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Eleven Cases Robert’s Uterus Treated by Hysteroscopy and Laparoscopy Successfully Delivered in 1 Case
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
676 Successful Pregnancy Outcome After Hysteroscopic Resection of Endometrial Carcinoma Mangubat MC, Estroso MB. Obstetrics and Gynecology, Perpetual Succour Hospital, Cebu City, Cebu, Philippines
Conclusion: The MyoSureÒ Lite tissue removal system is more effective at sampling the endometrial surface of post-menopausal uterine cavities compared to sharp curettage.
678 Study Objective: To evaluate pregnancy and obstetric outcomes in a young woman with endometrial carcinoma after fertility sparing surgery. Design: Case Report. Setting: Department of Obstetrics and Gynecology Perpetual Succour Hospital, Cebu City, Philippines. Patients: A 35 years old, Filipino, married, primigravid diagnosed with early stage endometrial adenocarcinoma is presented. Intervention: The patient initially diagnosed with abnormal uterine bleeding underwent transcervical resection of polyp and endometrium with final histopathologic report of moderately differentiated endometrioid adenocarcinoma. The patient declined surgery and pregnancy was conceived spontaneously 2 months after the procedure. Measurements and Main Results: She received normal obstetric care starting 17 weeks gestation with multidisciplinary approach and delivered spontaneously a live male neonate at 38 weeks gestation. The histological evaluation after hysteroscopy 7 weeks postpartum showed focal endometrial complex hyperplasia with atypia to endometrial carcinomain-situ. Conservative management consisted of oral megestrol acetate 160 mg daily and a repeat hysteroscopic biopsy after 3 months. Conclusion: Although fertility–sparing management of endometrial cancer is not the current standard of care for young women,hysteroscopic surgical resection of low grade early stage lesion may also be a rational option to preserve fertility and encourage pregnancy in a woman with unfulfilled motherhood.
677 Endometrial Sampling of the Post-Menopausal Uterus: MyoSureÒ Lite Tissue Removal System vs. Sharp Curettage Rosenblatt P, DiScuillo A, Warda H, Barcia S. Mount Auburn Hospital, Cambridge, Massachusetts Study Objective: To compare tissue removed by the MyoSureÒ Lite tissue removal system to sharp curettage for specimen quality and histologic diagnosis. Design: Laboratory study of excised tissue samples and immediately extirpated uteri in post-menopausal women with benign endometrial cavity findings on hysteroscopy. Setting: Laboratory and hospital pathology department. Patients: 4 post-menopausal extirpated uteri from cadavers. Up to 10 postmenopausal uteri immediately after hysterectomy for benign reasons. Intervention: Hysteroscopic evaluation of the extirpated uterus to exclude intrauterine lesions. Removal of the endometrial surface in one quadrant using the MyoSureÒ Lite tissue removal system. Curettage by sharp instrument of another quadrant of the uterus. Post-procedure hysteroscopy. Measurements and Main Results: In 4 cadaverous uteri, tissue samples obtained from one quadrant using MyoSureÒ Lite system were visually compared to resected tissue with sharp curettage. The average cutting time using MyoSureÒ Lite system was 59 seconds for the two samples where this information was recorded. Sharp curettage from a separate quadrant of the uterus was performed in the classic fashion for a D&C. Tissue from the sharp curettage was placed in a gauze and compared grossly to the specimen collected in the MyoSureÒ Lite tissue trap. Hysteroscopy performed after both procedures qualitatively confirmed that greater tissue was removed by MyoSure Lite system compared to the quadrant sampled with sharp curettage. Up to 10 cases will be similarly managed to evaluate freshly extirpated uteri obtained from postmenopausal women undergoing hysterectomy. Both gross and microscopic comparison will be made between the sampling techniques. Histologic diagnosis will be compared to the final hysterectomy specimen diagnosis to evaluate diagnostic accuracy of hysteroscopic sampling.
