The need for office hysteroscopy in your practice

Bradley’s message was clear: hysteroscopies are necessary, urgent, and underutilized procedures. During their presentation,1 Bradley is passionate about bringing real-life hysteroscopy into your practice by using patient images and videos to illustrate the many situations where performing hysteroscopy resulted in better care.

Bradley began by stating the obvious: you cannot see inside the uterine cavity for a routine exam. According to Bradley, the things inserted have been segregated, hidden, unrated, and underestimated. “Everything is blind,” she began. “I want us as a nation and as a world to stop having these pathetic hysterectomies.”

With hysteroscopies, you can assess the patient immediately. You can do them in the office without pain medication. Patients do not have to take off to work and can serve as their own transport. They also make a major contribution to informed consent. This means you can immediately – with confidence and accuracy – let the patient know what is going on in their body and initiate the necessary treatment.

For example, Bradley referred to a 28-year-old patient who came to her practice after 3 consecutive IUDs fell out with no apparent explanation. After using a flexible hysteroscope, she could see that the patient’s 8 fibroids and kissing lesions were to blame. Bradley noted that with just one Pipelle biopsy, the patient’s results would have been negative. With the hysteroscope, the patient’s fibroids could be recognized and resected.

In another case, Bradley was able to discover a small piece of cancer behind an elderly woman’s fibroids.

Too often she encounters foreign objects, lost coils, and sutures, which further underscores the importance of such a simple procedure. “That’s why we don’t want things to stay in the womb. The uterine cavity undergoes metaplastic changes and these things look like coral reefs, ”Bradley said, pointing to the picture on the screen. Contraceptives are too often a sight.

She went on to another example where a patient in her twenties was bleeding every day after giving birth. Years later, the patient entered menopause and had episodic spotting for 10 to 20 days a month. Bradley used her hysteroscope and discovered a cerclage that the patient had received 25 years ago that had migrated into the lining of the uterus. After removal, the patient’s bleeding stopped completely. Without the hysteroscope, the problem may have affected the patient indefinitely.

Perhaps the most troubling case was one a colleague shared with Bradley. In this scenario, the patient came after a caesarean section and stated that she had had a chronic discharge for months. Thanks to the hysteroscope, Bradley’s colleague discovered a sponge that had remained in the patient after the procedure, despite surgical checklists and counting.

“We have a device that is better than anything we could blind,” she concluded. “Make your hysteroscope your stethoscope. It is time for a revolution for women. You are counting on us. “

reference

  1. Bradley L. Office Hysteroscopy: Seeing is Believing. A manifesto for change. Presented at the 50th AAGL Global Congress on MIGS. 11/15/2021; Austin, Texas.


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