Dr. Pulcinella Ruggero

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Outpatient Hysteroscopic Surgery

Characteristics and Indications

This page describes the indications, instruments and techniques of outpatient hysteroscopic surgery

'Features and indications'

Hysteroscopic outpatient surgery or office surgery hysteroscopy makes use of specific techniques and instrumentation that have progressively extended its use and indications to the point of allowing the 30% of operative hysteroscopies to be performed with immediate discharge and avoiding the need for the complex pre-hospitalisation procedure,   

Indispensable prerequisites and selection criteria:

  • Easy diagnostic hysteroscopies
    - expected duration of intervention not exceeding 15 m'
    - size of the neoformation (not exceeding 15 mm)
    - completion of surgery in a single session

these assumptions are fundamentally based on patient acceptability:

Our indications

  • pedunculated or sessile polyps up to 15 mm
    - endocavitary myomas up to 15 mm
    - synechiolysis and partial septum

Instrumentation

  • Continuous-flow office hysteroscope with double jacket and working channel
  • 2.9 mm 30° bore optic
  • 2-way urological inflow and outflow pipes
  • 3 CCD camera
  • Light cable
  • Hysteroscopic column equipped with monitor, light source, camera control unit, versapoint bipolar electro-scalpel
  • Bipolar electrode for resection and fragmentation of the neoformation
  • 5 french ( 1.6 mm ) micro-scissors and micro-grips
  • Electronic peristaltic pump or mechanical pressure bag squeezer

 

If the criteria are met, hysteroscopic surgical treatment in the same session is possible (see and treat)

Technique of execution

  1. Gynaecological position with pelvis protruding beyond the bed base
  2. No disinfection of the genitals (however, check for the absence of ongoing inflammation).
  3. Vaginoscopy entry without using speculum or neck forceps
  4. Hysteroscopy under vision respecting the correct execution technique
  5. Start of the surgical procedure after inserting the bipolar electrode or micro-scissors into the working channel of the outer jacket
  6. Removing the neoformation in its entirety if possible or fragmenting it
  7. Release of photographic documentation testifying to pre-existing pathology and final outcome
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