دانلود کتاب Practical Manual of Hysteroscopy

فهرست مطالب :

Foreword to the Third Edition
Foreword to the Second Edition
Foreword to the First Edition
Preface
Abstract
Contents
Editor and Contributors
About the Editor
Contributors
Translators
1: History and Development of Hysteroscopy
1.1 The First Hysteroscope
1.2 Contact Hysteroscope and Modern Contact Hysteroscope
1.3 Hysteroscope with a Balloon at the End
1.4 Fluid Irrigation Mode (Original Continuous Irrigation System) and Uterine Distending Medium
1.5 Distention of Uterus with CO2
1.6 Invention of Fiber Hysteroscope
1.7 Continuous Flow Hysteroscope
1.8 A Clinical Review
1.9 Other Innovations
Suggested Reading
2: Equipment and Instruments for Hysteroscopy
2.1 Equipment for Hysteroscopy
2.1.1 Power System
2.1.1.1 High-Frequency Current Generator
2.1.1.2 Nd-YAG Laser
2.1.2 Lighting System
2.1.2.1 Cold Light Source
2.1.2.2 Light Guide Bundle
2.1.3 Uterine Distention/Irrigation System
2.1.4 Camera Imaging System
2.1.4.1 Imaging System
2.1.4.2 Monitor
2.1.4.3 High Definition Digital Camera System
2.1.4.4 Other Application Systems
2.2 Instruments for Hysteroscopic Diagnosis and Treatment
2.2.1 Fiber Hysteroscope
2.2.1.1 Diagnostic Fiber Hysteroscope (Fig. 2.14)
2.2.1.2 Therapeutic Fiber Hysteroscope
2.2.2 Rigid Hysteroscope
2.2.2.1 Diagnostic Rigid Hysteroscope
2.2.2.2 Therapeutic Rigid Hysteroscope
2.2.2.3 Mini-Hysteroscope
2.2.2.4 Hamou Hysteroscope
2.2.3 Integrated Hysteroscope
2.3 Instruments for Hysteroscopic Surgery
2.3.1 Hystero-Resectoscope (Fig. 2.24)
2.3.1.1 Telescope (Fig. 2.25)
2.3.1.2 Working Element (Fig. 2.26)
2.3.1.3 Hysteroscopic Sheaths (Fig. 2.27)
2.3.1.4 Obturator
2.3.2 Active Electrodes
2.3.2.1 Wire Loop Electrode
2.3.2.2 Needle Electrode (Fig. 2.32)
2.3.2.3 Roller Ball Electrode
2.3.2.4 Roller Bar/Roller Barrel Electrode (Fig. 2.34)
2.3.2.5 Vaporizing Electrode/Vaportrode (Fig. 2.35)
2.3.2.6 Band Electrode (Fig. 2.36)
2.3.3 Accessory Instruments and Equipment
2.3.4 Plasma Bipolar Resectoscope (Fig. 2.37)
2.4 Cleaning, Sterilization, and Maintenance of Hysteroscopic Instruments
2.4.1 Cleaning and Inspection of Hysteroscopic Instruments
2.4.2 Sterilization Methods for Instruments of Hysteroscope
2.4.2.1 Autoclave Sterilization
2.4.2.2 Low Temperature Sterilization
2.4.3 Arrangement of Device and Instruments for Hysteroscopic Surgery
2.4.4 Maintenance of Hysteroscopic Equipment
2.4.4.1 Optical Lens
2.4.4.2 Electronic Equipment
2.4.5 Storage After Operation
Suggested Reading
Equipment for Hysteroscopy
Instruments for Hysteroscopic Diagnosis and Treatment
Instruments for Hysteroscopic Surgery
Cleaning, Sterilization, and Maintenance of Hysteroscopic Instruments
3: Anatomy and Histology in Hysteroscopy
3.1 Anatomy of a Normal Uterus
3.1.1 Uterine Corpus
3.1.1.1 Endometrium
3.1.1.2 Myometrium
3.1.1.3 Serosa
3.1.1.4 Uterine Horn and Ostium of Fallopian Tube
3.1.2 Uterine Cervix
3.2 Cyclical Changes in Endometrium
3.2.1 The Menstruation Phase
3.2.2 Early Proliferative Phase
3.2.3 Late Proliferative Phase
3.2.4 Early Secretory Phase
3.2.5 Late Secretory Phase
4: Effects of Preoperative Medication for Hysteroscopy and Commonly Used Drugs in Gynecology on Endometrium
4.1 Preoperative Medication for Hysteroscopy
4.1.1 Mechanism of Pretreatment with Drugs Prior to Surgery
4.1.1.1 Pseudo-Pregnancy Therapy
4.1.1.2 Pseudo-Menopause Therapy
4.1.1.3 Medical Oophorectomy
4.1.1.4 Other Anti-Estrogen, Anti-Progesterone, and Endometrial Growth-Inhibiting Drugs
4.2 Nolvadex
4.3 Clomiphene
4.4 Levonorgestrel-Releasing Intrauterine System (LNG-IUS)
Suggested Reading
5: Application of High Frequency Electricity in Hysteroscopic Surgery and Its Thermal Effects on Tissues
5.1 The Electronic Circuit Compositions and Current Types in Hysteroscopic Electrosurgery
5.1.1 The Electronic Circuit Compositions in Hysteroscopic Electrosurgery
5.1.2 Current Types in Hysteroscopic Electrosurgery
5.1.2.1 Cutting Current
5.1.2.2 Coagulating Current
5.1.2.3 Blended Current
5.2 Electrothermal Effects in Hysteroscopic Surgery and Its Impact on the Tissues
5.2.1 The Changes in Tissue Cells Caused by Electrothermal Effects
5.2.1.1 Influence of Electrothermal Effect on Protein
5.2.1.2 Influence of Electrothermal Effect on Enzymes
5.2.2 Influence of the Electrothermal Effect on Uterine Tissues
5.2.2.1 Influence of Current Wave Patterns on the Thermal Damage to Tissues
5.2.2.2 Influence of Electrode Powers and Action Times on the Thermal Damage to Tissues
5.2.2.3 Setting of Electrode Power
