Hysteroscopic Management of a Stenotic Cervix скачать в хорошем качестве

Hysteroscopic Management of a Stenotic Cervix

Authors: Michael Wing Hei Suen, MD, FRCSC; Olga Bougie, MD, FRCSC; Sukhbir S Singh, MD, FRCSC, FACOG Abstract: Objective: To demonstrate an approach to the hysteroscopic management of cervical stenosis. Design: Step-by-step explanation of the techniques using video and animation (educational video). Setting: Tertiary academic hospital. Local institutional review board approval is not required for case reports or surgical videos. Patients: Gynecologists require intrauterine access for a number of procedures, but cervical stenosis may prevent successful surgery. Blind dilation of a stenotic cervix can lead to a cervical laceration or uterine perforation, with concomitant complications. Interventions: The hysteroscopic management of cervical stenosis includes optimizing the surgical environment, performing vaginoscopy and “no-touch” hysteroscopy, and lastly, revision of the cervical canal. Revision can be performed using microscissors, micrograspers or a cutting loop electrode. Outpatient hysteroscopy uses smaller instruments and shows operative success with patient satisfaction. Although these techniques are demonstrated in an outpatient hysteroscopy setting, they can also be adapted for use in an operating theatre. Main outcome measures: The individual steps and approach are emphasized. Results: Intrauterine access can be achieved with a variety of techniques as shown. Conclusion: The hysteroscopic “see-and-treat” approach demonstrated in this video can allow access into the uterine cavity despite cervical stenosis.