The practice of office hysteroscopy

Smith, Paul Philip (2015). The practice of office hysteroscopy. University of Birmingham. Ph.D.

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Advances in technology have led to the miniaturisation of hysteroscopes without compromising optical performance. This development has facilitated the routine use of diagnostic hysteroscopy in an outpatient setting without the need for general anaesthesia. Further developments have expanded hysteroscopy from a simply diagnostic intervention to an operative one with a plethora of hysteroscopic surgical procedures. The work in this thesis has adopted a mixed methodological approach to rigorously evaluate patient selection, feasibility and efficacy of office hysteroscopy. Based on the results of this thesis we recommend:
1) Women with recurrent PMB should be investigated with either hysteroscopy or saline infusion sonography.
2) Vaginoscopy should probably be used in preference to other techniques to introduce the hysteroscope into the uterine cavity.
3) Women who have a uterine cavity >9cm or dysmenorrhoea should be warned they are more likely to require further intervention after endometrial ablation.
4) There appears to be no difference between the effectiveness of bipolar radiofrequency ablation and thermal balloon ablation at five years of follow up.
5) Women who present with abnormal uterine bleeding and an endometrial polyp should have it removed.
6) The hysteroscopic morcellator should be used in preference to bipolar resection for endometrial polyp removal.

Type of Work: Thesis (Doctorates > Ph.D.)
Award Type: Doctorates > Ph.D.
College/Faculty: Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department: School of Clinical and Experimental Medicine
Funders: None/not applicable
Subjects: R Medicine > RG Gynecology and obstetrics


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