State-of-the-art hysteroscopic approaches to pathologies of the genital tract

307 Pages·2014·94.781 MB·English

by  Di Spiezio Sardo, Attilio, Nappi, Carmine

STATE-OF-THE-ART
HYSTEROSCOPIC APPROACHES
TO PATHOLOGIES OF
THE GENITAL TRACT
Carmine Nappi
Attilio Di Spiezio Sardo
School of Medicine and Surgery
University of Naples ‘Federico II’
Naples, Italy

I would like to dedicate this book to the women and to the
youth, and to the two Elenas of my family.
CN
To my wife, Anna, who has always been with me since the
early days of my career, for her unconditional and generous
support.
To my parents who have accompanied me throughout my
journey of personal and intellectual growth, who fostered my
passion for academic studies and especially for medicine.
To Prof. Carmine Nappi(cid:2)(cid:72)(cid:81)(cid:84)(cid:2)(cid:68)(cid:71)(cid:75)(cid:80)(cid:73)(cid:2)(cid:86)(cid:74)(cid:71)(cid:2)(cid:386)(cid:84)(cid:85)(cid:86)(cid:14)(cid:2)(cid:89)(cid:74)(cid:81)(cid:2)(cid:74)(cid:67)(cid:85)(cid:2)(cid:68)(cid:71)(cid:78)(cid:75)(cid:71)(cid:88)(cid:71)(cid:70)(cid:2)
in me ever since I was a young medical student, looking
out eagerly and enthusiastically at the world of gynecology,
who instilled in me the attitude that with a proper mind-
set and perseverance any goal can be reached, and who
(cid:2)(cid:82)(cid:84)(cid:81)(cid:88)(cid:75)(cid:70)(cid:71)(cid:70)(cid:2)(cid:69)(cid:81)(cid:80)(cid:86)(cid:75)(cid:80)(cid:87)(cid:75)(cid:80)(cid:73)(cid:2)(cid:85)(cid:87)(cid:82)(cid:82)(cid:81)(cid:84)(cid:86)(cid:2)(cid:67)(cid:80)(cid:70)(cid:2)(cid:69)(cid:81)(cid:80)(cid:386)(cid:70)(cid:71)(cid:80)(cid:69)(cid:71)(cid:14)(cid:2)(cid:86)(cid:74)(cid:87)(cid:85)(cid:2)(cid:71)(cid:80)(cid:74)(cid:67)(cid:80)(cid:69)-
ing my professional development.
To all those, who have encouraged me to explore the
world of hysteroscopy: in particular, to Adam Magos, who
guided me in the early stages of my hands-on training, to
Giampietro Gubbini,(cid:2)(cid:89)(cid:74)(cid:81)(cid:2)(cid:89)(cid:67)(cid:85)(cid:2)(cid:86)(cid:74)(cid:71)(cid:2)(cid:386)(cid:84)(cid:85)(cid:86)(cid:2)(cid:86)(cid:81)(cid:2)(cid:74)(cid:67)(cid:88)(cid:71)(cid:2)(cid:2)(cid:69)(cid:81)(cid:80)(cid:386)(cid:70)(cid:71)(cid:80)(cid:69)(cid:71)(cid:2)
in my abilities, to Stefano Bettocchi, for his affection and
(cid:69)(cid:81)(cid:80)(cid:386)(cid:70)(cid:71)(cid:80)(cid:69)(cid:71)(cid:14)(cid:2)(cid:67)(cid:80)(cid:70)(cid:2)for having instilled in me the passion for
ambulatory surgery, and to Ivan Mazzon, for his v aluable
lessons, which were instrumental in improving my surgical
skills, to Maurizio Guida for constantly providing support in
(cid:79)(cid:91)(cid:2)(cid:69)(cid:78)(cid:75)(cid:80)(cid:75)(cid:69)(cid:67)(cid:2) (cid:78)(cid:2)(cid:67)(cid:80)(cid:70)(cid:2)(cid:85)(cid:69)(cid:75)(cid:71)(cid:80)(cid:86)(cid:75)(cid:386)(cid:69)(cid:2)(cid:2)(cid:71)(cid:80)(cid:70)(cid:71)(cid:67)(cid:88)(cid:81)(cid:87)(cid:84)(cid:85)(cid:14)(cid:2)(cid:67)(cid:80)(cid:70)(cid:2)(cid:86)(cid:81)(cid:2)Luca Mencaglia,
who has always been generous with advices, ceaselessly
guiding and supporting me throughout the past years of
my career.
