Ambulatory services, with the performance of diagnostic and operative hysteroscopy as an outpatient or office procedure, are providing much of the stimulus for the development of devices that will offer women a better hysteroscopy experience. For the many women who are readily able to tolerate outpatient hysteroscopy, it offers significant advantages, as they can receive safe, efficient and effective assessment and treatment of abnormal uterine bleeding, with avoidance of the disadvantages of general anaesthesia and hospital admission. In addition, provision of such services is cost effective. Whilst the focus for the development of new devices has been the improvement of ambulatory hysteroscopy services, new instrumentation may be beneficial for hysteroscopy procedures in any setting. For ambulatory services, important goals are to reduce pain and the duration of procedures, and to enable the ready delivery of both diagnostic and therapeutic outpatient hysteroscopy.
This article discusses innovations for both diagnosis and treatment. Much of the information available about these new devices has been obtained from the manufacturers or from published abstracts submitted for presentation at international meetings that have not been peer-reviewed. Some of the reported studies have been randomised controlled trials, others the results of early investigations.
Highlights
- •
Innovative imaging systems for hysteroscopy were reviewed.
- •
Novel endometrial ablation devices were investigated.
- •
Hysteroscopic morcellators for removal of intrauterine lesions were reviewed.
New devices for hysteroscopy
Imaging systems with readily portable cameras and light sources can be used in examination rooms that are not solely dedicated for hysteroscopy; they enable more flexible use of space and without the storage difficulties of bulky, conventional imaging stacks.
EndoSee™
The EndoSee™ device (CooperSurgical, Trumbull, CT, USA) is novel ( Fig. 1 ). It is a handheld, battery-operated hysteroscopy system that consists of two main parts. The ‘HandTower™’ contains a small (3.5-inch diagonal) touch screen liquid crystal display (LCD) monitor, with video and control electronics and a rechargeable battery. It weighs 400 g; a charging cradle is provided. The hysteroscopes are single-use semi-rigid curved cannulas with a diameter of 15 F (4.5 mm) and a length of 287 mm. The lens, camera and light source are placed at the tip, and comprise a digital processing chip with a CMOS (complementary metal–oxide–semiconductor) sensor, as used in mobile phone and web cameras, with integrated LED (light emitting diode) dual light sources. The CMOS sensor has low static power consumption. The LED light provides a high-intensity light, but without significant heat production, which is important as it is placed inside the uterine cavity. There is a port at the proximal end of the cannula to which can be attached a syringe or inflow tubing for saline irrigation.
Results of observational studies using the device for diagnostic hysteroscopy, primarily in an office setting, were presented as open communications in the new instrumentation section of the AAGL Congress, 2013 . It was reported that good-quality hysteroscopic images were obtained with the device and with minimal need for cervical dilatation. Munro et al. collected data for 24 women who underwent office diagnostic hysteroscopy with the device in one of nine medical centres in the USA . Patient discomfort ranged from none to modest, insertion was generally easy, good visualisation was obtained and it was found to be easy to use. The findings of these investigators support use of the device in a non-specialised examination room, as it has the potential to replace the more usual bulky monitor, camera and light source equipment and without the need for sterilisation facilities.
Other cannulas for use with the HandTower™ may become available for endometrial biopsy and operative procedures, but these require further development . The role of EndoSee™ in the United Kingdom has yet to be determined.
UBIPack GYN
The purpose of the UBIPack GYN (SoproComeg, La Ciotat cedex, France) is to provide a portable system for undertaking hysteroscopic procedures ( Fig. 2 ). It consists of a one CCD (charge-coupled device) camera that has a lower power consumption than the standard CCD camera, with 3 m of cable which can be inserted into a USB port of a laptop or personal computer (not provided). It can be used with either flexible or rigid endoscopes and the software, ICE (Intelligent Control Endoscope) technology provided enables the camera to recognise and adapt to the endoscope in use. Both regular and pendulum heads are available. Light is provided by a compact LED source (UBILIGHT) that has a long duration of use (50,000 h) and with the equivalent light intensity of a 100-W xenon source, but with lower heat emission. The computer software provided, Soproimaging, functions with Windows 7 and provides patient management screens and enables printing of medical reports. Conventional diagnostic and operative rigid hysteroscopes are available too; 30° rod lens, 2.7 mm diameter, 300 mm length hysteroscope with a 10-F (3.3-mm) diagnostic sheath and a 14.9-F (5.0-mm) operative sheath (continuous flow) with 5 F working channel.
The CCD camera is typically used for medical and scientific applications and produces a higher-quality image than the CMOS sensor previously described, but has higher power consumption.
Tele Pack X LED
The Tele Pack X LED (Karl Storz, Tuttlingen, Germany) is not an entirely new system, but has been upgraded and now incorporates a new LED light source and a 15-inch LED backlight monitor ( Fig. 3 ). In addition, surgical procedures can now be recorded and downloaded via USB ports or an SD card slot. It remains a portable, all-in-one system comprising light source and monitor and can be used with all Karl Storz one-chip camera heads and video endoscopes and with a variety of other endoscopes. It is suitable for use in an office setting or operating theatre. The LED light source has an average service life of 30,000 h and is more powerful than the halide light source of the previous model, but with lower heat generation.
Endo-shaft® disposable hysteroscopy sheath
As an adjunct to the hysteroscopes that are available, an Italian company has developed a disposable sheath, Endoshaft® (Xmed srl, Medolla, Italy), that provides a barrier between the patient and the endoscope so that it can be used with another patient without being re-sterilised ( Fig. 4 ). A single hysteroscope could be used for all patients. This may reduce preparation time, enabling more patients to be seen on a list and without the same capital expenditure. Irrigation fluid passes down the outer sheath and the view at the hysteroscope tip is through a clear window at the distal tip of the sheath. The sheath is reported by the company as having smooth rounded surfaces to allow it to easily pass through the cervical canal. Endoshaft can be used with the commonly available hysteroscopes.