Profile of Women With Endometrial Polyps Treated in a Tertiary Hospital: Retrospective Chart Review and Review of Literature Mangubat MC, Pichay RL. Department of Obstetrics and Gynecology, Perpetual Succour Hospital, Cebu City, Cebu, Philippines Study Objective: To review the clinical presentation, risk factors, diagnostic investigations, associated gynecologic conditions and management of endometrial polyps. Design: 6-year retrospective descriptive chart review design. Setting: Department of Obstetrics and Gynecology, Perpetual Succour Hospital, Cebu City, Philippines. Patients: Women found by ultrasound and diagnosed hysteroscopically and by histopathology to have EPs were included. Patient characteristics included age, gravidity, BMI, presence or absence of symptoms, menopausal status, medical problems, infertility and use of hormonal medications. Intervention: Transvaginal ultrasonography was performed in all participants. A few had saline infusion sonography. These women underwent curettage, polypectomy and hysteroscopy. EPs were also incidental findings in patients who underwent hysterectomy. Measurements and Main Results: A total of 215 women found by ultrasound and diagnosed hysteroscopically and by histopathology with EPs were included. The average age was 51.56 years old +/- 12.14 (age range 23–81). 45.2% were menopausal with average age 56.81 years old +/- 8.91. 53% had gravidity >3. The average BMI was 29.78 +/- 3.49. The most common pretreatment symptoms were vaginal spotting (30%), heavy menstrual bleeding (27%), intermenstrual bleeding (9%), postcoital bleeding (7%), dysmenorrhea (7%) and irregular cycles (4%). Endometrial polyps were present in women with hypertension (62%), diabetes mellitus (23%), dyslipidemia (17%), thyroid disorder (11%), PCOS (2.8%), infertility (1.4%) and Tamoxifen therapy (1%). All cases underwent hysterectomy (51%), curettage (36%) and hysteroscopy (13%). The diagnosis was missed in 1.6% from curettage and endometrial biopsy. Recurrence of EPs was .7%. They were relatively common in women with leiomyoma(58%), endometriotic cysts(8%) adenomyosis (34%). Conclusion: Endometrial polyps are among the most common causes of abnormal uterine bleeding. They also remain asymptomatic. They appear in women with late menopause, hypertension, obesity, dyslipidemia, diabetes, hyperthyroidism, PCOS and Tamoxifen therapy. Hysteroscopy is the appropriate treatment for endometrial polyps.
679 Eleven Cases Robert’s Uterus Treated by Hysteroscopy and Laparoscopy Successfully Delivered in 1 Case Xia E. Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China Study Objective: To investigate the clinical features and the diagnosis and treatment of Robert’s uterus. Design: Retrospective analysis of diagnosis and treatment of 11 cases of Robert’s uterus. Setting: Teaching Hospital. Patients: From February 2005 to May 2014 there are 11 cases of Robert’s uterus diagnosed and treated in Fuxing Hospital. Their mean age was16.5years (15w19), suffered from enlarged uterus, dysmenorrhea, cycle abdomen pain and uterine cavity effusion. Intervention: They were performed hysteroscopic metroplasty monitored by laparoscopy or B ultrasonography.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 Measurements and Main Results: Among 11 cases, the chief complaint 4 unmarried cases was dysmenorrhea and the chief complaint of 7 married cases was infertility. Three cases had history of enucleate Choclate cyst for 4 tines One case complicated with adenomyosis. Two cases encountered from tubal endometriosis. All cases failed in preoperative diagnosis. Five cases were performed hysteroscopic surgery under B ultrasonic monitoring. Five cases were performed hysteroscopic surgery under laparoscopic monitoring and 1 case was performed hysteroscopic surgery under laparoscopic monitoring and ultrasound monitoring. The Robert’s uterus was confirmed during the surgery. One case got pregnancy 5 months after operation. At 40+ 5 gestation weeks Cesarean Section was performed and delivered a weight 3520 grams healthy girl who is now alive. Conclusion: For Robert’s uterus earlier and accurate diagnosis as well as proper surgical treatment is very important. Hysteroscopyic surgery under laparoscopic and (or) ultrasound monitoring is the effective and minimally invasive therapy of Robert’s uterus.
