Is routine hysteroscopy during LLETZ a valuable additional procedure?
ABSTRACT We aimed to critically review our experience with the value and risks of a diagnostic hysteroscopy performed in addition to LLETZ. We retrospectively included 442 womentients undergoing LLETZ and additional routine diagnostic hysteroscopy. Women for whom concomitant diagnostic hysteroscopy was somehow indicated were excluded. We focused on complications and intrauterine abnormalities detected by hysteroscopy that had not been seen on preoperative vaginal ultrasound. In 28/442 (6.3%), hysteroscopy and/or histological examination of the specimen removed by curettage revealed an abnormal intrauterine finding (benign endometrial polyps, n=20; benign cervical polyps, n=2; small leiomyomas inside the uterine cavity, n=1; septate/arcuate/unicornuate, n=5). A total of 38 surgical complications (8.6%) occurred. The two adverse events related to diagnostic hysteroscopy were uterine perforations (0.5%). In conclusion, only a few benign findings of questionable clinical relevance were discovered. Thus, we do not consider an additional routine diagnostic hysteroscopy during LLETZ beneficial for the patient.
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ABSTRACT: To evaluate the loop electrosurgical excision procedure (LEEP) and large loop excision of the transformation zone-conization (LLETZ-conization) in the management of cervical intraepithelial dysplasia using high-frequency, filtered waveform energy (radiosurgery). Two hundred thirteen women attending the outpatient cervical colposcopy clinic with smears consistent with an epithelial abnormality, but macroscopically or colposcopically not consistent with invasive carcinoma, were included in the study. LEEP and LLETZ-conization were performed in 72 and 141 women, respectively. A matched pair group of patients undergoing cold knife conization was used for the comparison with LLETZ-conization. Using LEEP, in 83% a clear resection margin of the biopsy specimen was achieved. In this subset, diagnosis and therapy were achieved in a single visit. No complications, such as hemorrhage, occurred during the operation or postoperative period. Comparison of LLETZ-conization with the matched-pair group undergoing cold knife conization showed a significantly shorter duration of surgery for LLETZ-conization (mean, 10.8 vs. 16.5 minutes, P < .001). We found no differences concerning posttreatment bleeding complications (2.8% vs. 3.3%) or clear resection margins (92% vs. 86%). Patients undergoing LLETZ-conization needed significantly less analgesic (P < .01). Radiosurgical loop excision is a safe and cost-effective method in the diagnosis and treatment of cervical intraepithelial neoplasia.The Journal of reproductive medicine 07/1996; 41(6):409-14. · 0.75 Impact Factor
Article: Complications of hysteroscopy.[show abstract] [hide abstract]
ABSTRACT: Most of the complications of hysteroscopy are avoidable and, fortunately, rare. With improved training, experience, and technology, most of these complications should become extinct. There will always be some unavoidable complications as well as difficulties resulting from inexperience. A goal for the future is to teach operating room personnel how to recognize and treat these complications to ensure the best patient outcome possible. Once gynecologic surgeons recognize the safety and efficacy of diagnostic and operative hysteroscopy as a minimally invasive option to treat benign uterine pathology, these procedures will proliferate and result in better patient care and improved quality of life.Obstetrics and Gynecology Clinics of North America 04/1999; 26(1):39-51. · 1.45 Impact Factor
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ABSTRACT: The prevalence of congenital uterine anomalies in women with reproductive failure remains unclear, largely due to methodological bias. The aim of this review is to assess the diagnostic accuracy of different methodologies and estimate the prevalence of congenital uterine anomalies in women with infertility and recurrent miscarriage (RM). Studies from 1950 to 2007 were identified through a MEDLINE search; all relevant references were further reviewed. The most accurate diagnostic procedures are combined hysteroscopy and laparoscopy, sonohysterography (SHG) and possibly three-dimensional ultrasound (3D US). Two-dimensional ultrasound (2D US) and hysterosalpingography (HSG) are less accurate and are thus inadequate for diagnostic purposes. Preliminary studies (n = 24) suggest magnetic resonance imaging (MRI) is a relatively sensitive tool. A critical analysis of studies suggests that the prevalence of congenital uterine anomalies is approximately 6.7% [95% confidence interval (CI), 6.0-7.4] in the general population, approximately 7.3% (95% CI, 6.7-7.9) in the infertile population and approximately 16.7% (95% CI, 14.8-18.6) in the RM population. The arcuate uterus is the commonest anomaly in the general and RM population. In contrast, the septate uterus is the commonest anomaly in the infertile population, suggesting a possible association. Women with RM have a high prevalence of congenital uterine anomalies and should be thoroughly investigated. HSG and/or 2D US can be used as an initial screening tool. Combined hysteroscopy and laparoscopy, SHG and 3D US can be used for a definitive diagnosis. The accuracy and practicality of MRI remains unclear.Human Reproduction Update 07/2008; 14(5):415-29. · 9.23 Impact Factor