5.2.3 Histopathological Changes of Electrothermal Injury
5.2.3.1 Light Microscope
5.2.3.2 Findings Under Electron Microscope
5.3 Clinical Application of Hysteroscopic Electrosurgery
5.3.1 Application of Cutting Current in Hysteroscopic Electrosurgery
5.3.2 Application of Coagulating Current in Hysteroscopic Electrosurgery
5.3.3 Application of High Frequency Vaporization in Hysteroscopic Electrosurgery
5.3.4 Application of High Frequent Bipolar System in Hysteroscopic Electrosurgery
Suggested Reading
6: Distention Medium in Hysteroscopy
6.1 CO2 Gas Insufflation
6.2 High Viscosity Distention Medium: Hyskon
6.3 Low Viscosity Distention Medium
6.3.1 Research on Complications Induced by Glycine Absorption
6.3.2 Research on the Complications Induced by Absorption of Sorbitol and Mannitol
6.3.3 Research on the Safety of 5% Glucose as Irrigating Fluid
6.4 Etiology and Clinical Presentation of TURP Syndrome
6.4.1 Etiology of TURP Syndrome
6.4.2 Clinical Presentation of TURP Syndrome
6.5 Treatment of TURP Syndrome
6.5.1 Treatment of Hyponatremia
6.5.1.1 Calculation of the Serum Sodium Deficit
6.5.1.2 Key Points in the Replacement of Sodium
6.5.2 Treatment of Acute Heart Failure
6.5.3 Treatment of Pulmonary Edema
6.5.4 Treatment of Cerebral Edema
6.5.5 Correction of Electrolyte Imbalance
6.6 TURP Syndrome: Prophylactic Measures
6.6.1 Prevention of Complications Caused by High Viscosity Distention Medium
6.6.2 Prevention of Complications Caused by Low Viscosity Distention Medium
6.7 Equipment for Uterine Distention with Fluids
Suggested Reading
7: Anesthesia for Hysteroscopy
7.1 Pre-anesthetic Assessment
7.1.1 Preoperative Visits on Patients and Participation in Preoperative Discussions
7.1.2 Getting Familiar with the Patient’s Medical History and Conducting a Systematic Physical Examination
7.1.3 Examining and Checking the Essential Laboratory Parameters
7.1.4 Assessment of Anesthesia Risks
7.2 Anesthetic Methods and Choices for Hysteroscopy
7.2.1 Topical Anesthesia
7.2.2 Paracervical Nerve Block
7.2.3 Epidural Anesthesia and Subarachnoid Block
7.2.4 General Anesthesia
7.2.4.1 Intravenous Anesthesia
7.2.4.2 General Anesthesia Using Laryngeal Mask Airway
7.2.4.3 Inhalation Anesthesia
7.3 Intraoperative Surveillance During Hysteroscopic Surgery
7.3.1 Routine Monitoring
7.3.1.1 Electrocardiogram (ECG)
7.3.1.2 Blood Pressure
7.3.1.3 Monitoring of Pulse Oxygen Saturation (SpO2)
7.3.1.4 Auscultation in the Precordium and Inside the Esophagus
7.3.2 Special Monitoring
7.3.2.1 Monitoring of Electrolyte
7.3.2.2 Blood Glucose Monitoring
7.3.2.3 Monitoring of Central Venous Pressure (CVP)
7.3.2.4 Noninvasive Estimation of Extravascular Lung Water (EVLW)
7.4 Prevention and Treatment of Complications During Hysteroscopy
7.4.1 Mechanical Injury
7.4.2 Bleeding
7.4.3 Gas Embolism
7.4.4 TURP Syndrome
Suggested Reading
8: Diagnostic Hysteroscopy
8.1 Hysteroscopy
8.1.1 Indications for Hysteroscopy
8.1.1.1 Abnormal Uterine Bleeding (AUB)
8.1.1.2 Abnormal Sonographic Findings in Uterine Cavity
8.1.1.3 Infertility
8.1.1.4 Physiological or Characteristic Changes Caused by Tamoxifen or Hormone Replacement Therapy (HRT)
8.1.1.5 Secondary Dysmenorrhea
8.1.1.6 After Complex Intrauterine Operations
8.1.1.7 Staging of the Endometrial Carcinoma
8.1.1.8 Uterine Myomas
8.1.1.9 Examination of Intrauterine Device
8.1.1.10 Abnormal Vaginal Discharge
8.1.2 Contraindications for Hysteroscopy
8.1.2.1 Absolute Contraindications
8.1.2.2 Relative Contraindications
8.1.3 Preoperative Evaluation
8.1.3.1 Patient’s History
8.1.3.2 Physical Examination
8.1.3.3 Laboratory Examination
8.1.3.4 Psychological Counseling
8.1.4 Uterine Distention System in Hysteroscopy
8.1.4.1 Fluid Medium for Uterine Distention
Uterine Distending Equipment
Distention Medium
8.1.4.2 Gas as Uterine Distention Medium
8.1.5 Timing of Hysteroscopy
8.1.6 Anesthesia and Analgesia in Hysteroscopy
8.1.6.1 Indomethacin Suppository
8.1.6.2 Kaflan
8.1.6.3 Paracervical Nerve Block
8.1.6.4 Surface Anesthesia of Cervical Mucosa
8.1.6.5 Endometrial Spraying Anesthesia
8.1.6.6 Intravenous Anesthesia
8.1.7 Procedures of Hysteroscopy
8.1.7.1 Preparation Before Hysteroscopy
8.1.7.2 Procedures
Fiber (Flexible) Hysteroscopy
Rigid Hysteroscopy
Comparison Between Fiber Hysteroscopy and Rigid Hysteroscopy
“No Touch” Technique
8.1.8 Hysteroscopy Combined with Ultrasonography
8.1.8.1 Indications for Hysteroscopy Combined with Ultrasonography
8.1.8.2 Procedures for Hysteroscopy Combined with Ultrasonography
