The Pivotal role of hysteroscopy in diagnosing subtle uterine lesions in infertile patients: Seeing the unseen can make the difference.

Background: Subtle uterine lesions are abnormal intracavitary conditions that, while not causing significant anatomical changes, can adversely impact fertility. Identifying these "subtle" lesions is challenging due to arbitrary interpretation, varied management strategies, unclear clinical significance, and insufficient clinician training in recognizing them. Hysteroscopy offers direct visualization and the capacity to obtain targeted biopsies, making it an invaluable tool for the diagnosis and treatment of these often overlooked conditions.

Proposal for a new classification of intrauterine adhesions by sites.

The authors propose a new classification of intrauterine adhesions (IUAs) to facilitate understanding for both the gynecologist and the patient, documenting the location and characteristics of the adhesions in a single image. This tool significantly improves surgical planning and patient outcomes in the treatment of intrauterine adhesions. In addition, having a simple and consistent method of describing IUAs will facilitate longitudinal studies tracking the outcomes of various surgical techniques, adhesion barriers and the impact of hormonal treatment.

HYSTEROSCOPIC MYOMECTOMY.

Leiomyomas are the most common pelvic tumors. Submucosal fibroids are a common cause of abnormal bleeding and infertility. Hysteroscopic myomectomy is the definitive management of symptomatic submucosal fibroids, with high efficacy and safety.

Hysteroscopic management of intrauterine benign diseases.

Hysteroscopy is the gold-standard procedure for evaluating the vagina, cervix, cervical canal and uterine cavity, with a great possibility of identifying lesions and being able to treat them at the same time in a 'See and Treat' procedure. The presence of the operative channel allows directed biopsy and excision of part of the lesions. Hysteroscopic treatment can be offered in office and hospital settings.

Virtual sonographic hysteroscopy in assisted reproduction: A retrospective cost-effectiveness analysis.

Objective: To analyze the cost-effectiveness of virtual sonographic hysteroscopy (VSH) performed before in vitro fertilization (IVF) (Scenario 1), frozen embryo transfer (Scenario 2), and oocyte donation (Scenario 3) attempts.

Methods: A retrospective analysis of data extracted from patients' files was conducted. Before undergoing the assigned treatment, VSH was offered to all patients.

Pain management for in-office hysteroscopy. A practical decalogue for the operator.

Hysteroscopy is known to be the gold standard for evaluation of intrauterine pathologies, pre-menopausal and post-menopausal abnormal uterine bleeding and, in addition to this, it is a crucial examination in the infertility work-up. In-office operative hysteroscopy incorporates the outstanding possibility of seeing and treating an intracavitary pathology in the same examination, eliminating all the risk related to anesthesia and reducing procedure-related costs. By now, performing operative procedures in the office setting is recognized as feasible and safe.

Results of the Insertion of Hysteroscopic Sterilization Devices in a Brazilian Public Hospital.

Objective:  To evaluate the insertion of the hysteroscopic intratubal sterilization device for female sterilization concerning the technique and the feasibility.

Methods:  Retrospective study with data collection of medical records of 904 patients who underwent device insertion between January and September 2016 in a public hospital in Rio de Janeiro (Brazil) with data analysis and descriptive statistics.

Results:  In 85.

Updates in office hysteroscopy: a practical decalogue to perform a correct procedure.

Nowadays, hysteroscopy is the gold standard for the diagnosis and treatment of intrauterine pathologies as it represents a safe and minimally invasive procedure that allows the visualization of the entire uterine cavity. Numerous technological innovations have occurred over the past few years, contributing to the development and widespread use of this technique. In particular, the new small-diameter hysteroscopes are equipped with an operating channel in which different mechanical instruments can be inserted, and they allow not only to examine the cervical canal and uterine cavity but also to perform biopsies or treat benign diseases in a relatively short time without anesthesia and in an outpatient setting.

From hysteroscopy to laparoendoscopic surgery: what is the best surgical approach for symptomatic isthmocele? A systematic review and meta-analysis.

Purpose: To investigate the effectiveness and risks of different surgical therapies for isthmocele in symptomatic women with abnormal uterine bleeding, infertility, or for the prevention of obstetric complications, considering safety and surgical complications.

Methods: PubMed/MEDLINE, Scopus, Embase, Science Direct, and Cochrane Library were systematically searched (n° CRD4201912035) for original articles on the surgical treatment of isthmocele published between 1950 and 2018. Data synthesis was completed using MedCalc 16.

Reproductive outcomes of infertile women undergoing "see and treat" office hysteroscopy: a retrospective observational study.

Introduction: This study aimed to assess the feasibility and efficacy of office hysteroscopy to diagnose and treat the specific uterine pathologies frequently diagnosed and thought to be associated with female infertility.

Material And Methods: Using office hysteroscopy, we examined the uterine cavity in women with primary or secondary infertility and evaluated the reproductive outcomes of those affected by one or more pathologies, including cervico-isthmic adhesions, intrauterine polyps and intrauterine adhesions. Additional patient characteristics considered were age and parity, uterine pathology, pain during hysteroscopy, and outcomes including spontaneous pregnancies achieved and time between treatment and pregnancy.

The importance of pseudocapsule preservation during hysteroscopic myomectomy.

Minimally invasive techniques for myomectomy are based on the rationale of preserving the myometrial integrity, in order to spare muscular and fibro-neurovascular myometrial fibers and ensure complete and bloodless myoma removal. Post-operative myometrial vascularization is crucial in injured muscle regeneration. The post-surgical myometrial healing is needful for uterine reproductive function.

