The operative hysteroscopy experience

Abstract

Objective: to access the possibilities of operative hysteroscopy. Many hysteroscopic operations make it possible to avoid hysterectomy thus preserving menstrual and reproductive functions. Besides medical problems intrauterine (IU) hysteroscopic surgery helps to improve psychoemotional status of these patients.

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Methods. Endoscopical equipment “Karl Storz” (Germany) was applied in our study. Mechanical instruments (semirigid forceps, scissors, optic rigid scissors) and resectoscope were used for the surgical manipulations. Intrauterine surgery was performed under intravenous anesthesia (diprivan, ketalar) in 348 patients, epidural anesthesia in 5 patients and endotracheal anesthesia in 6 patients.

Results. From 1996 to 1998 a total of 1881 hysteroscopies was made in gynecological department including 359 surgical ones: 138 polypectomies, 103 myomectomies, 48 endometrial ablations, 44 foreign body removals (“lost” IUDS, ligatures, bone fragments), 19 adhesion resections, 7 IU resections. Hormonal pretreatment with GnRG agonists (16 patients) as well as gestagens (38 patients) was carried out before surgery (myomectomy and endometrial resection). Abdominal ultrasonography proved to be useful in resection of extensive IU adhesions, IU septum and myomectomy to monitor the course of surgery. Intraoperationally during the mechanical myomectomy (5-6 cm) one patient had cervix vascular hemorrhage that necessitated cervix suturing and hemotransfusion.

Conclusion. Thus, we believe IU operative surgery to be highly efficient and reliable.