Development of a thinner and more flexible type of minihysteroscope with a controlled 90-degree bendable tip for vision-guided endometrium biopsy.
OBJECTIVE
Evaluation of the uterine cavity is limited with rigid 5-mm hysteroscopes because of the need for cervical dilatation, reduced movements inside the uterus, and no option for vision-guided biopsy. In cooperation with PolyDiagnost GmbH, Pfaffenhofen, Germany, a new type of flexible minihysteroscope with bendable tip was developed and evaluated.


METHODS
Prospective and parallel observational interindividual evaluation of flexible minihysteroscope and standard hysteroscope for diagnostic hysteroscopy (Canadian Task Force classification II-3).


METHODS
Obstetrics and gynecology department of a university clinic.


METHODS
Nine women, average age 65.0 years (range 46-89 years), with indications for diagnostic hysteroscopy.


METHODS
After defining requirements, a novel, thinner, and more flexible minihysteroscope, 18-cm long with a 2.67-mm outer diameter, was developed with straight zero-degree scope, 70-degree vision field, and 6000-pixel resolution. Two working channels, 1.2 mm and 0.55 mm, allow suction-irrigation and introduction of a 1.0-mm biopsy forceps or cytology brush. The tip of the instrument is 90-degree stageless bendable to both sides. Diagnostic hysteroscopy was performed with flexible minihysteroscope followed by standard rigid hysteroscopy to verify results.


RESULTS
From July 2003 through March 2004, both procedures were performed in nine patients with identical visual and histologic results. No complications occurred. No cervix-dilating instruments were necessary for introduction of the flexible minihysteroscope. Visualization of the entire uterine cavity is improved with the flexible scope because a bendable tip allows better peripheral vision (e.g., of the openings of the tubes). However, movement of the tip should be performed carefully due to potential risk of uterine perforation.


CONCLUSIONS
This new flexible minihysteroscope is less invasive compared with standard rigid hysteroscopy, which supports performance of ambulatory hysteroscopy and makes increased movements and vision-guided biopsy inside the uterine cavity possible.
Jacobs
Volker R
VR
Frauenklinik (OB/GYN), Technical University Munich, Munich, Germany.
Paepke
Stefan
S
Schwarz-Boeger
Ulrike
U
Fischer
Thorsten
T
Pildner von Steinburg
Stefanie
S
Plattner
Birgit
B
Schmalfeldt
Barbara
B
Schaaf
Hansgeorg
H
Kiechle
Marion
M
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000295:instrumentation* / Q000379:methods; D004717:Endometrium / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020702:Hysteroscopes; D015907:Hysteroscopy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results