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“Historical Aspects of Hysteroscopy”
Vol. 24, No.3, March 1973
FERTILITY AND STERILITY
Copyright @ 1973 by The Williams & Wilkins Co.
Printed in U.S.A.
Commentary on "Historical Aspects of Hysteroscopy" As Dr. Lindemann points out, the bottleneck to the increased use of this fascinating and provocative technic has been the difficulty in distending the uterine cavity and developing instruments of sufficiently small caliber with adequate light and flexibility. His proposal of applying a suction cup has much merit in that it successfully prevents leakage back of the CO 2 and thus somehow seems to promote some slight dilatation of the canal, facilitating the introduction of the scope into the uterus. In addition, the use of CO 2 as the distender of the uterine lumen (as opposed to a rubber balloon or dextran) decreases the tendency for trauma resulting in bleeding which might obscure the view; and it seems to be more suited for unobstructed transuterine probing or cauterization of the tube, as well as general intrauterine diagnostic procedures. There is little doubt that, just as laparoscopy has carved its niche in the gyne-
cologist's armamentarium, we are now on the threshold of yet another advance to be used for (a) intrauterine pathology diagnosis, e.g., Asherman's syndrome, carcinoma, and polyps; (b) transuterine tubal cauterization; and (c) preoperative splinting of the proximal portion of the tube for tubal end-to-end anastomosis. Once the operator has gained confidence in this technic another exciting possibility exists, i.e., in the multipara patient this procedure can often be done as an outpatient procedure with or without the ancillary use of a paracervical block. To be able to perform any or all of these procedures on an outpatient basis would be a tremendous boon to the gynecologist with limited hospital bed space or to population programs in some lesser developed countries. There is little doubt that the experience of investigators currently working with this procedure will be eagerly awaited. S. J. BEHRMAN, M.D.
243
FERTILITY AND STERILITY
Copyright @ 1973 by The Williams & Wilkins Co.
Printed in U.S.A.
Commentary on "Historical Aspects of Hysteroscopy" As Dr. Lindemann points out, the bottleneck to the increased use of this fascinating and provocative technic has been the difficulty in distending the uterine cavity and developing instruments of sufficiently small caliber with adequate light and flexibility. His proposal of applying a suction cup has much merit in that it successfully prevents leakage back of the CO 2 and thus somehow seems to promote some slight dilatation of the canal, facilitating the introduction of the scope into the uterus. In addition, the use of CO 2 as the distender of the uterine lumen (as opposed to a rubber balloon or dextran) decreases the tendency for trauma resulting in bleeding which might obscure the view; and it seems to be more suited for unobstructed transuterine probing or cauterization of the tube, as well as general intrauterine diagnostic procedures. There is little doubt that, just as laparoscopy has carved its niche in the gyne-
cologist's armamentarium, we are now on the threshold of yet another advance to be used for (a) intrauterine pathology diagnosis, e.g., Asherman's syndrome, carcinoma, and polyps; (b) transuterine tubal cauterization; and (c) preoperative splinting of the proximal portion of the tube for tubal end-to-end anastomosis. Once the operator has gained confidence in this technic another exciting possibility exists, i.e., in the multipara patient this procedure can often be done as an outpatient procedure with or without the ancillary use of a paracervical block. To be able to perform any or all of these procedures on an outpatient basis would be a tremendous boon to the gynecologist with limited hospital bed space or to population programs in some lesser developed countries. There is little doubt that the experience of investigators currently working with this procedure will be eagerly awaited. S. J. BEHRMAN, M.D.
243