Tanısal ve Operatif Histeroskopi
Özet
Histeroskopi, kamera ve dış kılıflar aracılığıyla uterus kavitesinin incelenmesini ve tedavi edilmesini sağlayan, günümüzde oldukça güvenli ve az invaziv hale gelmiş bir yöntemdir. Tanısal (ofis) histeroskopi, anestezi ve ameliyathane hazırlığı gerektirmeden poliklinik şartlarında yapılabilirken, daha büyük çaplı operatif sistemler için ameliyathane ve anestezi ihtiyacı doğmaktadır. İşlem için en uygun dönem endometriyumun proliferatif fazıdır. Uterin kavitede kitle şüphesi, anormal kanamalar ve infertilite başlıca endikasyonlar arasındayken; gebelik, genital enfeksiyonlar ve serviks kanseri kesin kontrendikasyonları oluşturur. Muayenede çoğunlukla spekulum kullanılmayan non-touch teknik tercih edilir. Görüş kalitesini artırmak ve uterusu genişletmek için karbondioksit gazı yerine, emboli riskinin az olması ve debrisi uzaklaştırması nedeniyle sıvı mediatörler daha sık kullanılır. Cerrahi enerji türüne göre salin (bipolar için) veya glisin, mannitol, sorbitol (monopolar için) gibi elektrolit ya da non-elektrolit sıvılar seçilir. Sıvı yönetiminde, hastaya geçen sıvı açığının (hipotoniklerde 1000 ml, izotoniklerde 2500 ml) takibi komplikasyonları önlemek açısından hayati önem taşır. Nadir görülmekle birlikte, uterin perforasyon en sık rastlanan komplikasyondur; bunun yanı sıra iyatrojenik sıvı yüklenmesi ile mesane veya bağırsak yaralanmaları da meydana gelebilir.
Hysteroscopy is a method that allows the evaluation and treatment of the uterine cavity using cameras and outer sheaths, which has become highly safe and minimally invasive today. While diagnostic (office) hysteroscopy can be performed under outpatient clinic conditions without the need for anesthesia or operating room preparation, larger-diameter operative systems require an operating room and anesthesia. The most suitable period for the procedure is the proliferative phase of the endometrium. While suspected uterine cavity masses, abnormal bleeding, and infertility are among the primary indications; pregnancy, genital tract infections, and cervical cancer constitute absolute contraindications. During the examination, the non-touch technique, which mostly avoids speculum use, is preferred. To improve visualization and distend the uterus, liquid mediators are more frequently used instead of carbon dioxide gas due to their lower risk of embolism and ability to remove debris. Depending on the type of surgical energy, electrolyte or non-electrolyte fluids such as saline (for bipolar) or glycine, mannitol, and sorbitol (for monopolar) are selected. In fluid management, monitoring the fluid deficit transferred to the patient (1000 ml for hypotonic fluids, 2500 ml for isotonic fluids) is vital to prevent complications. Although rare, uterine perforation is the most common complication; additionally, iatrogenic fluid overload, as well as bladder or bowel injuries, may occur.
Referanslar
Salazar CA, Isaacson KB. Office Operative Hysteroscopy: An Update. J Minim Invasive Gynecol. 2018;25(2):199-208. doi: 10.1016/j.jmig.2017.08.009.
Connor M. New technologies and innovations in hysteroscopy. Best Pract Res Clin Obstet Gynaecol. 2015;29(7):951-65. doi: 10.1016/j.bpobgyn.2015.03.012.
Shirk GJ, Gimpelson RJ. Control of intrauterine fluid pressure during operative hysteroscopy. J Am Assoc Gynecol Laparosc. 1994;1(3):229-33. doi: 10.1016/s1074-3804(05)81015-1.
Di Spiezio Sardo A, Bettocchi S, Spinelli M, et al. Review of new office-based hysteroscopic procedures 2003-2009. J Minim Invasive Gynecol. 2010;17(4):436-48. doi: 10.1016/j.jmig.2010.03.014.