8.1.8.3 Abnormal Findings in Hysteroscopy Combined with Ultrasonography
Intrauterine Lesions
Lesions on the Uterine Wall or Outside the Uterus
8.1.9 A Normal Uterus Under Hysteroscopy
8.1.9.1 Various Images Seen by Hysteroscopy
8.1.9.2 Normal Morphology of the Uterine Cavity Viewed by Hysteroscopy
Cervical Canal
Uterine Cavity
Endometrium
Endometrium of Women in Reproductive Age
Endometrium of Women in Postmenopause
Uterine Cornua and Fallopian Tubal Orifice
Other Intrauterine Findings
8.1.10 Abnormal Findings Under Hysteroscope
8.1.10.1 Submucosal Myoma
8.1.10.2 Intrauterine Adhesions
8.1.10.3 Congenital Uterine Abnormalities
8.1.10.4 Intrauterine Foreign Bodies
8.1.10.5 Endometrial Polyps
8.1.10.6 Endometrial Hyperplasia
8.1.10.7 Atypical Endometrial Hyperplasia
8.1.10.8 Endometrial Carcinoma
Hysteroscopic Findings
Keypoints of Diagnosis Under Hysteroscope
Precautions During Hysteroscopy
Practicability of Hysteroscopy
8.1.10.9 Intrauterine Inflammatory Disease
8.1.10.10 Denomyosis
8.1.11 Principles of Endometrial Biopsy for Histopathologic Examination During Hysteroscopy
8.1.12 Causes of and Solutions to Hysteroscopic Failures
8.1.13 Management After Hysteroscopy
8.1.14 Prevention and Treatment of Complications in Hysteroscopy
8.1.14.1 Damage
8.1.14.2 Bleeding
8.1.14.3 Infection
8.1.14.4 Vaso-Vagal Syndrome
8.1.14.5 Allergic Reaction
8.1.14.6 Gas Embolism and Pneumoperitoneum
8.1.15 Experiences and Evaluation of Hysteroscopy
8.1.15.1 Comparisons of Hysteroscopy and HSG
8.1.15.2 Comparisons of Hysteroscopy and D&C
8.1.15.3 Comparisons of Hysteroscopy and Ultrasonography
8.1.15.4 Comparisons of Hysteroscopy and Transvaginal Color Doppler (TVCD)
8.1.15.5 Comparisons of Hysteroscopy and Sonohysterosalpingography (SHSG) or Saline Infusion Sonogram (SIS)
8.1.15.6 Comparisons of Hysteroscope and Magnetic Resonance Imaging (MRI)
8.1.16 Minimally Invasive Diagnostic Hysteroscope
8.1.17 Narrow Band Imaging Hysteroscopy
8.1.17.1 Principles of NBI
8.1.17.2 Clinical Applications of NBI
8.1.17.3 Characteristics of Intrauterine Pathology Under NBI Hysteroscopy
8.1.17.4 Clinical Applications of NBI Hysteroscopy
8.1.18 Does Diagnostic Hysteroscopy Facilitate the Dissemination of Tumor Cells?
8.2 Applications of Hysteroscopy in Gynecological Diseases
8.2.1 Abnormal Uterine Bleeding
8.2.1.1 AUB Among Indications for Hysteroscopy
8.2.1.2 Hysteroscopic Techniques Related to Uterine Bleeding
8.2.1.3 Hysteroscopy for AUB
8.2.1.4 Roles of Hysteroscopy in the Diagnosis of Non-pregnancy AUB
Endometrial Polyps
Diagnosis
Values of Hysteroscopy
Submucosal Myoma
Diagnosis
Values of Hysteroscopy
Benign Endometrial Hyperplasia
Diagnosis
Values of Hysteroscopy
Atypical Endometrial Hyperplasia and Endometrial Carcinoma
Diagnosis
Values of Hysteroscopy
Chronic Endometritis
Diagnosis
Values of Hysteroscopy
8.2.1.5 Role of Hysteroscopy in Diagnosis of Postmenopausal Bleeding
8.2.1.6 Other Pathological Conditions Leading to AUB
Endometrial Atrophy
Adenomyosis
AUB Caused by Contraception or Hormone Therapy
Dysfunctional Uterine Bleeding (DUB)
8.2.2 Infertility
8.2.2.1 Indications of Hysteroscopy for Infertile Women
8.2.2.2 Infertility Factors Revealed by Hysteroscopic Examination
Uterine Myoma
Intrauterine Adhesion
Endometrial Polyps
Congenital Uterine Malformations
Intrauterine Foreign Bodies
Chronic Endometritis
8.2.2.3 Hysteroscopic Tubal Catheterization and Hydrotubation
8.2.2.4 Endometrial Changes in Patients with Infertility
8.2.3 Uterine Malformations
8.2.3.1 Formation and Classification of the Uterine Malformations
Congenital Uterine Anomalies
Co-existent Congenital Cervical Anomalies
Co-existent Congenital Vaginal Anomalies
8.2.3.2 Clinical Manifestations of Uterine Malformation
8.2.3.3 Diagnosis of Uterine Malformation
8.2.3.4 Role of Hysteroscopy in Diagnosis of Uterine Malformation
8.2.4 Intrauterine Foreign Bodies
8.2.4.1 The Embedment or Residual Intrauterine Contraceptive Device (IUD)
8.2.4.2 Residual Fetal Bones or Osseous Metaplasia of the Endometrium
8.2.4.3 Residual Pregnancy Tissue
8.2.4.4 Ruptured Cervical Dilator or Residual Laminaria Tent
8.2.4.5 Residual Non-absorbable Sutures Following Cesarean Section
8.2.5 Intrauterine Adhesions
8.2.5.1 Formation and Classification of Intrauterine Adhesions
8.2.5.2 Clinical Manifestations of Intrauterine Adhesions
8.2.5.3 Diagnosis of Intrauterine Adhesions
8.2.5.4 Role of Hysteroscopy in Diagnosis of Intrauterine Adhesions
8.2.6 Endometrial Carcinoma
