Enjoy the latest issue of the Hysteroscopy Newsletter.
The field of hysteroscopic surgery has seen many advances over the years, from improved optics, the flexible hysteroscope, the resectoscope, hysteroscopic morcellators and most recently, the 5-mm “mini”-resectoscope. The art of hysteroscopy never stops to amaze me.
The ability to perform a complex surgical procedure inside of the uterine cavity, without incisions, in the outpatient setting is revolutionary. Add to this the ability to achieve this without a speculum, tenaculum or cervical dilation; i.e. the vaginoscopic approach.
This “no-touch” technique has a multitude of applications. The vaginoscopic approach allows for the examination of the vagina and the cervix in patient in whom the use of a speculum is not feasible or is too uncomfortable, such as in children, e.g. for persistent vaginal discharge, bleeding or suspected foreign body, in virginal patients, and in postmenopausal patients with significant vaginal atrophy.
This approach is also very valuable in examining the vaginal, cervical and uterine anatomy in patients with Mullerian anomalies, as it compliments imaging studies and aids in surgical planning. Vaginoscopy also allows examination and biopsy of vaginal lesions and vaginal cuff endometriosis.
Other excellent applications for the vaginoscopic approach and hysteroscopically-guided cervical dilation is in patients with intrauterine synechiae or Asherman’s syndrome and in patients at high risk of, or with history of failed hysteroscopy secondary to a false track resulting from the common practice of blind cervical dilation.
This technique provides several advantages, including avoiding a false track, decreased risk of uterine or cervical perforation, and minimizing trauma to the cervix and endometrium, avoiding the bleeding and debris, hence providing excellent visualization.
I feel privileged to practice in this golden age of hysteroscopy, particularly with the coming-together of amazing hysteroscopic surgeons through the innovative Hysteroscopy Newsletter, the Global Congress of Hysteroscopy and the many successful hysteroscopic summits and congresses organized throughout the globe.
Nash Moawad
