Page 32 - World Journal of Laparoscopic Surgery

Prachi Arora et al
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was found on hysteroscopy, the diagnosis of blocked hysteroscopy. Khandwala has studied 7 patients. He
ostia by hysteroscopy was further evaluated by diagnostic described synechia in 4 patients and normal uterine
laparoscopy with chromopertubation in 9 patients. In 7 cavity in three patients.
patients, the hysteroscopic findings were confirmed by The procedure failure rate in the present study was
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diagnostic laparoscopy. But in 2 patients (22.22%), diag ­ 7.25%. Hilgarth and Khandwala have reported low
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nostic laparoscopy with chromopertubation revealed patent failure as 1.9 and 3.1% respectively. Patil et al and
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tubes, where ostia were seen to be blocked on hysteroscopy. Pellicano M et al used normal saline as distending
In can be concluded, that diagnostic laparoscopy with media in their study and observed that it is better tole-
chromopertubation is probably the best way at present to rated by patients. We also used isotonic saline as disten-
find out the tubal patency, but the lumen of the fallopian ding media, which provides good visualization and
tube can only be delineated by hysterogram. Hystero- better tolerated by patients.
scopy is the method to detect intrauterine cause of infer-
tility. Therefore the above 3 tests are complementary to REfEREnCES
each other in evaluating the uterine and tubal cause of 1. Nagele F, O’ Connor H. 2500 outpatients diagnostic
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infertility. Koskas et al proposed office hysteroscopy as hysteroscopies. Obstet Gynecol 1996;88(1):16­20.
part of first line examination infertile women. 2. Reviel A, Shushan A. Investigation of infertile couple. Human
In postmenopausal bleeding hysteroscopy is invalu- Reproduction 2002;17(8):1947­1949.
able, especially in confirming or ruling out the suspicion 3. Garuti G, Sambruni I, Colonnelli M, Luerti M. Accuracy of
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of endometrial carcinoma. hysteroscopy in predicting histopathology of endometrium in
1500 women. J Am Assoc Gynecol Laparosac 2001;8(2):207­213.
In the present study, atrophic endometrium was 4. Arslan S, Aytan H, gunyeli I, Koi o, Tuncay g, Tapisiz oL.
the commonest finding seen on hysteroscopy in 37.5% Office hysteroscopic evaluation of endometrium: can we hit
6
cases in postmenopausal group. Alwani et al observed the target. Arch Gynecol Obstet 2004;13.
atrophic endometrium in 60% of his cases. 5. Lasmar RB, Dias R, Barrozo PR, Oliveira MA, Coutinho
Endometrial polyp was detected on hysteroscopy in Eda S, da Rosa DB. Prevalence of hysteroscopic findings
5
1 patient (12.5%) in our study. Lasmar RB et al in their and histologic diagnoses in patients with abnormal uterine
bleeding. Fertil Steril 2008 Jun;89(6):1803­1807.
study found endometrial polyp in 1,374 (33.9%) cases. 6. Alwani CM, Ambiyen VR, Merchant RM. Diagnostic
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gorostiaga D et al reported atrophic endometrium hysteroscopy: preliminary study of 60 cases 1983;33:250.
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in 44% of cases in his study. Metello J et al studied the 7. Valle RF. Hysteroscopy in the evalution of female infertility.
diagnostic accuracy of hysteroscopy with endometrial Am J Obstet Gynecol 1980;137:425.
biopsy for diagnosing endometrial carcinoma and found 8. Roll H, Hilgarth M. A report of 560 hysteroscopic operations.
high accuracy in the diagnosis of endometrial neoplsia Hysteroscopy: principles and practice, chapter 3, page 25.
Editor Siegler and Lindemann, 1984.
and its precursors. None of the patient had endometrial 9. Koskas M, Mergui J, Yazbeck C, Uzan S, Nizard J. Office
carcinoma in our study. hysteroscopy for infertility: a series of 557 consecutive cases.
Diagnosis of leiomyoma can be established either by Obstet and Gynecol Int 2010 (2010).
USg, HSg and curettage. However, these techniques can 10. Metello J, Relva A, Milheras E, Colaço J, Retto H. Hysteroscopic
give false positive and false negative results. Hystroscopy diagnostic accuracy in postmenopausal bleeding. Acta Med
is more precise and confirmatory procedure. Hystero scopy Port 2008 Sep­Oct;21(5):483­488.
was carried out in the present series on 8 patients (11.6%) 11. Gorostiaga D, AM Arrizabalaga J­L Lobato I Brouard J­M,
Usandizaga A. Hysteroscopy: an alternative to dilatation
with the clinical diagnosis of leiomyoma uteri. Sub mucous and curettage in the diagnosis of post menopausal bleeding.
myoma was confirmed in 37.5% patients only on hystero­ J Obstet Gynecol 2001;21(1):67­69.
scopy and in 62.5% patients cavity revealed no fibroid. 12. Khandwala SD. Hysteroscopy using CO tubal insufflators
2
In the present study, 5 patients (7.3%) with missing without the vacuum cannula. J Obstet Gynae Ind 1986;36:955.
filaments (group V) were included. Device was located in 13. Roll H, Hilgarth M. A report of 560 hysteroscopic operations.
60% of the cases and was removed in all the cases. Though Hysterosocpy: principles and practice, chapter 3, page 25,
Editor Siegler and Lindemann, 1984.
X-ray abdomen and pelvis, and ultrasonogram can locate 14. Patil Sg, Bhute SB, Inamdar SA, Acharya NS, Shrivastava DS.
the IUD, but the exact localization of the device is difficult. Role of diagnostic hysteroscopy in abnormal uterine bleeding
Hysteroscopy protects the patient from the hazards of and its histopathologic correlation. J Gynecol Endosc Surg
radiation. Moreover, it is easier and convenient than the 2009 Jul­Dec;1(2):98­104.
radiological procedures. Hysteroscopy also obviates the 15. Pellicano M, Guida M, Zullo F, Lavitola G, Cirillo D, Nappi C.
Carbon dioxide versus normal saline as a uterine distension
need for blind and dangerous manipulations. medium for diagnostic vaginoscopic hysteroscopy in infertile
In our study in secondary amenorrhea group (group VI), patients: a prospective, randomized multicenter study. Fertil
In 60% of cases, atrophic endometrium was seen on Steril 2003;79(2):418­421.

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