eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Hysteroscopy: Follow-up

Author: John C Petrozza, MD, Instructor, Department of Obstetrics and Gynecology, Harvard Medical School; Consulting Staff and Chief, Division of Reproductive Medicine and IVF, Vincent Obstetrics and Gynecology, Massachusetts General Hospital
Coauthor(s): Gretchen E H Makai, MD, Instructor, Department of Obstetrics and Gynecology, Harvard Medical School; Generalist, Department of Obstetrics and Gynecology, Mount Auburn Hospital; Emily Sikking, MD, Staff Physician, Department of Obstetrics and Gynecology, New England Medical Center
Contributor Information and Disclosures

Updated: Jul 16, 2006

Outcome and Prognosis

Outcomes for each type of procedure are discussed in Indications. Attempts at hysteroscopic evaluation or treatment are obviously meant to overcome the traditional problems associated with invasive procedures performed in the past that involved prolonged hospital stays, increased morbidity, and increased costs.

In addition to surgical success rates, other important considerations are the patient's long-term satisfaction, sexual function, and overall quality of life. For example, when endometrial ablation is compared with hysterectomy, endometrial ablation is most cost-effective, and patients undergoing endometrial ablation report 80-85% sexual, functional, and psychological satisfaction.

Future and Controversies

New and improved instruments are available for endometrial ablation. The thermal balloon used for menorrhagia has effects equal to those of hysteroscopic ablation, though amenorrhea is not as common with the thermal balloon than with hysteroscopic ablation (Singer, 1994). The balloon method is fast and simple to complete.

Another FDA-approved method is the direct instillation of sodium chloride solution heated to 90°C onto the endometrium at low intrauterine pressures of 50 mm Hg. Again, success rates are similar to those of the hysteroscopic approach. However, the reported rate of amenorrhea is higher than that of the thermal balloon approach, and it is nearly similar to the 40% achieved with hysteroscopic ablation. Cryoablation of the endometrium has also been used with success. The NovaSure (Cytyc Corporation, Mountain View, Calif) procedure is performed to desiccate and coagulate the endometrium and a superficial layer of myometrium by using radiofrequency energy delivered through a bipolar array. Although the size of the instrument is a limiting factor, this technique is perhaps the easiest of all. The newest procedure is microwave endometrial ablation, which offers excellent rates of amenorrhea but which requires increased dilatation of the cervix to introduce the mechanism.

Innovative and borrowed techniques are enabling many other types of hysteroscopic interventions, such as hysteroscopic sterilization, hysteroscopic morcellation, and other new and improved hysteroscopic designs. Instruments are becoming smaller than before, enabling additional in-office interventions.

As sonohysterography becomes common, as 3-dimensional sonographic software improves, and as physicians are required to apply increasingly cost-effective procedures, these new technologies may be used to perform certain operative procedures that now are performed with hysteroscopy. For example, MRI-guided ultrasonic destruction of fibroids is already in clinical trials. Patient demand for safe and minimally invasive treatments will continue to drive research and development.

 


More on Hysteroscopy

Overview: Hysteroscopy
Workup: Hysteroscopy
Treatment: Hysteroscopy
Follow-up: Hysteroscopy
References
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References

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Further Reading

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Keywords

hysteroscope, rigid hysteroscope, contact hysteroscope, microcolpohysteroscope, flexible hysteroscope, electrosurgery, myomectomy, resectoscope, proximal tubal obstruction, removal of IUD, intrauterine device, müllerian anomalies, infertility evaluation, abnormal uterine bleeding, AUB, endometrial ablation

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Contributor Information and Disclosures

Author

John C Petrozza, MD, Instructor, Department of Obstetrics and Gynecology, Harvard Medical School; Consulting Staff and Chief, Division of Reproductive Medicine and IVF, Vincent Obstetrics and Gynecology, Massachusetts General Hospital
John C Petrozza, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, American Society for Reproductive Medicine, and Massachusetts Medical Society
Disclosure: Interlace Medical, Inc. Consulting fee Consulting

Coauthor(s)

Gretchen E H Makai, MD, Instructor, Department of Obstetrics and Gynecology, Harvard Medical School; Generalist, Department of Obstetrics and Gynecology, Mount Auburn Hospital
Gretchen E H Makai, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Medical Association
Disclosure: Nothing to disclose.

Emily Sikking, MD, Staff Physician, Department of Obstetrics and Gynecology, New England Medical Center
Emily Sikking, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.

Medical Editor

Thomas Michael Price, MD, Associate Professor of Reproductive Endocrinology, Director of Reproductive Fellowship Training Program, Duke University Medical Center
Thomas Michael Price, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Phi Beta Kappa, and Society for Gynecologic Investigation
Disclosure: Clinical Advisors Group Consulting fee Consulting; MEDA Corp Consulting Consulting fee Consulting; Gerson Lehrman Group Advisor  Consulting fee Consulting; Roche/GSK Spokesperson  Consulting fee Consulting; Abbott Pharmaceuticals Grant/research funds PI; Adiana Grant/research funds PI

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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