680 Successful Treatment of Cesarean Scar Pregnancy by Surgery of Hysteroscopic Resection Chou C-K, Hwang CT-L, Yeh L-S, Lin W-C, Chang CY-Y. Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan Study Objective: To report a case of successful treatment of cesarean scar pregnancy by hysteroscopic resection after failure of the methotrexate injection treatment. Design: case report. Setting: Tertiary medical center. Patients: A previously healthy 38-year-old, G9P5A3(cesarean section for four times), housewife. Intervention: transcervical hysteroscopic resection. Measurements and Main Results: A previously healthy 38-year-old, G9P5A3(cesarean section for four times), housewife was referred to the tertiary medical center due to ectopic pregnancy. Transvaginal sonography showed a gestational sac about 2cm at the cesarean scar defect and b-HCG was 4530. Patient did not have the peritoneal sign. So, he accepted methotrexate IM (50mg/m2) injection at OPD. But b-HCG was 4076 one week after the methotrexate injection. After discussion with patient, patient asked for operation. Thus, hysteroscopic resection of the gestational tissue was performed. The gestational tissue was smoothly removed and the blood loss was minimal. After operation, this patient did not have discomfort except mild vaginal bleeding. The b-HCG was decreased to 37.54 one week later and returned to normal two weeks after operation. Conclusion: Hysteroscopic resection to remove the gestational tissue is a good option in treating ectopic pregnancy at cesarean scar.
681 About Infertility Treatment Issue: Hysteroscopic Polypectomy and Outcome Manvelyan V,1 Hambartsoumian E,2 Grigoryan H,2 Chzmachyan R.2 1 ’’Surb Astvatsatsin’’ Maternity Hospital, Yerevan, Armenia; 2Fertility Center, Yerevan, Armenia Study Objective: Analysis of the received results of the hysteroscopic polypectomy in complex treatment of primary or secondary infertility. Design: Retrospective cohort study. Setting: Municipal Hospital. Patients: In 2004-2005 march, we examined 22 women with primary or secondary infertility. Endometrial polyp was diagnosed via transvaginal ultrasound followed by diagnostic hysteroscopy. The criteria for inclusion in the study were the age (18-35 years), primary or secondary infertility, endocrinological pathologies (hypothyreosis, hyperprolactinemia, PCOS, etc.) with single endometrial polyp (0.4-2.0 cm) of an average of 1.02 cm without clinical manifestations.
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Intervention: All the patients received endocrinological pathology correction and were studied before and after hysteroscopic polypectomy. Measurements and Main Results: All women underwent correction of endocrinological pathologies with either intrauterine insemination or sexual intercourse during 3-6 months. The conducted correction of endocrinological pathologies with the presence of the endometrial polyp did not bring to pregnancy. Following this, the same group of patients underwent hysteroscopic polypectomy while on-going or conducted correction, which led to pregnancy in 14 (63.6%) cases after 1 to 6 months of surgical intervention. The remaining 8 (36.4%) women remain under follow-up in a 3-to-8-month period. No relapse or complications were noted. Conclusion: The conducted study shows that hysteroscopic polypectomy increases the probability of pregnancy rates. Hysteroscopic polypectomy is a safe and feasible procedure with a low risk of complications.
