Hysteroscopy. State of the Art
Contributions to Gynecology and Obstetrics Vol. 20 Series Editor Ossi R. Köchli, Basel ABC Basel W Freiburg W Paris W London W New York W New Delhi W Bangkok W Singapore W Tokyo W Sydney
Hysteroscopy State of the Art Volume Editor Ossi R. Köchli, Basel 68 figures, 5 in color and 50 tables, 2000 ABC Basel W Freiburg W Paris W London W New York W New Delhi W Bangkok W Singapore W Tokyo W Sydney
Contributions to Gynecology and Obstetrics Founded 1976 by P.J. Keller, Zürich, Switzerland OOOOOOOOOOOOOOOOOOOOOOOOOOOOOO Ossi R. Köchli, MD Chief of Gynecology and Gynecologic Oncology, School of Medicine, University of Basel, Switzerland Library of Congress Cataloging-in-Publication Data Hysteroscopy: state of the art / volume editor, Ossi R. Köchli. p.; cm. (Contributions to gynecology and obstetrics, ISSN 0304 4246; vol. 20) Includes bibliographical references and indexes. ISBN 3 8055 7026 0 (alk. paper) 1. Hysteroscopy. I. Köchli, O.R. (Ossi R.) II. Contributions to gynecology and obstetrics; v. 20. [DNLM: 1. Hysteroscopy. 2. Uterine Diseases diagnosis. 3. Uterine Diseases therapy. WP 440 H999 2000] RG304.5.H97 H975 2000 618.1)4 dc21 00-033120 Bibliographic Indices. This publication is listed in bibliographic services, including Index Medicus/MED- LINE. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2000 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISBN 3 8055 7026 0
Contents VII Foreword Lindemann, H.-J. (Hamburg) 1 Pre- and Postoperative Hormonal Treatment in Patients with Hysteroscopic Surgery Römer, T.; Schmidt, T.; Foth, D. (Cologne) 13 Hysteroscopy in Infertility Diagnosis and Treatment Including Falloposcopy Hucke, J. (Wuppertal); De Bruyne, F.; Balan, P. (Düsseldorf) 21 Diagnostic Hysteroscopy for the Investigation of Abnormal Uterine Bleeding in Premenopausal Patients van Trotsenburg, M.; Wieser, F.; Nagele, F. (Vienna) 27 Diagnosis of Endometrial Cancer and Its Precursors Brandner, P.; Neis, K.J. (Saarbrücken) 41 Hysteroscopy and Adenomyosis Keckstein, J. (Villach) 51 Hysteroscopy in the Assessment of Postmenopausal Bleeding Bronz, L. (Bellinzona) 60 Tamoxifen-Induced Hyperplasia of the Endometrium Neis, K.J.; Brandner, P.; Schlenker, M. (Saarbrücken) 69 Differentiation and Management of Endometrium Abnormalities and Leiomyomas by Hydrosonography Tercanli, S.; Köchli, O.R.; Hoesli, I.; Feichter, G.; Schaub, A.; Holzgreve, W. (Basel) 81 Hysteroscopic Resection of Submucous Myomas Brandner, P.; Neis, K.J.; Diebold, P. (Saarbrücken)
91 Endometrial Ablation in the Year 2000 Do We Have More Methods than Indications? Köchli, O.R. (Basel) 121 Hysteroscopic Endometrial Resection Bratschi, H.U. (Berne) 137 Endometrial Ablation by Balloon Coagulation Gallinat, A. (Hamburg) 145 Endometrial Ablation for the Treatment of Dysfunctional Uterine Bleeding Using Balloon Therapy De Grandi, P. (Lausanne); El Din, A. (Morges) 154 Hydrothermal Ablation. A New Simple Method for Coagulating Endometrium in Patients with Therapy-Resistant Recurring Hypermenorrhea Römer, T.; Müller, J.; Foth, D. (Cologne) 161 Hysteroscopic Surgery Complications and Their Prevention König, M.; Meyer, A.; Aydeniz, B.; Kurek, R.; Wallwiener, D. (Tübingen) 171 The HysteroTrainer An in vitro Simulator for Hysteroscopy and Falloposcopy. Experimental and Clinical Background and Technical Realisation Including the Development of Organ Modules for Electrothermal Treatment Aydeniz, B.; Meyer, A.; Posten, J.; König, M.; Wallwiener, D.; Kurek, R. (Tübingen) 182 Consensus of Diagnostic and Operative Hysteroscopy. Consensus Statements of a Joint-Meeting of the Societies for Gynecological Endoscopy of Switzerland, Germany and Austria, October 1999 188 Author Index 189 Subject Index Contents VI
Foreword The book Hysteroscopy State of the Art presents experiences with hysteroscopy from well-known gynecologists. Until endoscopy was introduced to gynaecology as a routine procedure every gynaecologist was taught the exploring finger is the eye of the gynaecologist. Today we say a vigilant eye in the uterine cavity is better than a bunch of blind instruments. Phillip Bozzini, a physician in Frankfurt, Germany, first recommended examining the uterine cavity in 1805. The first description of hysteroscopy in the English journal Medical Press was given by Pantaleoni in 1869. The beginning of the present endoscopic method started when the German urologist Max Nitze presented his special cystoscope with built-in optical lenses and a light source at the tip of the instrument. Today, this cystoscope remains the prototype of all rigid endoscopes. For a long time nothing appeared in the literature on endoscopy of the uterine cavity. Afterwards, gynaecologists in various countries sporadically reported their experiences with hysteroscopy. CO 2 hysteroscopy was generally applied in diagnostic procedures, because carbon dioxide has the advantage of having the same refractory index as air. According to large surveys in 1986 and 1988, it was used generally in 90% of 180,000 hysteroscopies. Carbon dioxide was replaced by high- and low-viscosity liquids for surgical hysteroscopy. Due to traumatic penetration of the tissue, surgical treatment naturally leads to bleeding. As a result of the large quantity of blood, irrigation is necessary to improve visualization of the uterine cavity. The former fluid-overloading that sometimes caused fatal complications became less frequent due to the roller-pump technique with automatic balance of infusion and outflow of the rinsing liquid. VII
Hysteroscopy is currently being practised in many countries all over the world. It is a recognized and valuable asset to diagnostic and therapeutic management. Conventional surgical techniques, which require a laparotomy and uterotomy, are seldom applied today. Now, laser beam, HF coagulation, ultrasonic waves and thermoapplication for endometrium ablation are used. Uteroscopy was, is and will remain a method which requires special skill and interpretation. The future, however, will hopefully bring improvements in technology. When the spirit is present, new things will always be created. Prof. Hans-Joachim Lindemann, Hamburg Foreword VIII