The role of leiomyomas in the genesis of abnormal uterine bleeding (AUB).

Abnormal uterine bleeding (AUB) is the major complaint in approximately one-third of gynecological visits in premenopausal women, and in >70% of appointments of perimenopausal and postmenopausal women. Uterine myoma is one of the main causes of AUB during menacme, especially when it is submucosal. The association of myoma and AUB may be related to several factors, from local alterations of angiogenic and vasoactive substances to changes in uterine contractility.

The value of hysteroscopic biopsy in the diagnosis of endometrial polyps.

Several studies have demonstrated that the combination of hysteroscopy with endometrial biopsy is more accurate in differentiating endometrial polyps from endometrial hyperplasia and cancer. However, blind biopsy not always confirms hysteroscopic findings due to high rates of inadequate or insufficient material. The objective of this clinical, prospective, and comparative study was to establish a correlation between the histological results of office-based endometrial biopsies (hysteroscopically guided and blind) with the surgical polypectomy specimens.

Validation of a score to guide endometriosis therapy for the non-specialized gynecologist.

Objective: To validate a tool-the ECO system-developed to guide non-specialized gynecologists in the treatment of patients with suspected endometriosis in outpatient clinics.

Methods: In a retrospective study, data were assessed from patients presenting to a center in Brazil or a center in Germany with suspected endometriosis and pelvic pain between July 2012 and June 2013. Data reviewed included patient complaints, clinical extent of disease, patient goals, recent use of medication, previous pelvic surgeries, visual analog pain scale, treatment provided, and histopathology after surgery.

Percutaneous core biopsy of palpable breast lesions: accuracy of frozen section histopathological exam in the diagnosis of breast cancer.

Objective: to evaluate the accuracy of frozen section histopathology from fragments of tissue obtained by percutaneous core needle biopsy of palpable tumors in the diagnosis of breast cancer.

Methods: a cohort study was performed on 57 patients with palpable tumors and suspected breast cancer undergoing percutaneous thick needle core biopsy. The fragments were analyzed by the same pathologist.

Endometrial polyp size and polyp hyperplasia.

Objective: To assess the correlation between the size of endometrial polyps and the histopathologic diagnosis of hyperplasia or cancer.

Methods: A retrospective study was conducted using databases of the outpatient clinic at Antonio Pedro University Hospital in Niterói, Brazil, and of a private hysteroscopy service. The analysis included 1136 asymptomatic patients with an endometrial polyp identified on hysteroscopy, with pathologic examination, during the period 1999-2012.

A new system to classify submucous myomas: a Brazilian multicenter study.

Objective: To evaluate 2 different predicting scores of submucous myoma removal, fluid balance, and operative time in woman undergoing hysteroscopic myomectomy.

Design: A multicenter and prospective study (Canadian Task Force classification II-2).

Setting: Six hysteroscopy centers in Brazil.

Diagram to map the locations of endometriosis.

Objective: To develop and test a visual map that corresponds practically and objectively to the anatomical areas affected by endometriosis.

Method: The study comprised 150 questionnaires concerning 10 clinical cases of endometriosis presented as a visual diagram that were distributed at 3 different scientific events, among 3 groups of 50 gynecologists. Data were analyzed to evaluate the diagram's ability to graphically represent the endometriosis sites.

Feasibility of a new system of classification of submucous myomas: a multicenter study.

Objective: To evaluate the performance of the STEPW (size, topography, extension, penetration, wall) classification system in predicting partial or complete fibroid removal on hysteroscopic myomectomy.

Design: Multicenter, prospective study (Canadian Task Force classification II-2).

Setting: Four hysteroscopy centers in Brazil, China, Italy, and the United States.

[Hysteroscopic evaluation in patients with infertility].

Purpose: to describe hysteroscopy findings in infertile patients.

Methods: this was a retrospective series of 953 patients with diagnosis of infertility evaluated by hysteroscopy. A total of 957 patients investigated for infertility were subjected to hysteroscopy, preferentially during the first phase of the menstrual cycle.

[Endometrial osseous metaplasia: clinical presentation and follow-up].

Purpose: to describe the clinical signs and symptoms of patients with bone metaplasia and to assess the risk factors for changes in these symptoms after removal of the bone fragment.

Methods: a cross-sectional study was conducted on 16 patients with a diagnosis of bone fragments in the uterine cavity during the period comprising July 2006 to January 2009. The inclusion criterion was the detection of a bone fragment removed from the uterine cavity.

Genetic analysis of the cause of endometrial osseous metaplasia.

Objective: To analyze solitary bone fragments from the uterine cavity through DNA genotyping, thus elucidating whether they originate from metaplasia, from previous abortion, or both.

Methods: We conducted a case series study on 14 patients, of whom eight yielded bone DNA. The patients selected had histopathologic diagnoses of bone fragments inside the uterine cavity or previously removed samples available for analysis.

A simple and effective traction device for laparoscopic formation of a neovagina using the Vecchietti technique.

We sought to present a simple new traction device that was used with success in 4 cases of laparoscopic creation of a neovagina using a modified Vecchietti technique. Four patients were treated with laparoscopic creation of a neovagina. All women had Rokitansky-Küster-Hauser syndrome and no more than a 1-cm vestibule dimple.