De Wilde RL. Office Hysteroscopy: TROPHYscope CAMPO Compact Hysteroscope (®): Manufacturer: KARL STORZ, Tuttlingen, Germany. J Obstet Gynaecol India. 2014;64(4):301-3. doi: 10.1007/s13224-014-0593-5.
Di Spiezio Sardo A, Zizolfi B, Lodhi W, et al. 'See and treat' outpatient hysteroscopy with novel fibreoptic 'Alphascope'. J Obstet Gynaecol. 2012;32(3):298-300. doi: 10.3109/01443615.2011.645922.
Umranikar S, Clark TJ, Saridogan E, et al. BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy. Gynecol Surg. 2016;13(4):289-303. doi: 10.1007/s10397-016-0983-z.
Cholkeri-Singh A, Sasaki KJ. Hysteroscopy safety. Curr Opin Obstet Gynecol. 2016;28(4):250-4. doi: 10.1097/GCO.0000000000000289.
Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan KS. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA. 2002;288(13):1610-21. doi: 10.1001/jama.288.13.1610.
Deffieux X, Gauthier T, Menager N, Legendre G, Agostini A, Pierre F. Hysteroscopy: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol. 2014;178:114-22. doi: 10.1016/j.ejogrb.2014.04.026.
Bradley WH, Boente MP, Brooker D, et al. Hysteroscopy and cytology in endometrial cancer. Obstet Gynecol. 2004;104:1030-3. doi:10.1097/01.AOG.0000143263.19732.18.
Polyzos NP, Mauri D, Tsioras S, Messini CI, Valachis A, Messinis IE. Intraperitoneal dissemination of endometrial cancer cells after hysteroscopy: a systematic review and meta-analysis. Int J Gynecol Cancer. 2010;20(2):261-7. doi: 10.1111/igc.0b013e3181ca2290.
Obermair A, Geramou M, Gucer F, et al. Does hysteroscopy facilitate tumor cell dissemination? Incidence of peritoneal cytology from patients with early stage endometrial carcinoma following dilatation and curettage (D & C) versus hysteroscopy and D & C. Cancer. 2000;88(1):139-43.
Dovnik A, Crnobrnja B, Zegura B, Takac I, Pakiz M. Incidence of positive peritoneal cytology in patients with endometrial carcinoma after hysteroscopy vs. dilatation and curettage. Radiol Oncol. 2016;51(1):88-93. doi: 10.1515/raon-2016-0035.
Gu M, Shi W, Huang J, Barakat RR, Thaler HT, Saigo PE. Association between initial diagnostic procedure and hysteroscopy and abnormal peritoneal washings in patients with endometrial carcinoma. Cancer. 2000;90(3):143-7. doi: 10.1002/1097-0142(20000625)90:3<143::aid-cncr2>3.0.co;2-h.
Kudela M, Pilka R. Is there a real risk in patients with endometrial carcinoma undergoing diagnostic hysteroscopy (HSC)? Eur J Gynaecol Oncol. 2001;22(5):342-4. PMID: 11766735.
Selvaggi L, Cormio G, Ceci O, Loverro G, Cazzolla A, Bettocchi S. Hysteroscopy does not increase the risk of microscopic extrauterine spread in endometrial carcinoma. Int J Gynecol Cancer. 2003;13(2):223-7. doi: 10.1046/j.1525-1438.2003.13044.x.
Baker VL, Adamson GD. Threshold intrauterine perfusion pressures for intraperitoneal spill during hydrotubation and correlation with tubal adhesive disease. Fertil Steril. 1995;64(6):1066-9. doi: 10.1016/s0015-0282(16)57961-8.
de Sousa Damião R, Lopes RG, Dos Santos ES, Lippi UG, da Fonseca EB. Evaluation of the risk of spreading endometrial cell by hysteroscopy: a prospective longitudinal study. Obstet Gynecol Int. 2009;2009:397079. doi: 10.1155/2009/397079.
Cicinelli E, Tinelli R, Colafiglio G, et al. Risk of long-term pelvic recurrences after fluid minihysteroscopy in women with endometrial carcinoma: a controlled randomized study. Menopause. 2010;17(3):511-5. doi: 10.1097/gme.0b013e3181c8534d.