682 Normal Versus Abnormal Tubal Ostia at Hysteroscopy Kumar A. Hysteroscopic Surgery Division, Women’s Health Centre, Jaipur, Rajasthan, India Study Objective: To demonstrate hysteroscopic findings of normal and abnormal tubal ostia. Design: A retrospective study. Setting: A private women’s hospital. Patients: Patients undergoing hysteroscopic surgeries in our hospital between 1993 and 2015. Intervention: High resolution hysteroscopic images were taken in all patients and the images were later analysed in detail especially for the morphology and the intramural part of the tubal ostia. These images of the variant tubal ostia are included in this study. Measurements and Main Results: In this study we document multiple images of healthy and diseased tubal ostia. It is not sufficient enough to study the external morphology of the ostium while it is important to visualize the intramural part of the tubal ostium as well. The intramural epithelium of a normal tubal orifice is pink to pale red, at least four minor endosalpigean folds having a smooth surface can be seen aligned parallel to the long axis of the tube and the folds are separated by relatively large spaces through which the tubal wall can be appreciated. The vascularization of the minor folds is represented by a thin capillary positioned in the axis of the fold, and a few collateral vessels are seen. Diseased ostia are generally not well visualized, they could be pin hole to round dilated in morphology, the intramural epithelium is generally pale in color and is devoid of the normally seen minor folds, the surface of the minor folds is rough with eroded margins, capillary vascularization not seen, adhesion bands and whitish deposits may be seen in cases of endometrial tuberculosis, and micropolyps may be seen in cases of chronic endometritis. Physiologic contractions are impaired or generally not seen in the diseased ostia during the entire hysteroscopic procedure. Conclusion: Hysteroscopy is a useful modality of differentiating between normal and abnormal tubal ostia.
683 Significance of Endoscopic and Morphological Methods of Diagnosis for Specification of Female Sterility Variants Kolesova TE, Statnykh NV. Obstetrics and Gynecology, Perm State University of Medicine Named After Academician EA Wagner, Perm, Russian Federation Study Objective: To study the opportunities of different methods of diagnosis of salpingoperitoneal and uterine factors of sterility. Design: Prospective study. Setting: Gynecological Unit of Perm Regional Clinical Hospital. Patients: 43 patients with primary sterility (group 1 - 57%) and secondary sterility (group 2 - 43%) in the age from 21 till 40 years. Intervention: Operated for 6 months of 2013 – 2014.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
676 Successful Pregnancy Outcome After Hysteroscopic Resection of Endometrial Carcinoma Mangubat MC, Estroso MB. Obstetrics and Gynecology, Perpetual Succour Hospital, Cebu City, Cebu, Philippines
Conclusion: The MyoSureÒ Lite tissue removal system is more effective at sampling the endometrial surface of post-menopausal uterine cavities compared to sharp curettage.
678 Study Objective: To evaluate pregnancy and obstetric outcomes in a young woman with endometrial carcinoma after fertility sparing surgery. Design: Case Report. Setting: Department of Obstetrics and Gynecology Perpetual Succour Hospital, Cebu City, Philippines. Patients: A 35 years old, Filipino, married, primigravid diagnosed with early stage endometrial adenocarcinoma is presented. Intervention: The patient initially diagnosed with abnormal uterine bleeding underwent transcervical resection of polyp and endometrium with final histopathologic report of moderately differentiated endometrioid adenocarcinoma. The patient declined surgery and pregnancy was conceived spontaneously 2 months after the procedure. Measurements and Main Results: She received normal obstetric care starting 17 weeks gestation with multidisciplinary approach and delivered spontaneously a live male neonate at 38 weeks gestation. The histological evaluation after hysteroscopy 7 weeks postpartum showed focal endometrial complex hyperplasia with atypia to endometrial carcinomain-situ. Conservative management consisted of oral megestrol acetate 160 mg daily and a repeat hysteroscopic biopsy after 3 months. Conclusion: Although fertility–sparing management of endometrial cancer is not the current standard of care for young women,hysteroscopic surgical resection of low grade early stage lesion may also be a rational option to preserve fertility and encourage pregnancy in a woman with unfulfilled motherhood.