8.2.6.1 Diagnostic Methods of Endometrial Carcinoma
8.2.6.2 Hysteroscopic Diagnosis of Endometrial Carcinoma
8.2.6.3 Staging for Endometrial Carcinoma at Hysteroscopy
8.2.6.4 Screening for High-Risk Population with Endometrial Cancer by Hysteroscopy
Suggested Reading
Diagnostic Hysteroscopy
Applications of Hysteroscopy in Gynecological Diseases
9: Operative Hysteroscopy
9.1 An Overview of Hysteroscopic Electroresection Surgery
9.1.1 Facilities of Operating Room and Patient’s Body Position
9.1.1.1 Operating Room
9.1.1.2 Gynecologic Operating Table: It Should Have the Following Functions
9.1.1.3 Positioning
9.1.1.4 Prevention of Infection
9.1.2 Irrigating Methods in Hysteroscopic Operation
9.1.2.1 High-Pressure Irrigating
9.1.2.2 Low-Pressure Irrigating
9.1.2.3 Selection of Irrigation Fluid
9.1.3 Cervical Ripening Before Operative Hysteroscopy
9.1.3.1 Osmotic Dilators
9.1.3.2 Misoprostol
9.1.3.3 Phloroglucinol
9.1.4 Techniques of Hysteroscopic Electroresection
9.1.4.1 Operating Procedures
9.1.4.2 Techniques of Resecting
9.1.4.3 Electrocoagulation Hemostasis
9.1.4.4 Weight Calculation of the Excised Tissue
9.1.4.5 Volume Assessment of Bleeding in Hysteroscopic Resection
9.1.4.6 Calculation Method of Blood Loss
9.2 Transcervical Resection of Endometrium and Endometrial Ablation
9.2.1 Indications and Contraindications of TCRE or EA
9.2.1.1 Indications
9.2.1.2 Contraindications
9.2.2 Preoperative Preparations
9.2.2.1 Inquiry of a Detailed History
9.2.2.2 Comprehensive Examinations
9.2.2.3 Consultation
9.2.2.4 Endometrial Pretreatment
9.2.2.5 Timing of Surgery
9.2.2.6 Preparation on the Day Before Operation
9.2.2.7 Preparation on Operation Day
9.2.2.8 Operator’s Preparation
9.2.3 Anesthesia
9.2.3.1 Choice of the Patients
9.2.3.2 Choice of the Operators
9.2.3.3 Operation Duration
9.2.3.4 Combined with Laparoscopy
9.2.3.5 Day Surgery
9.2.3.6 Complications
9.2.4 Operative Procedures
9.2.4.1 Transcervical Resection of Endometrium (TCRE)
9.2.4.2 Endometrial Ablation (EA)
9.2.5 Intraoperative Complicated Conditions and Managements
9.2.5.1 Inadequate Distension of Uterine Cavity
9.2.5.2 Slow Clearance of the Fragments and Clots Inside the Uterine Cavity
9.2.5.3 Insufficient Resection
9.2.5.4 Unclear Observation of the Endometrium and Uterine Cavity
9.2.5.5 Too Rapid Absorption of Irrigation Fluid
9.2.5.6 Intraoperative Bleeding
9.2.5.7 Postoperative Hemorrhage
9.2.6 Intraoperative and Postoperative Care
9.2.6.1 Intraoperative Monitoring
9.2.6.2 Postoperative Care and Managements
9.2.6.3 Postoperative Care
9.2.7 Detection and Management of Operational Complications
9.2.7.1 Intraoperative Complications
9.2.7.2 Postoperative Complications
9.2.8 Experience and Evaluation of TCRE
9.2.8.1 Effects of Operation
9.2.8.2 Endometrial Repair After TCRE/EA
9.2.8.3 One-Stage TCRE
9.2.8.4 TCRE in the Treatment of Uterine Bleeding Resulting from the Hormone Therapy and Blood Coagulation Disorders
9.2.8.5 TCRE in the Treatment of Uterine Bleeding Caused by Severe Medical Diseases
9.2.8.6 Uterine Malignant Lesions Detected During TCRE/EA
9.2.8.7 TCRE for Emergency Hemostasis
9.2.8.8 Endometrial Adenocarcinoma Found During TCRE
9.2.8.9 A Repeat TCRE/EA
9.2.8.10 Hormone Replacement Therapy After TCRE/EA
9.2.8.11 TCRE for Infertility
9.2.8.12 TCRE for Adenomyosis
9.2.8.13 TCRE Applied to Larger Uterus
9.2.8.14 Comparison of TCRE and Drug Therapy for the Treatment of Menorrhagia
9.2.8.15 Comparison Between TCRE and Transabdominal or Transvaginal Hysterectomy
9.2.8.16 Comparison Between TCRE and Other Methods of Endometrial Ablation
9.3 Transcervical Resection of Myoma
9.3.1 Classification of Uterine Myomas
9.3.2 Indications and Contraindications of TCRM
9.3.3 Preoperative Preparations
9.3.3.1 Case Selection
9.3.3.2 Preoperative Medical Pretreatment
9.3.3.3 Routine Laboratory Examination
9.3.3.4 Timing of Surgery
9.3.4 Anesthesia
9.3.5 Operative Equipment
9.3.6 Operative Procedures
9.3.6.1 Pedunculated Submucous Myomas
9.3.6.2 Sessile Submucosal Myoma
9.3.6.3 Intramural Myomas with Inward Protrusion or Close to the Uterine Cavity, and Transmural Myomas
9.3.6.4 Multiple Submucous and Intramural Myoma
9.3.6.5 Cervical Myoma
9.3.6.6 Simultaneous Resection of Endometrium and Myoma
9.3.6.7 Removal of Adenomyoma
9.3.6.8 Large Myomas >6 cm in Diameter
9.3.6.9 Diffuse Uterine Leiomyomatosis (DUL)
9.3.6.10 Operating Techniques of TCRM
9.3.7 Intraoperative Special Conditions and Management
9.3.8 Intra- and Postoperative Monitoring and Management
9.3.8.1 Intraoperative Monitoring
