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Evidence Based Practical Tips For Office Hysteroscopy

Evidence Based Practical Tips For Office Hysteroscopy. Dr. Shashwat Jani. M.S. ( Gynec ). Diploma in Advance Endoscopy ( France ) . Assistant Prof., Smt. N.H.L. Mun . Medical College, Ahmedabad, Gujarat . Mobile : +91 99099 44160 . E- mail : drshashwatjani@gmail.com.

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Evidence Based Practical Tips For Office Hysteroscopy

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  1. Evidence Based Practical Tips ForOffice Hysteroscopy Dr. Shashwat Jani. M.S. ( Gynec ). Diploma in Advance Endoscopy ( France ) . Assistant Prof., Smt. N.H.L. Mun. Medical College, Ahmedabad, Gujarat. Mobile : +91 99099 44160. E- mail : drshashwatjani@gmail.com

  2. Greetings From Ahmedabad . . . Dr Shashwat Jani. 9909944160

  3. What is E.B.M. ...??? • Evidence Based Medicine…?  • ExperienceBased Medicine…?  • Eminence Based Medicine....?   Dr Shashwat Jani. 9909944160

  4. Dr Shashwat Jani. 9909944160

  5. Sources • Cochrane library . • Royal College of Obstetricians &Gynecologists (RCOG) Guidelines. • Journal of Evidence Based Obstetrics & Gynecology. • National Guideline Clearinghouse . ( U.S. Govt. ). • New Zealand Guidelines Group • PubMed. • Italian Society of Gynecological Endoscopy. • International Society Of Gynecology Endoscopy. • American Association Of Gynecology Laparoscopist. Dr Shashwat Jani. 9909944160

  6. What is Office Hysteroscopy .??? “ Diagnostic hysteroscopy and some operative hysteroscopic procedures should be conducted outside of the formal operating theatre setting in an appropriately equipped and staffed ambulatory situations & yet guarantying patient’s safety & privacy. “ Dr Shashwat Jani. 9909944160

  7. No Anesthesia nor Analgesia. • No drugs ( Atropine only ). • No speculum nor Tenaculum. • Operative procedures. Dr Shashwat Jani. 9909944160

  8. Prof Bettocchi • A pioneer in the field of office hysteroscopy, Prof Bettocchi, in 2004 reported on 4863 operative hysteroscopic procedures where a vaginoscopic technique was used without analgesia or anesthesia. • As technology has further advanced and hysteroscopes have reduced in size, office procedures have become even more feasible. • There have also been improvements in energy sources such as bipolar (as opposed to monopolar) that have decreased complications related to the operative distension media, this has made operative hysteroscopy more acceptable. Dr Shashwat Jani. 9909944160

  9. SET UP Set Up Dr Shashwat Jani. 9909944160

  10. Hysteroscopy Instrumentation • Lockable cabinet • Telescope • Sheath system • Hysteroscope - Diagnostic - Operative Resectoscope • Distention systems Fluid delivery system • Light source and cable • Video cameras and monitors

  11. Indications… DIAGNOSTIC : • Unexplained abnormal Uterine bleeding (AUB) . • Peri and post menopausal bleeding. • Selected infertility cases. • Abnormal HSG. • Unexplained Infertility. • Recurrent pregnancy loss. • Should be used prudently only after other investigations. Dr Shashwat Jani. 9909944160

  12. INDICATIONS… Therapeutic: • IUD removal • Biopsy of intrauterine lesions • Hemangioma and A-V malformations • Resection of uterine septum • Uterine synechiae • Cannulation of fallopian tubes • Sterilization . • Uterine polyps. • Submucous myomas. • Endometrial ablation. Dr Shashwat Jani. 9909944160

  13. Timing… Ideally Post menstrual Period Dr Shashwat Jani. 9909944160

  14. Anesthesia… 3 mm Flexible/Rigid • Usually not needed 5.5 mm Rigid w/o Dilatation • Parous usually not needed • Tenaculum site local • 1% Lidocaine 5.5 mm Rigid with Dilatation • Tenaculum site local • Paracervical block Dr Shashwat Jani. 9909944160

  15. Analgesia… • Routine use of Opiates NOT recommended. • Women without contraindications should be advised to consider taking standard doses of NSAIDs around 1 hour before their scheduled outpatient hysteroscopy appointment with the aim of reducing pain in the immediate postoperative period. Dr Shashwat Jani. 9909944160

  16. Cervical Preparation… Routinely NOT recommended… See and Treat • Cervical dilation usually not needed • 3 mm flexible hysteroscope with sheath. Misoprostol • Cramping and bleeding • Give narcotic pain medication Dr Shashwat Jani. 9909944160

  17. Misoprostol • Misoprostol is not required in every patient, but should be considered in selective patients : - Post menopausal patients, - Nulliparous patients, - Patients who have had previous cervical surgery or where the procedure is assessed to be difficult in dilating cervix. • Oral / Vaginal 400 μgm 6-8 hr prior. • Sublingual 400 μgm 2-4 hr prior. Dr Shashwat Jani. 9909944160

  18. Types of Hysteroscope • Miniature hysteroscopes (2.7mm with a 3 –3.5mm sheath) should be used for diagnostic outpatient hysteroscopy as they significantly reduce the discomfort experience by the woman. • 1.9 mm Microhysteroscope should be reserved for special cases like severe cervical stenosis. Dr Shashwat Jani. 9909944160

  19. There is insufficient evidence to recommend 0° or fore-oblique optical lenses (i.e. 12°, 25° or 30° off-set lenses) for routine outpatient hysteroscopy. Now ,,, Types Of Hysteroscopes? Dr Shashwat Jani. 9909944160

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