Olympus Flexible Hysteroscopy

August 23, 2006
Michael Moore, MD

OBGYN.net Conference CoverageFrom the 31st Annual Meeting of the American Association of Gynecological Laparoscopists (AAGL)

Michael Moore, MD: This is Michael Moore; I’m at the Olympus booth at the AAGL meeting with Doctor Rene Marty from Paris, France. Dr Marty, you developed a flexible hysteroscope.

Rene Marty, MD: Well, I was one of the people that brought in the SP50, yes.

Michael Moore, MD: It’s fantastic, I’ve seen it. Now this has no fibre optic lenses.

Rene Marty, MD: No, you have two types of fibres, one type going from the eye to the uterus with the lights and the other one from the uterus to the eye with the image. That’s it.

Michael Moore, MD: Yes. Do you use the SP flexible hysteroscope for all your diagnostic procedures?

Rene Marty, MD: Yes. I think it’s a wonderful hysteroscope for outpatient procedures because first of all, it’s flexible so it’s impossible to create false routes like the rigid ones and also because it’s a very small, 3mm is very small, so you don’t, you scarcely need to dilate the cervix to introduce, very scarcely, maybe 5% of the cases, especially on post-menopausal women, of course, and also with the flexibility, you can adapt the hysteroscope always to the individual anatomy which is impossible with any kind of rigid and for me, it’s very important because if you have intuvation or retrovation, latrivation, well you just adjust your, you just adjust the tip of your hysteroscope and you go right if you must go right, and so on. So you do not touch the endometrium or, as you know, if you hurt the endometrium, you may create a few hemorrhages and if you have blood, you don’t see anything. So that’s also a very important point in favor of the flexible and also another important point is the fact that you don’t need any pre-medication at all in 90% of the cases. I do it in office procedures and I use it also in hospital and just the patient comes in, you just explain and say what you are going to do and then, because of, there is a camera, she is always very interested in looking at the screen and everything works perfectly well. 

Another advantage also is that you have an operating channel of 1.2mm and this operating channel allows to use flexible biopsy forceps, 3 French size, so you can get biopsies and also because of the flexibility you can get more precise biopsy than you get with any kind of rigid because you can select exactly the spots where you want to go even, for example, if you have a doubt behind a polyp, in the endometrial hypoplasia, with a rigid you cannot go because you cannot turn over, pass over and with a flexible, you just do that then you can perform really where you want to, you’re by your seat so it’s safer and the results are more reliable.

So, and also you can use some grafting process and so on through this channel and this allows grasping, for example, an embedded IUD and taking it out and also another advantage is that you, if you want to be just in front, just in front of the ostium with the flexible, it’s always possible, always. So you cannulate, you’re just in front and then you just go through. It’s a very easy procedure, also. So now for more than, well, I should say more than fifteen years, maybe eighteen years, I only use flexible.

Michael Moore, MD: You use nothing but flexible for fifteen years?

Rene Marty, MD: No, no, no.

Michael Moore, MD: That’s incredible.

Rene Marty, MD: The problem is when you switch from the rigid as I did to the flexible, you must keep cool because at the beginning for your first six months, I was almost ready to throw away my little toy, the flexible, because I was so used to the rigid so I didn’t know exactly how to use the other one because it’s completely different.

Michael Moore, MD: So there is a little bit of a learning curve.

Rene Marty, MD: Oh, yes, very important, very important.

Michael Moore, MD: So your patients’ pain is reduced significantly with the flexible scope?

Rene Marty, MD: It’s reduced a lot, yes, yes. We don’t need, they always leave after fifteen minutes and well, of course, sometimes, occasionally, you have a problem. Anyway, in this case, you stop and you perform anesthesia or so but it’s, let’s say, maybe 2 out or 3 out of 100 patients.

Michael Moore, MD: So you only use local anesthesia?

Rene Marty, MD: No, nothing. Generally speaking, never nothing and no analgesic, no, nothing. Just the hysteroscope. But I think maybe it’s important to explain, to take enough time to explain before to the patient, she is not a gynecologist, so you explain this is my instrumentation, this is 3mm, this is flexible, and so and so, and also another detail, if I may say, we use normal saline one litre and a half above the patient.

Michael Moore, MD: By gravity.

Rene Marty, MD: By gravity only, so no danger of hydra patient ever because impossible. We didn’t have any because of that and sometimes the patients say that because of the dilatation, they feel like dysmenorrhea.

Michael Moore, MD: So they have a few cramps.

Rene Marty, MD: Yes, cramps, sorry, that’s it. So now I tell them before if you feel some cramps, it won’t be, it’s not going to increase, it’s just because of the fluid so don’t worry and so it works out.

Michael Moore, MD: Okay, so a few cramps and that’s about it.

Rene Marty, MD: Yeah, and they accept it, well, it’s on the proof of the patient. No dilatation, no harm, no anesthesia. As a matter of fact, the fibre hysteroscope, any kind of fibre hysteroscope, adapts to each individual anatomy. This is really the point and because of that, you get what you want.

Michael Moore, MD: So you can take better-directed biopsies and emulations.

Rene Marty, MD: Yes.

Michael Moore, MD: What about polypectomy, myomectomy?

Rene Marty, MD: Oh, yes, polypectomy, oh, myomectomy must be very small one, but polypectomy, yes, very easy also, with a lasso or any way and also, of course, biopsies and proper biopsies, you know that it’s important specially for the patients expecting that they want to have a baby after medical appropriation and you, when you perform your fibroid hysteroscopy at the same time it is very useful to have a biopsy, so it’s easy to do it and you can choose exactly where you want to go and so it’s very important for the future. That hysteroscope is great. It’s easy to use, it’s so, as long as you use it after that, you don’t want to go back. I never saw people, sometimes they hesitate, I understand, but as soon, as long as you use it, you don’t go back to the other one, the rigid, after never. Well, anyway, I’m convinced, you can see that.

Michael Moore, MD: Oh, yes, no, it’s what you’ve done has been fantastic, to bring a scope that’s less painful for the patient and yet highly accurate. Congratulations and thank you so much.

Rene Marty, MD: No, no. Thank you.