LONG JOURNEY IN A SMALL WOUMB.

Mounir M M Elhao,Ain Shams University.

Cairo,Egypt.

Early Cancer Detection Unit 1981 - 2005 180,541 pts

69,705 68,859

13,518 10,334 9,152 8,973

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Cyto. Path. nonGyncyt

Hystero. FNA Colp

April 10, 2023 Prof. Dr. Mounir M. F. El-Hao 3

Hysteroscopy 1986-2005

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April 10, 2023 Prof. Dr. Mounir M. F. El-Hao 4

April 10, 2023 Prof. Dr. Mounir M. F. El-Hao 5

April 10, 2023 Prof. Dr. Mounir M. F. El-Hao 6

Secretory activity diagnosed by five criteria: Endometrial thickness. Vascularity. Prominence of glands. Surface roughness. Tubal ostea Appearance. Depending on the five criteria( sensitivity

was 81.9 %)

(Mounir Elhao et al,1992.)

Thickness. Vascularity. Surface glands These criteria were very sensitive.for

diagnosis of ovulation.( sensitivity 90%)

The practice of D&C in rarely needed.

844 infertile women Fine adhesions.No menstrual disorders. Coarse adhesion,oligohypomenorrhoea. Dense adhesions,Tubular cavity. Complete Occlusion,amenorrhoea. Main causes Curettage,CS,Infections. TTT.Scissors,Diathermy knife.(Sammour,Elhao,Yehya &

Saleh,March,1993)Paris

Correction of major degree of IUS (Grade 3& 4)

With the use of electro cautary needle under hysteroscopic guidance resulted into very poor pregnancy rates.(2cases only)Both of them resuted into missed abortion.

Elhao,Lamii,Elnazer,& Hamza.MD Thesis(1996)

In 32 cases (43.2% ) G1&2 In 44 cases (56.8%) G 3&4

Recurrence of adhesions after surgical hysteroscopy was in almost 1/3 of cases.maily in G3&4,Mainly after puerpural sepsis.

Now the use of scissors under office and routine hysteroscopy gives far more better results.(ongoing study .)

50 cases of missed IUCDs threads,hysteroscopy was successful in extraction of 100%(20 cases) of IUCDs While D&C was successful in only 90 % of cases.

Maged ,Elhao et al.1989.

New technique of Hysteroscopic extraction of IUCD,using the telescope oh the hysteroscope and a mini crocodile forceps.from 286 cases of missed threads,236 were found to be intrauterine,and were either successfully extracted (220cases) with diagnostic telescope and mini-crocodile forceps.or left in place after withdrawal of the threads(16 cases.)

(Elhao,1990)

72 patient wearing IUCDs,41 cases complaining of irregular uterine bleeding.while 31 cases as controls.

In the group of AUB 27 cases of the 41 cases had local pathplogy or abnormal position of IUCDs but only one case of the control had local pathological lesion.

Elhao et al,1989

In 50 cases of previous CS there were Scar not detected 11 Fibrotic white band 16 Granulation tissue 13 Minute defect. 03 Large defect. 05 Cervicat scar 02 What should we do?Yehya,Sammour,Elhao

2-3 %of the population. 20% of repeated miscarriages. Since Edstrom in 1074,described hysteroscopic

resection of uterine septum the technique was practiced

Elhao,Sammour and Elgammal,MS thesis,(1993.)One of the most satisfactory procedures in hysteroscopic

surgery and gynecology.

First described by ELDSTROM in 1974 Hysteroscopic management of lateral fusion

defects,septate,suseptate ,partial bicornuate and uterus bicollis with or without septate vagina was done since early eighties.obstetric performance wasmarkedly improved after this procedure.

Electric Knife ,loop,or cold scissors. Unipola or bipolar diathermy. With or without anesthesia. Mounir Elhao,Sammour (several studies.)

April 10, 2023 Prof. Dr. Mounir M. F. El-Hao 24

The most satisfactory results which were achieved by hysteroscopy.wether by electric knife or by scissors.By routine resectoscope or office.

April 10, 2023 Prof. Dr. Mounir M. F. El-Hao 25

On fifty patients with high risk for uterine malignancy,(Diabetic,hypertensive,,obese,infertile,low parity),

The study concluded that a negative hysteroscopic finding was considerted conclusive of absence of uterine pathology

Also the study concluded that panoramic hysteroscopy is a valid alternative of traditional D and C.

(Sammour,Elhao,Eissa,Khalifa and Elmogazi. 1992),

Cases were 2 or more D&Cs were performed for irregular uterine bleeding.(33 patients.)

Hysteroscopy revealed abnormal intracavitary pathology in 81.8 % of cases examined.(10 myomas,4 polyps, 11 hyperplasia,1 atrophy and cancer in 1 case.)

