FEATURE OBS/GYNE


 Loop electrosurgical excision procedure (LEEP) For treating cervical dysplasia:


Contraceptive Management - IUD (intrauterine device) insertion and removal


- Hysteroscopic Sterilization ( Adiana, Essure): is a permanent birth control where small flexible micro-inserts are placed into the fallopian tubes


Endometrial biopsy Office Hysteroscopy Endometrial Ablation Micro laparoscopic surgery


OFFICE HYSTEROSCOPY Hysteroscopy may be safely and conveniently performed in the office setting. It may be performed with local anesthesia or even intravenous sedation. New technology makes office hysteroscopy more effective, less expensive, safer, and easier to perform than invasive diagnostic alternatives. Office hysteroscopy has been proven to have superior sensitivity and specificity in evaluating the endometrial cavity. The basic equipment for office


hysteroscopy is relatively simple - a scope, a light source, a camera, and a monitor. Auxiliary instruments would include scissors, biopsy forceps, and graspers. Newer scopes allow the physician to see the entire uterus upon entering the cervix. Office hysteroscopy can be done entirely


with local anesthesia, the only painful part comes at the end of the procedure when a biopsy tissue is taken, saving this for last so as not to disturb the endometrium. Patient preparation is one of the most


important aspects for successful office hysteroscopy. The technological advances made in recent years - for example the introduction of small‐diameter hysteroscopes - have brought about remarkable progresses in the field of office hysteroscopy. However, the main limiting factor to a large‐scale use of office hysteroscopy is the level of pain or discomfort a patient feels during or soon after the procedure, which is often caused by the instrument diameter. Hysteroscopy not only allows


for providing tissue, but permits the gynecologist to choose selected areas for directed biopsy and identify polyps and submucous fibroids. The establishment of an office hysteroscopy unit need not


Arab Health Issue 3 2011 57


be complicated. Hysteroscopy can be performed in a routine office exam room, although a room dedicated to procedures will facilitate its use. A video camera and monitor to display the findings to the patient is a very nice addition, but the hysteroscopic procedure is short enough so that direct visualization is quite easy for the physician. Office hysteroscopy is advantageous


both to the patient and the physician. For the patient it is little more than an extended office visit, usually providing a prompt diagnosis to a problem. Diagnostic office hysteroscopy is a safe procedure, with few significant complications, and the patient can resume normal activities immediately. Savings in terms of physician time average one to two hours when compared to a hospital D&C. These savings occur primarily as a result of minimal office preparation, decreased turnover time between procedures, no anesthesia, and no commute between the hospital and office. With the current focus on cost containment and patient demand for minimally invasive techniques, it is


anticipated that there will be an increased motivation in the office-based gynecological practice to substitute a less expensive and more effective therapeutic procedure, such as office hysteroscopy, for the routine surgical D&C.


PRACTICAL TECHNIQUES TO ENHANCE THE SAFETY OF HEALTHCARE WORKERS IN OFFICE-BASED SURGERY Observation for the general protective measures must be undertaken, with organization of the surgical field. Consideration of alternative treatments in high-risk patients also must be in place. The safe handling and transferring of sharp instruments is a must. In conclusion, there are benefits to an office-based procedure compared to a hospital-based procedure. The scheduling is much easier, the stress is much less, and the cost also is much less. ■


AH


 REFERENCES References available on request (magazine@iirme.com)


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