Review of New Office-Based Hysteroscopic Procedures 2003–2009

Di Spiezio Sardo, Attilio; Bettocchi, Stefano; Spinelli, Marialuigia; Guida, Maurizio; Nappi, Luigi; Angioni, Stefano; Sosa Fernandez, Loredana Maria; Nappi, Carmine

doi:10.1016/j.jmig.2010.03.014

« Previous Next »The Journal of Minimally Invasive Gynecology
Volume 17, Issue 4 , Pages 436-448, July 2010

Review of New Office-Based Hysteroscopic Procedures 2003–2009

Attilio Di Spiezio Sardo, MD
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples “Federico II,” Naples, Italy
- Corresponding author: Attillio Di Spiezio Sardo, Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples “Federico II,” Via Sergio Pansini 5, Naples 80131, Italy.
Stefano Bettocchi, MD
- Department of General and Specialistic Surgical Sciences, Section of Obstetrics and Gynaecology, University of Bari, Bari, Italy
Marialuigia Spinelli, MD
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples “Federico II,” Naples, Italy
Maurizio Guida, MD
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples “Federico II,” Naples, Italy
Luigi Nappi, MD
- Department of Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
Stefano Angioni, MD
- Departments of Surgery, Maternal-Fetal Medicine, and Imaging Sciences, Unit of Gynecology, Obstetrics, and Physiopathology of Human Reproduction, University of Cagliari, Cagliari, Italy
Loredana Maria Sosa Fernandez, MD
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples “Federico II,” Naples, Italy
Carmine Nappi, MD
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples “Federico II,” Naples, Italy

Received 6 December 2009; accepted 12 March 2010.

Abstract

Office operative hysteroscopy is a recent technique that enables treatment of uterine pathologic disorders in the ambulatory setting using miniaturized hysteroscopes with mechanical or electric instruments. The available international literature from 1990 to 2002 has clearly demonstrated that such technique enables performance of hysteroscopically directed endometrial biopsy and treatment of uterine adhesions, anatomic disorders, polyps, and small myomas safely and successfully without cervical dilation and the need for anesthesia. This review provides a comprehensive survey of further advancements of office operative hysteroscopy in the treatment of other gynecologic pathologic conditions that have not been included in the schema of treatment indications for office procedures proposed in 2002. A search of MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews identified articles published from 2003 to 2009. Eighteen articles were identified: 9 on hysteroscopic sterilization; 1 on office-based metroplasty, 8 on office-based treatment of some uncommon gynecologic pathologic conditions (e.g., hematometra, diagnosis and treatment of vaginal lesions, treatment of uterine cystic neoformations, bleeding from the cervical stump, diagnosis and treatment of endocervical ossification, and removal of uterovaginal packing). All performed procedures were carried out safely and successfully in the office setting, with high patient tolerance and minimal discomfort. The success of the procedures has been confirmed by resolution of symptoms and at follow-up ultrasonographic and hysteroscopic examinations. Currently, as a result of technologic advancements and increased operator experience, an increasing number of gynecologic pathologic conditions traditionally treated in the operating room may be treated safely and effectively using office operative hysteroscopy.

Keywords: Bipolar electrode, Hysteroscopic surgery, Mechanical instruments, Miniaturized hysteroscopes, Office operative hysteroscopy