Hysteroscopy and Microcolpohysteroscopy [antikvár]

Preface The possibilities of visualizing the uterine cavity have long interested gynecologists. In spite of the remarkable efforts and the ingenuity of researchers for more than a century, however, hysteroscopy has not, until recently, found a place in current practice. Although part of the reason for hysteroscopy's slow acceptance has been related to the development of the necessary technology, the nature of the uterus itself has caused the greatest delay. Despite the apparent ease of access, passage through the cervical canal—where the mucous membranes are extremely fragile and bleed easily—is difficult. The uterine cavity is a potential rather than an actual space, and accurate visualization of it requires distension. Of these difficulties the most troublesome has been the cervical canal's tendency to bleed. Forceful passage, with or without previous dilatation, even under anesthesia inevitably provokes bleeding. This bleeding requires the use of fluids or a strong stream of carbon dioxide to prevent the blood from obscuring the gynecologist's field of vision. It was the necessity of overcoming these difficulties that led to the development of a new endoscope, the microhysteroscope, invented in 1979 and produced commercially 1 year later. The properties of this instrument, which include both panoramic and contact vision modes, permit constant visual control in the cervical canal. The various magnification capabilities of the microhysteroscope allow the operator to negotiate the canal with precision. This atraumatic crossing of the endocervical canal removes the need for anesthesia, diminishes the risk of bleeding, and obviates the necessity of using fluid media. Because of its ease of performance, microhysteroscopy has become a routine, atraumatic, reproducible examination that can be performed in the physician's office. This Atlas describes the normal and abnormal appearances of the uterine cavity that may be observed using the microhysteroscope and defines the place of this novel technique in daily gynecologic practice. After a brief historical review, the difficulties encountered in uterine endoscopy will be discussed, and the means of surmounting these difficulties, through the use of a rigorous technique, will be described. Because of the sophistication of the instrument, there will be a full discussion of the optical and technical principles on which it relies. Intensive use of this method for 10 years and the accumulated experience of thousands of microhysteroscopic examinations form the basis for the text, including a detailed description of the following: 1. The method and contribution of microhysteroscopy in the diagnosis of various pathologic entities 2. The operative procedures generally possible in ambulatory patients as part of the total diagnostic examination 3. The reliability of the method, which compares the visual interpretations at various magnifications with the results of anatomic and pathologic examinations and to hysterosalpingographic findings In addition, the microhysteroscope has the capability to provide magnifications up to xl50, permitting cellular studies in vivo, particularly of the uterine cervix. This application is one of hysteroscopy's most promising. This Atlas will define the place that this technique may have among the procedures currently being used in the battle against cervical cancer. It is possible that the application of microhysteroscopy in the early diagnosis of preinvasive carcinoma of the cervix