopic metroplasty; Septate uterus; Recurrent abortion; Primary infertility; Hysteroscopy; Reproductive outcome; Bipolar energ