Traditional Hysteroscopic Entry into the Endometrial Cavity

Apr 15, 2019 | 184 Views

Barry Sanders

This short video outlines the traditional method of hysteroscopic entry into the endometrial cavity.

Treatment of Asherman’s Syndrome in an Outpatient Hysteroscopy Setting

Jul 5, 2019 | 236 Views

Olga Bougie, Karine Lortie, Innie Chen, Hassan Shenassa, Sukhbir Sony Singh

This video outlines the approach to the hysteroscopic lysis of adhesions performed to surgically manage Asherman’s Syndrome. This video uses case presentations and discusses a case series outlining how to manage this in an outpatient setting.

Hysteroscopic Resection of Deep Sub-Endometrial Fibroid (FIGO stage III bordering on hybrid stage II)

Sep 26, 2019 | 176 Views

Amanda Michael , Essam Michael

Deep subendometrial fibroids represent a technical challenge for complete hysteroscopic removal. Such fibroids include deep type II submucosal fibroids, type III fibroids (intramyometrial abutting the endometrium), and hybrid stage II-V fibroids (intramyometrial extending in both directions, submucosa and subserosa) according to FIGO classification.This video demonstrates a case of a 34 year old female who had failed several embryo transfers with good quality blastocysts. After comprehensive testing for her recurrent implantation failure, the sole finding was a 2.3cm posterior wall, upper cavity, sub-endometrial fibroid 3mm from the serosa.The video presented captures the hysteroscopic removal of this 2.3cm intramural posterior wall fibroid in the upper cavity abutting and subtly elevating the posterior endometrium. The clip demonstrates the complete and safe removal of this technically challenging myoma, while offering some surgical tips. Following her myomectomy, the patient conceived after a subsequent embryo transfer and had a full-term caesarean delivery.

A Hysteroscopic Technique for Resection of Type 2 Uterine Fibroids

Sep 26, 2019 | 296 Views

Alicia Long, Michael Suen, Sukhbir Sony Singh

The objective of this video is to review a technique for the hysteroscopic resection of Type 2 uterine fibroids. This is an educational video review featuring a case patient. Visual identification of fibroid type, surgical technique, and perioperative considerations are discussed. Gynecologists frequently perform hysteroscopic fibroid resections; however, Type 2 fibroids present a unique challenge where long operative time, excessive blood loss and fluid absorption, incomplete resection, and uterine perforation are important considerations. Our case patient is a 35 year old G1P0A1 woman with a history of secondary infertility, dysmenorrhea and heavy menstrual bleeding. Ultrasound demonstrated a 4.0 x 4.6 x 4.3cm Type 2 uterine fibroid, with a maximal distance of 7.8mm between the outer edge of the fibroid and the uterine serosa. The hysteroscopic management of Type 2 fibroids includes perioperative optimization, including preoperative planning and medical optimization. Ultrasound images should be reviewed prior to surgery, to determine the type of fibroid and the distance to the serosa. Visual identification of fibroid type at the time of hysteroscopy is also possible by observing the angle between the fibroid at its intersection with the endometrium. The techniques demonstrated in this educational video demonstrate visual identification and hysteroscopic resection of a Type 2 fibroid, including the creation of an endometrial flap overlying the defect after resection, to minimize postoperative intrauterine adhesions. In this case, resection is performed in the operating room using a monopolar resectoscope. Identification of fibroid type, including visual diagnosis, as well as attention to surgical technique and perioperative considerations, are essential for hysteroscopic resection of Type 2 uterine fibroids.

Porcine Tongue Hysteroscopy: A Novel Simulation Model for Operative Hysteroscopy Teaching

Sep 27, 2019 | 150 Views

Emily Wright, Kate Smith, Michael Suen, Neeraj Mehra

Hysteroscopic surgery is a fundamental skill for all obstetricians and gynaecologists. Time pressure within each case and inadequate OR exposure times can limit hands-on skills acquisition for residents. In order to ensure residents are obtaining and practicing fundamental skills, it is essential to develop teaching methods that can be used outside of an OR setting. The porcine tongue model is a simple and inexpensive model for operative hysteroscopy teaching that is both realistic and effective in teaching residents the fundamentals of hysteroscopic surgery. This presentation outlines the assembly of the model, as well as shows real-time use of the model for teaching.

Surgical Correction of Dysmorphic Uteri

Sep 27, 2019 | 182 Views

Michael Sullivan, Cici Zhu, Fatma Alhadhoud, Sukhbir Sony Singh

Uterine anomalies contribute to impaired fertility, especially pregnancy loss and preterm birth. Dysmorphic uteri is a newly defined class of uterine anomalies characterized by a T-shaped cavity and hypertrophic lateral walls. Pilot studies indicate surgical correction of dysmorphic uteri may improve fertility outcomes.We show three cases of hysteroscopic metroplasty to expand dysmorphic uteri in patients with recurrent pregnancy loss. In two cases, the dysmorphic uteri were initially misdiagnosed as normal on two-dimensional ultrasound, suggesting the anomaly may be underdiagnosed. Relaxing incisions were made along the lateral and anteroposterior walls using a Collins knife. Follow-up hysteroscopic lysis of adhesions were performed as an outpatient. Follow-up three-dimensional ultrasound demonstrated expansion and normalization of the uterine cavity. Dysmorphic uteri are an under-recognized cause of impaired fertility and surgical management may improve fertility outcomes. These cases demonstrate the importance of accurate diagnosis to facilitate appropriate treatment options.

Resection of the Complete Uterine Septum

Sep 28, 2019 | 270 Views

Geoffrey Zeni, Andrew Zakhari, Ari Sanders, Lisa Allen

The surgical correction of a complete uterine and cervical septum. 1. Overview of the background, clinical presentation and relevant pre-operative planning.2. An illustration and instruction for surgical correction.3. Discussion of the post-operative care and long-term outcomes.