677 Endometrial Sampling of the Post-Menopausal Uterus: MyoSureÒ Lite Tissue Removal System vs. Sharp Curettage Rosenblatt P, DiScuillo A, Warda H, Barcia S. Mount Auburn Hospital, Cambridge, Massachusetts Study Objective: To compare tissue removed by the MyoSureÒ Lite tissue removal system to sharp curettage for specimen quality and histologic diagnosis. Design: Laboratory study of excised tissue samples and immediately extirpated uteri in post-menopausal women with benign endometrial cavity findings on hysteroscopy. Setting: Laboratory and hospital pathology department. Patients: 4 post-menopausal extirpated uteri from cadavers. Up to 10 postmenopausal uteri immediately after hysterectomy for benign reasons. Intervention: Hysteroscopic evaluation of the extirpated uterus to exclude intrauterine lesions. Removal of the endometrial surface in one quadrant using the MyoSureÒ Lite tissue removal system. Curettage by sharp instrument of another quadrant of the uterus. Post-procedure hysteroscopy. Measurements and Main Results: In 4 cadaverous uteri, tissue samples obtained from one quadrant using MyoSureÒ Lite system were visually compared to resected tissue with sharp curettage. The average cutting time using MyoSureÒ Lite system was 59 seconds for the two samples where this information was recorded. Sharp curettage from a separate quadrant of the uterus was performed in the classic fashion for a D&C. Tissue from the sharp curettage was placed in a gauze and compared grossly to the specimen collected in the MyoSureÒ Lite tissue trap. Hysteroscopy performed after both procedures qualitatively confirmed that greater tissue was removed by MyoSure Lite system compared to the quadrant sampled with sharp curettage. Up to 10 cases will be similarly managed to evaluate freshly extirpated uteri obtained from postmenopausal women undergoing hysterectomy. Both gross and microscopic comparison will be made between the sampling techniques. Histologic diagnosis will be compared to the final hysterectomy specimen diagnosis to evaluate diagnostic accuracy of hysteroscopic sampling.
Profile of Women With Endometrial Polyps Treated in a Tertiary Hospital: Retrospective Chart Review and Review of Literature Mangubat MC, Pichay RL. Department of Obstetrics and Gynecology, Perpetual Succour Hospital, Cebu City, Cebu, Philippines Study Objective: To review the clinical presentation, risk factors, diagnostic investigations, associated gynecologic conditions and management of endometrial polyps. Design: 6-year retrospective descriptive chart review design. Setting: Department of Obstetrics and Gynecology, Perpetual Succour Hospital, Cebu City, Philippines. Patients: Women found by ultrasound and diagnosed hysteroscopically and by histopathology to have EPs were included. Patient characteristics included age, gravidity, BMI, presence or absence of symptoms, menopausal status, medical problems, infertility and use of hormonal medications. Intervention: Transvaginal ultrasonography was performed in all participants. A few had saline infusion sonography. These women underwent curettage, polypectomy and hysteroscopy. EPs were also incidental findings in patients who underwent hysterectomy. Measurements and Main Results: A total of 215 women found by ultrasound and diagnosed hysteroscopically and by histopathology with EPs were included. The average age was 51.56 years old +/- 12.14 (age range 23–81). 45.2% were menopausal with average age 56.81 years old +/- 8.91. 53% had gravidity >3. The average BMI was 29.78 +/- 3.49. The most common pretreatment symptoms were vaginal spotting (30%), heavy menstrual bleeding (27%), intermenstrual bleeding (9%), postcoital bleeding (7%), dysmenorrhea (7%) and irregular cycles (4%). Endometrial polyps were present in women with hypertension (62%), diabetes mellitus (23%), dyslipidemia (17%), thyroid disorder (11%), PCOS (2.8%), infertility (1.4%) and Tamoxifen therapy (1%). All cases underwent hysterectomy (51%), curettage (36%) and hysteroscopy (13%). The diagnosis was missed in 1.6% from curettage and endometrial biopsy. Recurrence of EPs was .7%. They were relatively common in women with leiomyoma(58%), endometriotic cysts(8%) adenomyosis (34%). Conclusion: Endometrial polyps are among the most common causes of abnormal uterine bleeding. They also remain asymptomatic. They appear in women with late menopause, hypertension, obesity, dyslipidemia, diabetes, hyperthyroidism, PCOS and Tamoxifen therapy. Hysteroscopy is the appropriate treatment for endometrial polyps.
