Dysmorphic Uterus. Should we Update the Current Classification?
To describe three different subtypes of dysmorphic uteri identified using 3D ultrasound and hysteroscopy.
ConclusionIn premenopausal women with abnormal uterine bleeding, treatment of intrauterine pathology often does not reduce the complaints, thus questioning the effectiveness of hysteroscopic removal of these structures.
Evaluation and management of abnormal uterine bleeding (AUB) are possible in the office. Approaching AUB evaluation from an etiology-based perspective allows the gynecologist to focus evaluation efforts on the most probable causes of AUB for a particular patient and therefore customize the management accordingly. Developing skills with imaging such as transvaginal ultrasound, saline infusion sonography, and diagnostic hysteroscopy are important for AUB etiology diagnosis. Operative hysteroscopy experience can be developed for AUB management in the office and endometrial ablation provides a minimally invasive solution for some patients.
ConclusionThe utilization of a stone retrieval basket is a novel and effective method for retrieving a wide based endometrial polyp following incomplete resection with hysteroscopic scissors.
ConclusionUterine anomalies may be challenging to characterize based on exam or ultrasound alone. Surgical management of gynecological pathology, such as fibroids, requires understanding of normal and anomalous anatomic landmarks and innovative application of common instrumentation. This patient's unique anatomy allowed intrauterine instrumentation normally preformed blindly to be directly visualized by hysteroscopy. This allowed safe and effective treatment in a technically challenging case.
The aim of this video is to demonstrate the use of laparoscopic ultrasound guidance during hysteroscopic resection of a congenital uterine and vaginal septum.
The differential diagnosis of fibroids could be challenging with other uterine masses including adenomyomas or uterine cancers and sarcomas. Minimally Invasive procedures including morcellation mandates a thorough imaging and if possible histologic analyses. To date such a pathologic approach has a very poor accuracy, even conducted under ultrasound, MRI or hysteroscopic guidance. A targeted biopsy requires the development of state of the art imaging and robotics to enable a secure, reproducible, and accurate sampling.
The use of intraoperative sonographic guidance for second trimester elective dilation and curettage (D&E) procedure reduces the incidence of uterine perforation. Nevertheless, the role of intraoperative sonographic guidance during curettage procedure following second trimester medical induction has not been evaluated. We aim to evaluate the effect of intraoperative sonographic guidance during curettage procedure following second trimester uterine evacuation.
The objective of our study was to assess our health system's rate of overdiagnosis of uterine AVM on pelvic ultrasound.
A 42 year old G4P2022 with two prior cesarean sections presents with secondary infertility and intermenstrual spotting. Transvaginal ultrasound shows 1.8 × 1.0 × 1.9 cm fluid filled cesarean scar defect (Figure 1). The patient elected for surgical management and underwent laparoscopic resection and primary closure of her cesarean scar niche. Hysteroscopy was performed under laparoscopic visualization to identify the location of the niche. The bladder was dissected off the lower uterine segment to the level below the defect.
ConclusionWhilst radical completion surgery should be advised in UA, this case, in addition to all published conservatively managed cases of UA, demonstrates that conservative management is possible in appropriately selected women. Intensive monitoring post-operatively is essential owing to the risk of recurrence; however, this may pose deleterious side effects which require consideration.