Various surgical techniques for hysteroscopic surgery
- Mar 25, 2018 -

1. Hysteroscopic endometrial polypectomy:

1 When the polyp is removed, cut the pedicle of the polyp with a ring electrode from the distance from the polyp and cut it. It is appropriate to cut the superficial muscular tissue 2-3 mm below the depth of the pedicle.

2 For patients with fertility requirements, both the root pedicle and the normal lining of the lesion should be protected.

2. Hysteroscopic intrauterine adhesion separation:

1 Select the separation method according to the type of adhesion and the scope of adhesion.

2 Membrane adhesions can be isolated using micro scissors. Muscular adhesions are mostly separated by needle electrodes or ring electrodes.

3 The anatomical morphology of the uterine cavity should be clear during the separation operation. The operation should be performed along the midline of the uterine cavity to the both sides. Note the symmetry of the uterine cavity.

4 Special emphasis is placed on the protection of normal endometrium during surgery.

When the uterine cavity adhesion is separated, ultrasonic or laparoscopic monitoring can be used according to the degree of adhesion to improve the efficacy and safety of the operation.

3. Hysteroscopic endometrial resection:

1 The endometrium is excised or coagulated in the form of a ring or a spherical electrode.

2 Generally from the bottom of the palace to the bilateral uterine horn and lateral wall intima, and then from the top down to remove the uterus and posterior wall of the intima.

3 The depth of resection or coagulation should include the full depth of the endometrium and 2-3 mm of muscle tissue below it. The resection or coagulation range ends 0.5-1.0 cm (partial resection) or 0.5-1.0 cm below (complete resection) above the inner os of the cervix. .

4 During the operation, the depth of destruction of the intima of the bilateral uterine cavity and the uterine horn should be noted. If necessary, the rings and spherical electrodes can be used alternately to minimize the residual of the endometrium.

4. Hysteroscopic uterine mediastinal resection:

1 Incomplete uterine septum resection or separation, should start from the tip of the mediastinal tissue, left and right alternately to the base of the mediastinum.

2 The cutting or separating direction of the working electrode should be along the midline so as not to damage the myometrial tissue of the anterior or posterior wall.

3 When cutting or separating to the bottom of the uterus, attention should be paid to distinguishing the boundary between the mediastinum and the uterine fundus.

4 In the removal or separation of the mediastinum, try to avoid damage to the normal uterine muscle wall tissue, so as to avoid bleeding or perforation.

5 When the complete mediastinum is excised or separated, it is separated or removed horizontally from the cervix to the fundus, in the same way as a partial mediastinum. Some mediastinal septae do not have to be incised and may be left in vaginal delivery or cesarean deliveries.

5. Hysteroscopic myomectomy:

1 The type of fibroids should be evaluated before hysteroscopic myomectomy, and surgery is performed according to different types of fibroids.

Type 20 submucosal fibroids: Estimated fibroids can be completely removed through the cervix, ring electrodes can be removed after the pedicles of fibroids, oval clamp to take out. For larger fibroids, the ring electrode should be cut from both sides of fibroids to reduce the volume of fibroids, and then take the egg oval pliers to grasp and twist and take out, as appropriate, trimming fibroid tumor cavity and stop bleeding. For fibroids that have fallen into the vagina, the pedicles of the fibroids are cut off under hysteroscopy. 2 Type I and Type II submucosal myoma: The tumor was enucleated with the active electrode in the most prominent part of the fibroid, causing the fibroid tumor to protrude toward the uterine cavity and then resected.

3 During the operation, the uterine tumor can be moved into the uterine cavity by using oxytocin, water separation and other methods.

4 For uterine fibroids that cannot protrude into the uterine cavity, it is not appropriate to forcibly dig into the muscle wall, and the fibroids are removed to be parallel to the surrounding muscular wall. The remaining part of the fibroids is subjected to secondary surgery as the case may be.

5 sudden intramural fibroids: For intramural intermural fibroids that can be performed hysteroscopic resection, surgical methods and principles refer to type 1 and type II submucosal fibroids.

6 It is recommended that B ultrasound monitoring be used during surgery to improve the safety of the operation.

6. Hysteroscopic intrauterine foreign body removal or resection:

1 Intrauterine device: When intrauterine device remains, incarcerated or adhered to tissue, it should be separated by hysteroscopy under direct vision until it is fully exposed, and then removed with a foreign object. For the IUD between the residual muscle wall, ultrasonic positioning combined with the appropriate and separated according to the above method.

2 Pregnancy tissue residues: According to the type of residual tissue and residual sites, acicular or ring electrodes are selected for separation or resection, as appropriate. Pay attention to the protection of the normal endometrium during surgery.

3 When dealing with residual tissue in the uterine horn, grasp depth and avoid uterine perforation.

4Cervical cesarean scar pregnancy (sudden uterine cavity) resection should be treated as appropriate by drug therapy and (or) uterine vascular obstruction after surgery, intraoperative choice of ultrasound or combined laparoscopic surgery