Makhlouf and Elhao,1989.

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Traditionally, the resectoscope has played a major role in the resolution of these pathologies, forcing the hysteroscopist to use this large diameter instrument even in the presence of small lesions (Loffer, 1990; Corson and Brooks, 1991; Hallez, 1996; Porreca et al,, 1996; Bettocchi et al,, 1998). The results were excellent, but due to the size of the instruments and hence the need to dilate the cervical canal, the use of general anaesthesia and an operating room were generally required.

Seems to have an important role during the procedure.Fluid absorption was less,bleeding was less and vision was better in the pour-8 group.

Elhao,Fateen,Mostafa and Taha,MS degree.(1998).

Elhao et al,

Abdelmaaboud,Faris MD thesis.(2007)

76 cases done with 25% dextrose for uterine distetion as a safe and clear medium,However in recent experience its seems unsafe due to operative procedure opening deep sinuses and intravasation of the fluid and causing hyperglycaemia.

Elhao,1988.

Patients infertile for at least one year with proven PTB by HSG and or Laparoscopy (witout evidence of other major explanation for their infertility.)were subjected to tubal cannulation.using one of many cannulation kits.

The study showed recanalisation rate of 77.7%

M Sabri,K Lamii and M Elhao,(MD thesis,1996.)

Recently,with more experience,a trial on antichlamidial therapy for three month is worthwhile before cannulation.

From october 1993 to october 1996.,80 patients prepared for endometrial resection .25 depot provera,25 GnRHa and 30 patients non treatment group.

Conclusions were that progestins were cheaper and better than no treament but with more side effects….GnRHa gave better control of menorrhagia ,more effective reduction of endometrial thickness and reduction of uterine size ,less fluid absorption.

Shalaby,Hussein,Elhoussiny and Elhao,(1998.)

With more experience.No Need For preoperative preparations.

Amer (2006 ).

In the last 10 years, technological improvements have led to the production of smaller diameter scopes. This has prompted the industry to develop sheaths which continue to have a final diameter of ~5 mm, includes the working channel and continuous flow features.

is satisfactory distension of the uterus. While many different media have been

used, recent advances in equipment have greatly simplified the use of saline for diagnostic and simple operative hysteroscopy.

Saline 0.9%.Best, Office, Bipolar. Glucose 5 %. Glycene.Best operative

Unipolar(<1000.) Hyskon.Not any more.(DIC.) Glucose 10 %,Hyperglycaemia.

Office hysteroscopy is a time-efficient and cost-effective procedure, made possible by the development of small instruments. Proper patient selection and training of office personnel are mandatory to minimize complications and maximize efficacy.

Distribution of the hysteroscopic findings in examined women

Distribution of the hysteroscopic findings in examined women

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Table (4): Hysteroscopy findings in four hundred examined women.

Findings N %

Normal finding 106 26.50

Endometrial hyperplasia 84 21.00

Intrauterine synechia 78 19.50

Missed IUD 27 6.75

Intrauterine polyp 24 6.00

Mullerian anomalies 24 6.00

Intrauterine fibroid 21 5.25

Cervical lesion 8 2.00

Tubal block 7 1.75

Atrophic endometrium 7 1.75

Abnormal vascular endometrium 5 1.25

Depressed fundus 5 1.25

Retained products of conception 2 0.50

Suspicious endometrium 2 0.50

Total 400 100.00

Normal finding represented 26.50% of all cases as showen in table (4)

Table (3): Indications of office hysteroscopy in four hundred cases examined.

Indication N %

Abnormal uterine bleeding 155 38.75

Infertility 94 23.5

Intrauterine synechia 47 11.75

Missed intrauterine device 34 8.5

Recurrent abortion 23 5.75

Amenorrhea 22 5.5

Intrauterine polyp 13 3.25

Mullerian anomalies 4 1

Intrauterine fibroid 4 1

Cornual tubal block 2 0.5

Contact bleeding 1 0.25

Dyspareunia 1 0.25

Total 400 100

Referred with aforementioned diagnosis.

Pain stratification in 400 examined patients with office

hysteroscopy.

Office hysteroscopy is a time-efficient and cost-effective procedure, made possible by the development of small instruments. Proper patient selection and training of office personnel are mandatory to minimize complications and maximize efficacy.

Lindheim SR, Kavic S, Shulman SV, Sauer MV (2005)

CONCLUSION:

Office hysteroscopy is a very practical tool for an office setting.

Minor operative procedures are possible,using scissors or bipolar diathermy.

All degrees of IUS arebetter treated with mini scissors and office hysteroscopy.

Hysteroscopic endometrial resection and large myomas are in need for General anaesthesia and 9mm resectoscope.