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Advantages of positioning the gynecologic laparoscopist at the patient's head
August 1998, Vol. 5, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists
105. Intrauterine Pathology in Asymptomatic Young Candidates for IUDs
bleeding after hysteroscopy for menorrhagia. It may be useful in studies evaluating large numbers of patients.
LAH Melki, MA Pinho de Oliveira, WT Filho, PAP Lemos, RS Damiao. Pedro Ernesto Hospital, University of State of Rio de Janeiro, Rio de Janeiro, Brazil.
103. Advantages of Positioning the Gynecologic Laparoscopist at the Patient's Head LM Marquez. Houston Northwest Medical Center, Houston, Texas.
Objective. To describe a surgical setup that positions the gynecologic laparoscopist at the patient's head and cannulas lateral to the umbilicus. Measurements and Main Results. More than 243 procedures (often more than 1/patient) were performed in the past 3 years (LAVH, TLH, vaginal cuff suspension, Butch, oophorectomy, ovarian cystectomy, myomectomy, lysis of adhesions) with the surgeon standing at the head of the patient rather than at the side and cannulas placed lateral to the umbilicus. This creates direct correspondence between visual image and hand action, improves instrument maneuverability, enhances surgical technique, simplifies suturing, and reduces surgeon strain. Conclusion. Positioning the system at the patient's head improves the surgeon's ability to learn and perform advanced laparoscopic procedures.
Objective. To assess the uterine cavity before inserting the IUD. Measurements and Main Results. One hundred fiftysix women (age range 18-35 yrs) who were candidates for IUDs underwent routine diagnostic office hysteroscopy with CO2. Results were normal uterine cavity in 116 women (74.3%) and abnormal findings in 35 (22.4%). In five patients (3.2%) it was not possible to complete the examination. In the group with abnormal findings hysteroscopic diagnoses were submucous myoma (12, 7.6%), intrauterine adhesions (11, 7.0%), narrow cervical canal (6, 3.9%), and endometrial polyp (6, 3.9%). No complications occurred. Conclusion. Young asymptomatic women are not always free of pathology in the uterine cavity. Therefore, routine office diagnostic hysteroscopy should be considered in those who wish to have an IUD.
104. A New Minifibrohysteroscope for Diagnostic Evaluation
106. Pitfalls in Hysteroscopic Diagnosis of Malignancies of the Uterine Corpus
R Marry, M Uzan, L Carbillon. Hopital Jean Verdier, Universit6 Paris XlII, France.
LAH Melki, MA Pinho de Oliveira, PAL Pinto, RS Dami~o, WT Filho. Pedro Ernesto Hospital, University of State of Rio de Janeiro, Rio de Janeiro, Brazil.
Objective. To introduce the new HYF-XP minifibrohysteroscope from Olympus. Measurements and Main Results. This instrument has four major modifications compared with current ones. The outer diameter is thinner, 3 versus 3.5 mm, allowing easier insertion; the frontal view is enlarged from 90 to 100 degrees for better orientation; a high-quality image is obtained because the number of optic fibers is increased twofold, allowing accurate diagnosis; and a bigger image size (x 1.3) on the monitor is obtained for excellent observation. The operating channel remains 1.2 ram, allowing use of 3F ancillary instruments for cytobrushing and targeted endometrial biopsies. We successfully used the HYF-XP in 250 procedures. Conclusion. Given its numerous advantages, the HYFXP seems to be an ideal hysteroscope for ambulatory hysteroscopy with or without directed biopsies.
Objective. To discuss pitfalls that can contribute to false negative hysteroscopic diagnosis of malignancies of the uterine corpus. Measurements and Main Results. Four women (ages 43, 61, 65, and 73 yrs) with AUB underwent routine office hysteroscopy with CO2 and directed biopsies. In three, hysteroscopic diagnosis was submucous myoma. Histology diagnosed nodular endometrial carcinoma in one and mixed mesodermal sarcoma in another; both lesions resembled submucous myoma. The third woman had true submucous myoma and small focus of endometrial carcinoma, but hysteroscopy was done under suboptimal visualization (blood in uterine cavity). The last woman (youngest patient) had a polyp that blurred the diagnosis of a small focus of endometrial carcinoma next to the isthmus.