9.3.8.2 Postoperative Monitoring and Treatment
9.3.9 Identification and Treatment of Operative Complications
9.3.9.1 Bleeding
9.3.9.2 Uterine Perforation
9.3.9.3 Fluid Overload and Hyponatremia
9.3.9.4 Inversion of Uterus
9.3.9.5 Uterine Fistula
9.3.9.6 Uterine Myoma Malignancy
9.3.10 Experience and Evaluation of TCRM
9.3.10.1 Operating Process and Outcome of TCRM
9.3.10.2 Effects of TCRM
9.3.10.3 Fertility After TCRM
9.3.10.4 Repeat Operation After TCRM
9.3.10.5 Effects of Preoperative Application of GnRH Analogs on the Short- and Long-Term Outcomes Following TCRM
9.4 Transcervical Resection of Endometrial Polyps
9.4.1 Histopathological Classification
9.4.1.1 Originating from Mature Endometrium (Functional Polyp)
9.4.1.2 Originating from Immature Endometrium (Nonfunctional Polyp)
9.4.1.3 Adenomyoma Polyp
9.4.1.4 Postmenopausal Polyp
9.4.2 Indications and Contraindications of TCRP
9.4.3 Preoperative Preparation and Anesthesia
9.4.4 Operative Procedures
9.4.4.1 Clamping Under Hysteroscopy
9.4.4.2 Intercepting Under Hysteroscopy
9.4.4.3 Hysteroscopic Electroresection
9.4.5 Intra- and Postoperative Monitoring and Management
9.4.6 Identification and Management of Operative Complications
9.4.7 Experience and Evaluation of TCRP
9.4.7.1 Therapeutic Effect of TCRP
9.4.7.2 Postoperative Recurrence of Endometrial Polyps
9.4.7.3 TCRP Combined with TCRE to Improve Therapeutic Effect
9.4.7.4 TCRP and Infertility
9.4.7.5 Malignancy in Endometrial Polyp
9.5 Transcervical Resection of Septum
9.5.1 Embryology and Classification of Uterine Malformations
9.5.1.1 Septate Uterus
9.5.1.2 Bicornuate Uterus
9.5.1.3 T-Shaped Uterus
9.5.1.4 Unicornuate Uterus
9.5.1.5 Robert Uterus
9.5.1.6 Arcuate Uterus
9.5.1.7 Rudimentary Uterus
9.5.2 Indications of TCRS
9.5.3 Preoperative Preparation and Anesthesia
9.5.3.1 Preoperative Assessment
9.5.3.2 Timing of Operation
9.5.3.3 Operative Preparation
9.5.3.4 Anesthesia
9.5.4 Operative Procedures
9.5.4.1 Mechanical Resection with Scissors Under Hysteroscope
9.5.4.2 Transcervical Resection of Uterine Septum (TCRS)
9.5.4.3 Hysteroscopic Resection of Septum by Laser
9.5.4.4 Transcervical Uterine Incision (TCUI)
9.5.4.5 Uterine Unification for Bicornuate Uterus by Combined Laparoscopy and Hysteroscopy
9.5.5 Intraoperative Complex Conditions and Management
9.5.6 Intraoperative and Postoperative Monitoring and Management
9.5.6.1 Ultrasound Surveillance
9.5.6.2 Laparoscopic Monitoring
9.5.7 Identification and Treatment of Operative Complications
9.5.8 Experience and Assessment of Hysteroscopic Metroplasty
9.5.8.1 Septate Uterus
9.5.8.2 Bicornuate Uterus
9.5.8.3 T-Shaped Uterus
9.5.8.4 Unicornuate Uterus
9.5.8.5 Robert Uterus
9.5.8.6 Arcuate Uterus
9.6 Transcervical Resection of Intrauterine Adhesions
9.6.1 Operative Indications and Contraindications
9.6.1.1 Indications
9.6.1.2 Contraindications
9.6.2 Preoperative Preparations
9.6.3 Anesthesia
9.6.4 Surgical Procedures
9.6.4.1 Transcervical Resection of Intrauterine Adhesions (TCRA)
9.6.4.2 Hysteroscopic Lysis of Adhesions with Scissors
9.6.4.3 Lysis of Adhesions with Fiber Optic Lasers
9.6.5 Intraoperative Complicated Conditions and Cautions
9.6.6 Intraoperative Monitoring
9.6.6.1 Ultrasonography
9.6.6.2 Laparoscopy
9.6.7 Postoperative Management and Adjunctive Therapy
9.6.7.1 Hormone Treatment
9.6.7.2 Intrauterine Placement of Barriers
9.6.7.3 Prophylactic Antibiotics
9.6.7.4 Second-Look Hysteroscopy
9.6.8 Diagnosis and Management of Operative Complications
9.6.9 Experiences and Evaluations of TCRA
9.6.9.1 Success Rate of Operations
9.6.9.2 Postoperative Menstruations
9.6.9.3 Postoperative Recurrence of Adhesions
9.6.9.4 Postoperative Conception and Reproductive Outcomes
9.6.9.5 Factors Affecting Reproductive Prognosis After TCRA
9.7 Transcervical Removal of Uterine Foreign Body
9.7.1 Intrauterine Device (IUD)
9.7.2 Retention of Fetal Bone
9.7.3 Endometrial Ossification and Cervical Ossification
9.7.4 Residual Trophoblastic Remnants
9.7.5 Cervical Pregnancy
9.7.6 Cesarean Scar Pregnancy
9.7.7 Fragmented Cervical Dilator or Laminaria Tent
9.7.8 Surgical Suture Threads
9.8 Other Hysteroscopic Operations
9.8.1 Transcervical Uterine Incision (TCUI)
9.8.1.1 Indications
9.8.1.2 Operative Procedures
9.8.1.3 Experience and Evaluation of the Operation
9.8.2 Transcervical Resection for Biopsy (TCRB)
9.8.2.1 For Diagnosis of Adenomyosis
9.8.2.2 For Diagnosis of Endometrial Tuberculosis
9.8.3 Hysteroscopic Resection of Cystic Adenomyosis
9.8.3.1 Indications