ADSS
8 State-of-the-Art Hysteroscopic Approaches to Pathologies of the Genital Tract
Foreword
Diagnostic imaging procedures and surgical absence of structured postgraduate education.
endoscopy are among the fastest developing The European Society for Gynaecological Endo-
medical procedures of the century. scopy(cid:2)(cid:10)(cid:39)(cid:53)(cid:41)(cid:39)(cid:11)(cid:2)(cid:74)(cid:67)(cid:85)(cid:2)(cid:69)(cid:81)(cid:87)(cid:80)(cid:86)(cid:71)(cid:84)(cid:71)(cid:70)(cid:2)(cid:86)(cid:74)(cid:71)(cid:2)(cid:78)(cid:67)(cid:86)(cid:86)(cid:71)(cid:84)(cid:2)(cid:70)(cid:71)(cid:386)(cid:69)(cid:75)(cid:71)(cid:80)(cid:69)(cid:91)(cid:2)
by setting up the Gynaecological Endoscopic
Hysteroscopy, the gold standard for the evalua-
Surgical Education and Assessment (GESEA)
tion and treatment of intra uterine pathologies, has
Programme, comprising lectures, hands-on
been experienced for a long time as an invasive
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technique, characterized by a slow learning
on e-learning modules, focuses on the theoretical
curve. The revolutionary advances taking place in
aspects of the technique. Indeed, the correct
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approach to diagnostic and operative hystero-
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scopy not only requires an adequate attitude
pursuit of excellence, propelling the evolution
towards intra-uterine surgery, but also a thorough
of both science and technology, have made
theoretical knowledge of anatomy, pathology,
hysteroscopy a simple, safe and well-tolerated
instruments, energy sources and complications.
(cid:81)(cid:72)(cid:386)(cid:69)(cid:71)(cid:2)(cid:82)(cid:84)(cid:81)(cid:69)(cid:71)(cid:70)(cid:87)(cid:84)(cid:71)(cid:2)(cid:81)(cid:72)(cid:72)(cid:71)(cid:84)(cid:75)(cid:80)(cid:73)(cid:2)(cid:85)(cid:87)(cid:82)(cid:71)(cid:84)(cid:68)(cid:2)(cid:75)(cid:79)(cid:67)(cid:73)(cid:75)(cid:80)(cid:73)(cid:2)(cid:67)(cid:80)(cid:70)(cid:2)
It is an irrefutable truth that words can only give
documentation options.
an approximate impression of the information
Hysteroscopy has not only helped to overcome the
available. For this reason, this book with its most
fallacy of simple curettage. Apart from providing
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the option of selective treatment of pathology with
importance for all gynecologists opting to enter
almost no risk of damage to adjacent tissues, it has
into the world of advanced hysteroscopy.
become the preferred mode of access to inspect
Prof. C. Nappi and Dr. A. Di Spiezo Sardo have
the subendometrial myometrium for abnormalities.
compiled a most unique and comprehensive col-
A new indication for the hystero scopist is the
lection of didactically elaborated contents, which
exploration of the junctional zone between myo-
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metrium and endometrium – con sidered an area of
so that I highly recommend it for the essential
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reading list of any gynaecologist.
on implantation disorders and abnormal uterine
This textbook on hysteroscopy gives an overview
bleeding of unknown origin. Careful inspection
of all major topics, from the basics to advanced
of this zone receives a lot of interest since it can
surgical procedures and should therefore be
provide answers to important questions like those
recommended for use as a reference to all
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colleagues preparing themselves for the GESEA
on the implantation process. Also in patients with
Diploma as Hysteroscopic Surgeon.
abnormal uterine bleeding disorders or uterine
enlargement of doubtful origin, it allows to obtain A new era in hysteroscopy has begun, and the
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a histopathological examination prior to making a book gives an excellent proof of the enriching
(cid:386)(cid:80)(cid:67)(cid:78)(cid:2)(cid:70)(cid:71)(cid:69)(cid:75)(cid:85)(cid:75)(cid:81)(cid:80)(cid:2)(cid:81)(cid:80)(cid:2)(cid:86)(cid:74)(cid:71)(cid:2)(cid:86)(cid:84)(cid:71)(cid:67)(cid:86)(cid:79)(cid:71)(cid:80)(cid:86)(cid:16) combination of traditional skills and young scien-
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Unfortunately, we have to admit that, even though
I like to congratulate Prof. Carmine Nappi and
we have at our disposal the most advanced
Dr. Attilio Di Spiezo Sardo for this very remarkable
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book !