679 Eleven Cases Robert’s Uterus Treated by Hysteroscopy and Laparoscopy Successfully Delivered in 1 Case Xia E. Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China Study Objective: To investigate the clinical features and the diagnosis and treatment of Robert’s uterus. Design: Retrospective analysis of diagnosis and treatment of 11 cases of Robert’s uterus. Setting: Teaching Hospital. Patients: From February 2005 to May 2014 there are 11 cases of Robert’s uterus diagnosed and treated in Fuxing Hospital. Their mean age was16.5years (15w19), suffered from enlarged uterus, dysmenorrhea, cycle abdomen pain and uterine cavity effusion. Intervention: They were performed hysteroscopic metroplasty monitored by laparoscopy or B ultrasonography.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 Measurements and Main Results: Among 11 cases, the chief complaint 4 unmarried cases was dysmenorrhea and the chief complaint of 7 married cases was infertility. Three cases had history of enucleate Choclate cyst for 4 tines One case complicated with adenomyosis. Two cases encountered from tubal endometriosis. All cases failed in preoperative diagnosis. Five cases were performed hysteroscopic surgery under B ultrasonic monitoring. Five cases were performed hysteroscopic surgery under laparoscopic monitoring and 1 case was performed hysteroscopic surgery under laparoscopic monitoring and ultrasound monitoring. The Robert’s uterus was confirmed during the surgery. One case got pregnancy 5 months after operation. At 40+ 5 gestation weeks Cesarean Section was performed and delivered a weight 3520 grams healthy girl who is now alive. Conclusion: For Robert’s uterus earlier and accurate diagnosis as well as proper surgical treatment is very important. Hysteroscopyic surgery under laparoscopic and (or) ultrasound monitoring is the effective and minimally invasive therapy of Robert’s uterus.
680 Successful Treatment of Cesarean Scar Pregnancy by Surgery of Hysteroscopic Resection Chou C-K, Hwang CT-L, Yeh L-S, Lin W-C, Chang CY-Y. Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan Study Objective: To report a case of successful treatment of cesarean scar pregnancy by hysteroscopic resection after failure of the methotrexate injection treatment. Design: case report. Setting: Tertiary medical center. Patients: A previously healthy 38-year-old, G9P5A3(cesarean section for four times), housewife. Intervention: transcervical hysteroscopic resection. Measurements and Main Results: A previously healthy 38-year-old, G9P5A3(cesarean section for four times), housewife was referred to the tertiary medical center due to ectopic pregnancy. Transvaginal sonography showed a gestational sac about 2cm at the cesarean scar defect and b-HCG was 4530. Patient did not have the peritoneal sign. So, he accepted methotrexate IM (50mg/m2) injection at OPD. But b-HCG was 4076 one week after the methotrexate injection. After discussion with patient, patient asked for operation. Thus, hysteroscopic resection of the gestational tissue was performed. The gestational tissue was smoothly removed and the blood loss was minimal. After operation, this patient did not have discomfort except mild vaginal bleeding. The b-HCG was decreased to 37.54 one week later and returned to normal two weeks after operation. Conclusion: Hysteroscopic resection to remove the gestational tissue is a good option in treating ectopic pregnancy at cesarean scar.