9.8.3.2 Operative Procedures
9.8.3.3 Experience and Evaluation of the Operation
9.8.4 Transcervical Resection of Cervical Lesion (TCRC)
9.8.4.1 Indications
9.8.4.2 Operative Procedures
9.8.4.3 Experience and Evaluation of the Operation
9.9 Other Techniques of Endometrial Ablation
9.9.1 Uterine Balloon Thermo-Ablation (UBT)
9.9.2 Hydrothermo Ablation (HTA)
9.9.3 Multi-Electrode Balloon Ablation (MEBA)
9.9.4 Microwave Endometrial Ablation (MEA)
9.9.5 Bipolar Radiofrequency Endometrial Ablation (RFEA)
9.9.6 Cryo-Endometrial Ablation
9.9.7 Endometrial Laser Intrauterine Thermotherapy (ELITT)
9.9.8 Micro-Hysteroscopy Versapoint Bipolar Electrosurgery Intrauterine System (Versapoint)
Suggested Reading
An Overview of Hysteroscopic Electroresection Surgery
Transcervical Resection of Endometrium and Endometrial Ablation
Transcervical Resection of Myoma
Transcervical Resection of Endometrial Polyps
Transcervical Resection of Septum
Transcervical Resection of Intrauterine Adhesions
Transcervical Removal of Uterine Foreign Body
Other Hysteroscopic Operations
Other Techniques of Endometrial Ablation
10: Combined Hysteroscopy and Laparoscopy
10.1 Indications for Combined Hysteroscopy and Laparoscopy
10.2 Contraindications for Combined Hysteroscopy and Laparoscopy
10.3 Operative Procedures of Combined Hysteroscopy and Laparoscopy
10.3.1 Step 1: The Joint Examination of Hysteroscopy and Laparoscopy
10.3.2 Step 2: Hysteroscopic Surgery Under Laparoscopic Monitoring
10.3.2.1 Endometrial Resection
10.3.2.2 Resection of Broad-Based Sessile Submucosal Myomas and Inward-Protruding Intramural Myomas
10.3.2.3 Surgical Correction of Uterine Septum
10.3.2.4 Lysis of Severe Intrauterine Adhesions
10.3.3 Step 3: Laparoscopic Surgery and Hysteroscopic Surveillance
10.3.4 Step 4: Laparoscopic Exploration and Surgery
10.4 Application of Combined Hysteroscopy and Laparoscopy
10.4.1 Diagnosis and Treatment of Infertility
10.4.1.1 Combined Hysteroscopy and Laparoscopy in Diagnosis and Treatment of Uterine Malformations
10.4.1.2 Diagnosis and Treatment of Tubal Infertility
10.4.2 Etiological Diagnosis and Treatment of Chronic Pelvic Pain
10.4.3 Monitoring Complicated Hysteroscopic Surgery
10.4.4 Metroplasty for Complete Bicornuate Uterus
10.4.5 Laparoscopic Uterine Artery Ligation and Hysteroscopic Surgery for Intrauterine Lesions with High Risk of Hemorrhage
10.4.6 Diagnosis and Treatment of the Coexistent Pelvic and Intrauterine Lesions
Suggested Reading
11: Ultrasonography Monitoring During Hysteroscopic Surgery
11.1 Techniques of Ultrasonography Guidance
11.2 Ultrasonography Guidance for Intraoperative Operation
11.2.1 Ultrasonography Guidance for TCRE
11.2.2 Ultrasonography Guidance for Endometrial Ablation
11.2.3 Ultrasonography Guidance for TCRM
11.2.4 Ultrasonography Guidance for TCRS
11.2.5 Ultrasonography Guidance for TCRA
11.2.6 Ultrasonography Guidance for TCRF
11.2.6.1 Removal of the Residual IUD
11.2.6.2 Removal of Complete or Broken Metal Ring
11.2.6.3 Removal of Fetal Bones
11.2.6.4 Removal of Residual Placental Tissues
11.3 Ultrasonography Guidance and Uterine Perforation
11.3.1 Causes of Uterine Perforation
11.3.1.1 Intrauterine Myomas
11.3.1.2 Adenomyosis
11.3.1.3 Placenta Residues
11.3.1.4 Intrauterine Retention and Embedment of Fetal Bones
11.3.1.5 Severe Intrauterine Adhesions
11.3.1.6 Old Injuries in the Uterine Wall
11.3.1.7 The Position of the Uterus
11.3.2 Sonographic Features of Uterine Perforation
11.3.3 Intraoperative Monitoring and Uterine Perforation
11.4 The Value of Ultrasonography Guidance in Hystersocopic Surgery
Suggested Reading
12: Complications of Hysteroscopic Surgery
12.1 Organ Injury
12.1.1 Uterine Perforation
12.1.1.1 Incidence
12.1.1.2 Factors for Occurrence of Uterine Perforation
12.1.1.3 Identification of Uterine Perforation
12.1.1.4 Seriousness of Uterine Perforation
12.1.1.5 Treatment of Uterine Perforation
12.1.1.6 Prevention of Uterine Perforation
12.1.1.7 Long-Term Prognosis of Uterine Perforation
12.1.2 Injury to Adjacent Organs Induced by Uterine Perforation
12.1.3 Large Vessel Injury Following Uterine Perforation
12.1.4 Other Injuries
12.2 Fluid Overload
12.2.1 Physiology of Low-Viscosity and Electrolyte Fluid
12.2.2 Fluid Overload and Dilutional Hyponatremia
12.2.3 TURP Syndrome
12.2.4 Prevention of TURP Syndrome
12.2.5 Treatment of TURP Syndrome
12.2.6 Monitoring Device for the Prevention of Fluid Overload (Portable)
12.2.7 New Operative Device: Imitated Bipolar System