Armstrong SC, Showell M, Stewart EA, Rebar RW, Vanderpoel S, Farquhar CM. Baseline anatomical assessment of the uterus and ovaries in infertile women: a systematic review of the evidence on which assessment methods are the safest and most effective in terms of improving fertility outcomes. Hum Reprod Update. 2017;23(5):533-547. doi: 10.1093/humupd/dmx019.
Yang JH, Chen MJ, Yang PK. Factors increasing the detection rate of intrauterine lesions on hysteroscopy in infertile women with sonographically normal uterine cavities. J Formos Med Assoc. 2019;118:488-493. doi: 10.1016/j.jfma.2018.08.017.
Bosteels J, Kasius J, Weyers S, Broekmans FJ, Mol BW, D'Hooghe TM. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev. 2015;(2):CD009461. doi: 10.1002/14651858.CD009461.pub3.
Fagioli R, Vitagliano A, Carugno J, Castellano G, De Angelis MC, Di Spiezio Sardo A. Hysteroscopy in postmenopause: from diagnosis to the management of intrauterine pathologies. Climacteric. 2020;23(4):360-368. doi: 10.1080/13697137.2020.1754387.
Vitale SG, Bruni S, Chiofalo B, Riemma G, Lasmar RB. Updates in office hysteroscopy: a practical decalogue to perform a correct procedure. Updates Surg. 2020;72(4):967-976. doi: 10.1007/s13304-020-00713-w.
Bettocchi S, Bramante S, Bifulco G, et al. Challenging the cervix: strategies to overcome the anatomic impediments to hysteroscopy: analysis of 31,052 office hysteroscopies. Fertil Steril. 2016;105(5):e16-e17. doi:10.1016/j.fertnstert.2016.01.030.
Muzii L, Boni T, Bellati F, et al. GnRH analogue treatment before hysteroscopic resection of submucous myomas: a prospective, randomized, multicenter study. Fertil Steril. 2010;94(4):1496-1499. doi: 10.1016/j.fertnstert.2009.05.070.
Mavrelos D, Ben-Nagi J, Davies A, Lee C, Salim R, Jurkovic D. The value of pre-operative treatment with GnRH analogues in women with submucous fibroids: a double-blind, placebo-controlled randomized trial. Hum Reprod. 2010;25(9):2264-9. doi: 10.1093/humrep/deq188.
Munro MG, Storz K, Abbott JA, et al. AAGL Practice Report: Practice Guidelines for the Management of Hysteroscopic Distending Media: (Replaces Hysteroscopic Fluid Monitoring Guidelines. J Am Assoc Gynecol Laparosc. 2000;7:167-168.). J Minim Invasive Gynecol. 2013;20(2):137-48. doi: 10.1016/j.jmig.2012.12.002.
Mak JN, Imran A, Burnet S. Office hysteroscopy: back to the future! Climacteric. 2020;23(4):350-354. doi: 10.1080/13697137.2020.1750589.
Oppegaard KS, Lieng M, Berg A, Istre O, Qvigstad E, Nesheim BI. A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women: a randomised controlled trial. BJOG. 2010;117(1):53-61. doi: 10.1111/j.1471-0528.2009.02435.x.
Karakus S, Akkar OB, Yildiz C, Yenicesu GI, Cetin M, Cetin A. Comparison of Effectiveness of Laminaria versus Vaginal Misoprostol for Cervical Preparation Before Operative Hysteroscopy in Women of Reproductive Age: A Prospective Randomized Trial. J Minim Invasive Gynecol. 2016;23(1):46-52. doi: 10.1016/j.jmig.2015.08.006.
Phillips DR, Nathanson HG, Milim SJ, Haselkorn JS. The effect of dilute vasopressin solution on the force needed for cervical dilatation: a randomized controlled trial. Obstet Gynecol. 1997;89(4):507-11. doi: 10.1016/S0029-7844(97)00006-9.
ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstetrics and gynecology.2009;113(5):1180-1189.
Technology assessment No. 7: Hysteroscopy. Obstet Gynecol. 2011;117(6):1486-1491. doi: 10.1097/AOG.0b013e3182238c7d.