681 About Infertility Treatment Issue: Hysteroscopic Polypectomy and Outcome Manvelyan V,1 Hambartsoumian E,2 Grigoryan H,2 Chzmachyan R.2 1 ’’Surb Astvatsatsin’’ Maternity Hospital, Yerevan, Armenia; 2Fertility Center, Yerevan, Armenia Study Objective: Analysis of the received results of the hysteroscopic polypectomy in complex treatment of primary or secondary infertility. Design: Retrospective cohort study. Setting: Municipal Hospital. Patients: In 2004-2005 march, we examined 22 women with primary or secondary infertility. Endometrial polyp was diagnosed via transvaginal ultrasound followed by diagnostic hysteroscopy. The criteria for inclusion in the study were the age (18-35 years), primary or secondary infertility, endocrinological pathologies (hypothyreosis, hyperprolactinemia, PCOS, etc.) with single endometrial polyp (0.4-2.0 cm) of an average of 1.02 cm without clinical manifestations.
S193
Intervention: All the patients received endocrinological pathology correction and were studied before and after hysteroscopic polypectomy. Measurements and Main Results: All women underwent correction of endocrinological pathologies with either intrauterine insemination or sexual intercourse during 3-6 months. The conducted correction of endocrinological pathologies with the presence of the endometrial polyp did not bring to pregnancy. Following this, the same group of patients underwent hysteroscopic polypectomy while on-going or conducted correction, which led to pregnancy in 14 (63.6%) cases after 1 to 6 months of surgical intervention. The remaining 8 (36.4%) women remain under follow-up in a 3-to-8-month period. No relapse or complications were noted. Conclusion: The conducted study shows that hysteroscopic polypectomy increases the probability of pregnancy rates. Hysteroscopic polypectomy is a safe and feasible procedure with a low risk of complications.
682 Normal Versus Abnormal Tubal Ostia at Hysteroscopy Kumar A. Hysteroscopic Surgery Division, Women’s Health Centre, Jaipur, Rajasthan, India Study Objective: To demonstrate hysteroscopic findings of normal and abnormal tubal ostia. Design: A retrospective study. Setting: A private women’s hospital. Patients: Patients undergoing hysteroscopic surgeries in our hospital between 1993 and 2015. Intervention: High resolution hysteroscopic images were taken in all patients and the images were later analysed in detail especially for the morphology and the intramural part of the tubal ostia. These images of the variant tubal ostia are included in this study. Measurements and Main Results: In this study we document multiple images of healthy and diseased tubal ostia. It is not sufficient enough to study the external morphology of the ostium while it is important to visualize the intramural part of the tubal ostium as well. The intramural epithelium of a normal tubal orifice is pink to pale red, at least four minor endosalpigean folds having a smooth surface can be seen aligned parallel to the long axis of the tube and the folds are separated by relatively large spaces through which the tubal wall can be appreciated. The vascularization of the minor folds is represented by a thin capillary positioned in the axis of the fold, and a few collateral vessels are seen. Diseased ostia are generally not well visualized, they could be pin hole to round dilated in morphology, the intramural epithelium is generally pale in color and is devoid of the normally seen minor folds, the surface of the minor folds is rough with eroded margins, capillary vascularization not seen, adhesion bands and whitish deposits may be seen in cases of endometrial tuberculosis, and micropolyps may be seen in cases of chronic endometritis. Physiologic contractions are impaired or generally not seen in the diseased ostia during the entire hysteroscopic procedure. Conclusion: Hysteroscopy is a useful modality of differentiating between normal and abnormal tubal ostia.
683 Significance of Endoscopic and Morphological Methods of Diagnosis for Specification of Female Sterility Variants Kolesova TE, Statnykh NV. Obstetrics and Gynecology, Perm State University of Medicine Named After Academician EA Wagner, Perm, Russian Federation Study Objective: To study the opportunities of different methods of diagnosis of salpingoperitoneal and uterine factors of sterility. Design: Prospective study. Setting: Gynecological Unit of Perm Regional Clinical Hospital. Patients: 43 patients with primary sterility (group 1 - 57%) and secondary sterility (group 2 - 43%) in the age from 21 till 40 years. Intervention: Operated for 6 months of 2013 – 2014.