The Role of Hysteroscopy in the Diagnosis and Treatment of Adenomyosis

Uterine adenomyosis is a common gynecologic disorder in women of reproductive age, characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Dysmenorrhea, abnormal uterine bleeding, chronic pelvic pain, and deep dyspareunia are common symptoms of this pathological condition. However, adenomyosis is often an incidental finding in specimens obtained from hysterectomy or uterine biopsies. The recent evolution of diagnostic imaging techniques, such as transvaginal sonography, hysterosalpingography, and magnetic resonance imaging, has contributed to improving accuracy in the identification of this pathology. Hysteroscopy offers the advantage of direct visualization of the uterine cavity while giving the option of collecting histological biopsy samples under visual control. Hysteroscopy is not a first-line treatment approach for adenomyosis and it represents a viable option only in selected cases of focal or diffuse "superficial" forms. During office hysteroscopy, it is possible to enucleate superficial focal adenomyomas or to evacuate cystic haemorrhagic lesions of less than 1.5 cm in diameter. Instead, resectoscopic treatment is indicated in cases of superficial adenomyotic nodules > 1.5 cm in size and for diffuse superficial adenomyosis. Finally, endometrial ablation may be performed with the additional removal of the underlying myometrium

Histogram plots for R, G and B channels for calf endometrium for (a) angle 1 and (b) angle 2 views (after gamma correction)

<p><b>Copyright information:</b></p><p>Taken from "A standardised protocol for texture feature analysis of endoscopic images in gynaecological cancer"</p><p>http://www.biomedical-engineering-online.com/content/6/1/44</p><p>BioMedical Engineering OnLine 2007;6():44-44.</p><p>Published online 29 Nov 2007</p><p>PMCID:PMC2246140.</p><p></p

Box plots of selected texture features of experimental tissue (calf endometrium) for Angle 1 and Angle 2 views before and after gamma correction

<p><b>Copyright information:</b></p><p>Taken from "A standardised protocol for texture feature analysis of endoscopic images in gynaecological cancer"</p><p>http://www.biomedical-engineering-online.com/content/6/1/44</p><p>BioMedical Engineering OnLine 2007;6():44-44.</p><p>Published online 29 Nov 2007</p><p>PMCID:PMC2246140.</p><p></p> Plots (a) and (b) present SF variance and SGLDM contrast features before gamma correction respectively. Plots (c) and (d) present the same texture features after applying gamma correction. (The notched box shows the median, lower and upper quartiles and confidence interval around the median for each feature. The dotted lines connect the nearest observations within 1.5 of the inter-quartile range (IQR) of the lower and upper quartiles.

Texture feature value variability for the angle 1 and angle 2 views as a function of scale for SGLDM entropy and GLDS homogeneity

<p><b>Copyright information:</b></p><p>Taken from "A standardised protocol for texture feature analysis of endoscopic images in gynaecological cancer"</p><p>http://www.biomedical-engineering-online.com/content/6/1/44</p><p>BioMedical Engineering OnLine 2007;6():44-44.</p><p>Published online 29 Nov 2007</p><p>PMCID:PMC2246140.</p><p></p

Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery

In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general

Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery

In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general.publisher: Elsevier articletitle: Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery journaltitle: European Journal of Obstetrics & Gynecology and Reproductive Biology articlelink: http://dx.doi.org/10.1016/j.ejogrb.2016.02.003 content_type: article copyright: Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.status: publishe