12.2.8 Conclusion
12.3 Intra- and Postoperative Bleeding
12.3.1 Factors and Mechanisms of Intra- and Postoperative Bleeding
12.3.1.1 The Cutting Depths of TCRE, TCRA, and TCRP Reaching the Uterine Vascular Layer
12.3.1.2 Bleeding from the Myometrium of the Fundus Because of the Injury of the Vessels When TCRS Reaches the Fundus
12.3.1.3 Bleeding from the Base of Myomas with Large Size and Special Location
12.3.1.4 Bleeding from the Damaged Vessels During Hysteroscopic Operations on Intrauterine Conception in Special Locations
12.3.1.5 Disturbed Contractility of the Uterus with Adenomyosis or Myoma
12.3.1.6 Uterine Arteriovenous Fistula
12.3.1.7 Coexisting with Relevant Medical Diseases
12.3.2 Intraoperative Bleeding of Hysteroscopic Surgeries
12.3.2.1 Identification of Intraoperative Bleeding
12.3.2.2 Prevention and Treatment of Intraoperative Bleeding
12.3.3 Bleeding in the Early Postoperative Period
12.3.3.1 Identification of Bleeding in the Early Postoperative Period
12.3.3.2 Prevention and Treatment of Bleeding in the Early Postoperative Period
12.3.4 Bleeding in the Late Postoperative Period
12.3.5 Prolonged Bleeding in the Postoperative Period
12.4 Infection
12.4.1 Characteristics of Female Genital Organs
12.4.2 Factors Causing Postoperative Infection
12.4.2.1 Factors Related to Procedures
12.4.2.2 Changes in the Internal Environment of Reproductive Tract
12.4.2.3 Factors Related to Instrument
12.4.3 Microbiological Characteristics of Infections After Hysteroscopy
12.4.4 Diagnosis and Treatment of Postoperative Infection
12.4.4.1 Clinical Symptoms
12.4.4.2 Physical Signs
12.4.4.3 Auxiliary Examination
12.4.4.4 Treatment
12.4.5 Reports of Infections After Operative Hysteroscopy
12.4.6 Preventive Measures Against Infection
12.4.6.1 Strict Sterilization of Instruments
12.4.6.2 Strict Sterile Operation
12.4.6.3 Improvement in Patient Status
12.4.6.4 Application of Prophylactic Antibiotics
12.5 Venous Air Embolism
12.5.1 Incidence
12.5.2 Etiology
12.5.3 Pathogenesis
12.5.4 Pathophysiology
12.5.5 Clinical Manifestations
12.5.6 Diagnosis of VAE
12.5.6.1 Symptoms and Signs
12.5.6.2 Laboratory Tests
12.5.6.3 Imaging Examination
12.5.6.4 Electrocardiogram Examination
12.5.7 Monitoring of VAE
12.5.8 Emergency Managements
12.5.9 Prevention and Treatment of VAE
12.6 Intrauterine Adhesions
12.6.1 Incidence of Postoperative Intrauterine Adhesions
12.6.1.1 Hysteroscopic Endometrial Surgery
12.6.1.2 Hysteroscopic Resection of Myomas
12.6.1.3 Hysteroscopic Surgery on Uterine Malformations
12.6.1.4 Hysteroscopic Lysis of Intrauterine Adhesions
12.6.1.5 Other Hysteroscopic Surgeries
12.6.2 Mechanisms of Occurrence of Postoperative Intrauterine Adhesions
12.6.3 Symptoms of Postoperative Intrauterine Adhesions
12.6.3.1 Menstrual Disorders
12.6.3.2 Pregnancy Disorders
12.6.3.3 Hematometra
12.6.4 Diagnosis of Postoperative Intrauterine Adhesions
12.6.4.1 Gynecologic Ultrasonography
12.6.4.2 Second-Look Hysteroscopy
12.6.5 Prevention of Postoperative Intrauterine Adhesions
12.6.5.1 Reduction of the Surgical Trauma During Hysteroscopic Surgery
12.6.5.2 Artificial Cyclic Hormone Treatment After Hysteroscopic Surgery
12.6.5.3 Intrauterine Insertion of Barriers After Hysteroscopic Surgery
12.6.5.4 Prophylactic Antibiotics
12.6.5.5 Second-Look Hysteroscopy After Hysteroscopic Surgery
12.6.6 Treatment of Postoperative Adhesions
12.6.6.1 Division of Adhesions During Second-Look Hysteroscopy Under Ultrasonography Guidance
12.6.6.2 Hysteroscopic Lysis of Adhesions
12.6.6.3 Hysterectomy
12.7 Postoperative Pregnancy
12.7.1 Possibility of Pregnancy After TCRE
12.7.2 Risk of Pregnancy After TCRE
12.7.2.1 Abnormal Placenta Implantation
12.7.2.2 High Incidence of Ectopic Pregnancy
12.7.2.3 High-Risk Population Related to Induced Abortion
12.7.3 Diagnosis and Management of Pregnancy After TCRE
12.7.3.1 Diagnosis
12.7.3.2 Management
12.8 Postablation-Tubal Sterilization Syndrome
12.8.1 Etiology of PASS
12.8.2 Diagnosis of PASS
12.8.3 Treatment of PASS
12.8.4 Prevention of PASS
12.9 Accidental Electrical Injuries
12.9.1 Electrical Burn Accidents
12.9.1.1 Burns Around the Negative Plate
12.9.1.2 Burns Outside the Site of Negative Plate
12.9.2 Electric Shock Accidents
12.9.3 Accidents Caused by Electromagnetic Interference
12.9.4 Accidents Caused by Sparks
12.10 Other Complications
12.10.1 Hematometra
12.10.2 Abdominal Pain
12.10.3 Iatrogenic Uterine Adenomyosis
12.10.4 Treatment Failure and Recurrence of Symptoms
12.10.5 Malignant Lesions of the Uterus