$29
105. Intrauterine Pathology in Asymptomatic Young Candidates for IUDs
bleeding after hysteroscopy for menorrhagia. It may be useful in studies evaluating large numbers of patients.
LAH Melki, MA Pinho de Oliveira, WT Filho, PAP Lemos, RS Damiao. Pedro Ernesto Hospital, University of State of Rio de Janeiro, Rio de Janeiro, Brazil.
103. Advantages of Positioning the Gynecologic Laparoscopist at the Patient's Head LM Marquez. Houston Northwest Medical Center, Houston, Texas.
Objective. To describe a surgical setup that positions the gynecologic laparoscopist at the patient's head and cannulas lateral to the umbilicus. Measurements and Main Results. More than 243 procedures (often more than 1/patient) were performed in the past 3 years (LAVH, TLH, vaginal cuff suspension, Butch, oophorectomy, ovarian cystectomy, myomectomy, lysis of adhesions) with the surgeon standing at the head of the patient rather than at the side and cannulas placed lateral to the umbilicus. This creates direct correspondence between visual image and hand action, improves instrument maneuverability, enhances surgical technique, simplifies suturing, and reduces surgeon strain. Conclusion. Positioning the system at the patient's head improves the surgeon's ability to learn and perform advanced laparoscopic procedures.
Objective. To assess the uterine cavity before inserting the IUD. Measurements and Main Results. One hundred fiftysix women (age range 18-35 yrs) who were candidates for IUDs underwent routine diagnostic office hysteroscopy with CO2. Results were normal uterine cavity in 116 women (74.3%) and abnormal findings in 35 (22.4%). In five patients (3.2%) it was not possible to complete the examination. In the group with abnormal findings hysteroscopic diagnoses were submucous myoma (12, 7.6%), intrauterine adhesions (11, 7.0%), narrow cervical canal (6, 3.9%), and endometrial polyp (6, 3.9%). No complications occurred. Conclusion. Young asymptomatic women are not always free of pathology in the uterine cavity. Therefore, routine office diagnostic hysteroscopy should be considered in those who wish to have an IUD.
104. A New Minifibrohysteroscope for Diagnostic Evaluation
106. Pitfalls in Hysteroscopic Diagnosis of Malignancies of the Uterine Corpus
R Marry, M Uzan, L Carbillon. Hopital Jean Verdier, Universit6 Paris XlII, France.
LAH Melki, MA Pinho de Oliveira, PAL Pinto, RS Dami~o, WT Filho. Pedro Ernesto Hospital, University of State of Rio de Janeiro, Rio de Janeiro, Brazil.
Objective. To introduce the new HYF-XP minifibrohysteroscope from Olympus. Measurements and Main Results. This instrument has four major modifications compared with current ones. The outer diameter is thinner, 3 versus 3.5 mm, allowing easier insertion; the frontal view is enlarged from 90 to 100 degrees for better orientation; a high-quality image is obtained because the number of optic fibers is increased twofold, allowing accurate diagnosis; and a bigger image size (x 1.3) on the monitor is obtained for excellent observation. The operating channel remains 1.2 ram, allowing use of 3F ancillary instruments for cytobrushing and targeted endometrial biopsies. We successfully used the HYF-XP in 250 procedures. Conclusion. Given its numerous advantages, the HYFXP seems to be an ideal hysteroscope for ambulatory hysteroscopy with or without directed biopsies.
Objective. To discuss pitfalls that can contribute to false negative hysteroscopic diagnosis of malignancies of the uterine corpus. Measurements and Main Results. Four women (ages 43, 61, 65, and 73 yrs) with AUB underwent routine office hysteroscopy with CO2 and directed biopsies. In three, hysteroscopic diagnosis was submucous myoma. Histology diagnosed nodular endometrial carcinoma in one and mixed mesodermal sarcoma in another; both lesions resembled submucous myoma. The third woman had true submucous myoma and small focus of endometrial carcinoma, but hysteroscopy was done under suboptimal visualization (blood in uterine cavity). The last woman (youngest patient) had a polyp that blurred the diagnosis of a small focus of endometrial carcinoma next to the isthmus.
$29