indications and a comprehensive armamentarium
of techniques, hysteroscopy is still not widely Leuven, April 2014
used in daily practice. The main cause for this Rudi Campo
situation is the lack of teaching in hysteroscopy President of the European Society of
during conventional medical training and the Gynaecological Endoscopy (ESGE)
State-of-the-Art Hysteroscopic Approaches to Pathologies of the Genital Tract 9
Preface
Technical and technological advances, ever more and therapeutic options in the management of
erratic and fast-paced, are continuously revolu- intrauterine pathologies, and, more recently, of
tionizing our everyday life, at times forcing us to those seen in the cervix and vagina.
race ahead just to keep up with the times. This
Therefore, these days, state-of-the art hystero-
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scopy should constitute an integral part of the
which in recent decades has been all but reborn
cultural and professional armamentarium not only
through modern technologies, leading to results
for the select few, but indeed of every gynecolo-
that are both thrilling and astonishing, even in the
gist, including those belonging to the younger
eyes of the most skeptical.
generation, and including even those who trained
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and burgeoning progress is without doubt that
Such is the ambitious goal of this textbook,
seen in gynecologic endo scopy, and particularly
intended as an instructive, practical guide, for
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quick and easy reference, concise yet replete with
During the forty years of my career, I have pictures and detailed references, and meant to
witnes sed, sometimes with a skeptical attitude, be a useful source to all gynecologists, whether
a remarkable development in this technique, young or old, in their clinical practice.
which I have followed with the greatest interest
But for the youngest of these, we recommend this
and curiosity ever since I was a young assistant,
book in the spirit for which it has been designed:
and up until the present time, whereupon I have
for the attainment of the required skill, for building
both the honor and the privilege of directing the
prudence, moderation and responsibility in the
Department of Obstetrics and Gynecology of the
sober use of techniques and technologies, without
University of Naples ‘Federico II’, which today takes
excess, and without yielding to the insidious
pride in having a unit of diagnostic and operative
temptations of technological idolatry. Indeed,
hysteroscopy of real international standing.
hysteroscopy is a reliable and indispensable
Hysteroscopy, in its early days, was considered
technique, conquering as it captivates, having the
the ‘Cinderella’ sub-specialty of gynecologic
greatest potential and future prospects, and yet it
endo scopy, a modality that was both laborious
remains but one formidable weapon in the arsenal
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of clinical reasoning, of which it must remain only
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a part, and which – purely and simply – it cannot
instrumentation – indeed it was rarely used in the
replace.
routine clinical practice, which, for the purposes
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of diagnosis and treatment of intrauterine patholo-
human activity, technological development is
gies, relied almost exclusively upon curettage.
transformed into real clinical progress only when
Over the past twenty years, continuous and rapid
governed and attuned by a professional endowed
advances in technologies and techniques, along
with critical awareness. If science becomes
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subjugated to technologies, the bonds between
efforts on the part of the surgeons to improve
development and progress can break apart, and
their performance, and to overcome obstacles
harmony between technological development
once deemed insurmountable, have opened up
and clinical progress will be subverted into an
new horizons for hysteroscopic modalities, often
antinomy.
feasible in an ambulatory setting, and which today
Carmine Nappi
are considered the gold standard of diagnostic
Naples, March 2014
10 State-of-the-Art Hysteroscopic Approaches to Pathologies of the Genital Tract
State-of-the-Art Hysteroscopic Approaches to
Pathologies of the Genital Tract
Carmine Nappi1 and Attilio Di Spiezio Sardo2
1) Full Professor of Gynecology and Obstetrics
Director of Department of Integrated Practice in Obstetrics,
Gynecology and Urology, School of Medicine and Surgery,
University of Naples ‘Federico II’
2) Assistant Professor of Gynecology and Obstetrics affiliated
with the School of Medicine and Surgery of the University of
Naples ‘Federico II’
Address for correspondence:
Dott. Attilio Di Spiezio Sardo
AOU ‘Federico II’
Via Pansini 5, 80131 Napoli, Italy
E-mail: [email protected]
© 2014 ® Tuttlingen, Germany
Printed in Germany, ISBN 978-3-89756-450-3
P.O. Box, D-78503 Tuttlingen, Germany
Phone: +49 / 7461 / 14590
Fax: +49 / 7461 / 708-529
E-mail: [email protected]
Editions in languages other than English and German are in
preparation. For up-to-date information, please contact
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