12.10.6 Uterine Necrosis
12.10.7 Pulmonary Hemorrhage
12.10.8 Transient Blindness
12.10.9 Nerve Injury
12.10.10 Death
12.10.11 Complications of the Second Generation Endometrial Ablation
Suggested Reading
Organ Injury
Fluid Overload
Intra- and Postoperative Bleeding
Infection
Venous Air Embolism
Intrauterine Adhesions
Postoperative Pregnancy
Postablation-Tubal Sterilization Syndrome
Accidental Electrical Injuries
Other Complications
13: Hysteroscopy for Other Purposes
13.1 Vaginoscopy
13.1.1 Indications of Vaginoscopic Diagnosis and Operation
13.1.2 Contraindications of Vaginoscopic Diagnosis and Operation
13.1.3 Procedures of Vaginoscopic Diagnosis and Operation
13.1.3.1 Vaginoscopic Examination
13.1.3.2 Vaginoscopic Diagnosis and Operation
13.1.3.3 Vaginoscopic Removal of Vaginal Foreign Bodies
13.1.3.4 Vaginal Wall Biopsy Under Vaginoscopy
13.1.3.5 Hysteroscopic Resection or Coagulation Vaginoscopically
13.1.4 Applications of Vaginoscopic Examination and Operation
13.2 Hysteroscopy in Place of Culdoscopy in Fertiloscopy
13.3 Hysteroscopy in Place of Laparoscopy
13.4 Hysteroscopy in Place of Cystoscopy
13.4.1 Indications for Hysteroscopy in Place of Cystoscopy
13.4.2 Contraindications for Hysteroscopy in Place of Cystoscopy
13.4.3 Matters Need Attention for Using a Hysteroscope as a Cystoscope
Suggested Reading
14: Hysteroscopy Training
14.1 Training Procedures
14.2 Requirements for an Operator
14.3 How to Teach Beginners
14.4 How to Cut Tissues
Suggested Reading
15: The Future of Hysteroscopy
Suggested Reading
16: Digital Storage and Application of Endoscopic Image
16.1 Basic Concept
16.2 Storage and Application of Static Images
16.3 Storage and Application of Dynamic Images
16.4 Concept and Composition of Nonlinear Editing System
16.5 Clinical Applications of Digital Video Image Data
Appendix 1: Routine Orders in a Hysteroscopic Ward
Doctor’s Orders on Admission
Standing Orders
Stat Orders
Hysteroscopic Operations
Orders on the Day Before Operation
Postoperative Orders
Special Management After TCRS and TCRA
Conditions on Discharge
Precautions After Hysteroscopic Operation
Laparotomy Surgery
Orders on the Day Before Operation
Postoperative Orders
Precautions After Operation
Conditions on Discharge
Routine Orders of Diagnostic or Operative Laparoscopy
Orders on the Day Before Operation
Bowel Preparation
Methods of Bowel Preparation (See Table- Appendix 1)
Three Days Before Operation
Two Days Before Operation
On the Day Before Operation
Postoperative Orders
Conditions on Discharge
Routine Orders of Transvaginal Surgery
Preoperative Preparation for Transvaginal Surgery
Orders on the Day Before Operation
Standing Orders After Transvaginal Surgery
Documents Provided to the Patients on Discharge
Clinical Medication
Antibiotics in Common Usage
Fluid replacement
Addendum
Appendix 2: A Practical Manual of Hysteroscopic Surgery
Facilities of Operating Room and Patient’s Body Position
Preoperative Preparations
Transcervical Resection of Endometrium (TCRE)
Indications
Contraindications
Timing of Operation
Anesthesia
Operating Procedures
Intraoperative Ultrasonography Monitoring and Guidance
Postoperative Precautions
Transcervical Resection of Myoma (TCRM)
Indications
Contraindications
Preoperative Preparations
Timing of Operation
Anesthesia
Operating Procedures
Postoperative Management
Postoperative Precautions
Transcervical Resection of Endometrial Polyp (TCRP)
Indications
Contraindications
Preoperative Preparation
Timing of Operation
Anesthesia
Operating Procedures
Postoperative Management
Postoperative Precautions
Transcervical Resection of Uterine Septum (TCRS)
Indications
Preoperative Preparations
Operating Procedures
Postoperative Precautions
Transcervical Resection of Adhesions (TCRA)
Indications
Preoperative Preparations
Operating Procedures
Postoperative Precautions
Transcervical Removal of Uterine Foreign Body (TCRF)
Removal of IUD
Indications
Methods
Removal of the Residual Trophoblastic Remnants
Removal of Residual Fetal Bone
Removal of Remaining Sutures
Monitoring of TCRF
Transcervical Resection of Cervix (TCRC)
Preoperative Preparations
Operating Procedures
Postoperative Precautions
Appendix 3: Patient Consent Form for Hysteroscopic Operation in the Hysteroscopy Center of Fuxing Hospital, Capital Medical University
Appendix 4: Patient Consent Form for Hysteroscopic Diagnosis in the Hysteroscopy Center of Fuxing Hospital, Capital Medical University
Appendix 5: Report of Diagnostic Hysteroscopy