Hisayuki Kaseki

Laser Hysteroscopic Myomectomy Guided by Laparoscopically Assisted Intra-Abdominal Sonohysterography (LHMY-GLAIS): A Preliminary Report

The purpose of this study was to evaluate a new method of hysteroscopic myomectomy based on laser energy delivered by hysteroscopy and guided laparoscopically by intra-abdominal sonography. Laser photo-irradiation and vaporization of myomas was clearly monitored by intra-abdominal sonography, particularly in patients with intramural myomatous components. Fluids used for uterine distention and intra-abdominal washings were those containing electrolytes, therefore abolishing risk for hyponatremia. The exact position of the ultrasound transducer was monitored by laparoscopy while sonohysterography confirmed the exact location of the laser fiber tip and the direction of the laser beam. The actual direction of the laser was controlled by hysterofiberoscopy. Complete removal or vaporization of myomas was successfully performed in 21 of 24 selected women, an 87.5% success rate in patients with single myomas, and 33.3%, 1 of 3, in patients with multiple myomas. No complications occurred. We conclude that this nov...

Evaluation of a prototype flexible digital video hysteroscope (Y0001)

A prototype flexible DV hysteroscope (Y0001) with a tip diameter of 4.8 mm was investigated through comparisons with two other hysteroscopes with subequal tip diameters: A rigid office hysteroscope (OHS) and a hystero-fiberscope (1T). The angle of view, area of coverage, and resolution were compared for each hysteroscope. The angles of view of Y0001 and 1T were found to be significantly larger than that of OHS (p<0.005 and p<0.02, respectively). Y0001 and 1T also had significantly larger areas of coverage than OHS (p<0.005 and p<0.05, respectively). At a focal distance of 5 mm, there was no significant difference in resolution between Y0001 and OHS (p>0.1). The resolution of OHS was marginally higher than that of 1T at this distance, although the difference was not significant (0.05<p<0.1). OHS and Y0001 were also compared in terms of their ease of use in a case of submucosal myomectomy; the viability of the intraoperative images obtained from the two devices was also compared. Y0001 was shown to be superior to OHS in its capability to flexibly reach the recesses of the uterine cavity. The success rate of hysteroscopic biopsy with Y0001 was 100%. The study shows that Y0001 has a wider angle of view, larger area of coverage, and better usability than OHS, indicating that flexible surgical hysteroscopes may be less liable to cause intraoperative complications than rigid hysteroscopes.