“My hysteroscope is my stethoscope. I use it in every opportunity when the story doesn’t match,” Linda D. Bradley, MD, said during her presentation at AAGL’s 50th Global Congress on MIGS, “Office Hysteroscopy: Seeing is Believing. A Manifesto for Change.”
Bradley’s message was clear: hysteroscopies are necessary, urgent, and underutilized procedures. During her presentation,1 Bradley passionately made a compelling case for embracing office hysteroscopy in your practice, using patient pictures and videos to illustrate the many situations in which performing hysteroscopies led to better care.
Bradley began with stating the obvious: With a routine exam, you are unable to see within the uterine cavity. According to Bradley, the things that are inserted have been sequestered, hidden, unevaluated, and underappreciated. “Everything is blind,” she began. “What I want us to do, as a nation and as a world, is to stop having these pathetic hysterectomies.”
With hysteroscopies, you can evaluate the patient immediately. You can do them in the office without pain medication. Patients don’t have to take off for work and can serve as their own transportation. They also contribute greatly to informed consent. That is, you can immediately let the patient know—with confidence and accuracy—what is going on in her body and begin necessary treatment.
For instance, Bradley referred to a 28-year-old patient who came into her office after 3 consecutive IUDs fell out without an apparent explanation. After using a flexible hysteroscope, she was able to see that the patient’s 8 fibroids and kissing lesions were to blame. Bradley noted that, with only a Pipelle biopsy, the patient’s results would have been negative. By using the hysteroscope, the patient’s fibroids were able to be detected and resected.
In another case, Bradley was able to detect a small piece of cancer behind the fibroids of an elderly woman.
Too often, she comes across foreign objects, lost IUDs, and suture material, which further emphasized the importance of such a simple procedure. “This is why we do not want stuff to be left in the uterus. The endometrial cavity undergoes metaplastic changes, and these things look like coral reefs,” Bradley said, pointing to the image on display. Contraceptive products are far too common a sight.
She continued with another example in which a patient bled every day after delivery in her 20s. Years later, the patient became menopausal and had episodic spotting 10 to 20 days out of the month. Bradley used her hysteroscope and discovered a cerclage the patient had received 25 years prior that had migrated into the endometrial cavity. After removing it, the patient’s bleeding stopped completely. Without the hysteroscope, the issue may have impacted the patient indefinitely.
The most disturbing case may have been one a colleague shared with Bradley. In this scenario, the patient came in after a cesarean section explaining that she’d been experiencing chronic discharge for months. Thanks to the hysteroscope, Bradley’s colleague discovered a sponge that had been left inside the patient after her procedure, despite surgical checklists and counting.
“We have a device that is better than anything we could do blind,” she concluded. “Make your hysteroscope your stethoscope. It’s time for a revolution for women. They’re counting on us.”