Hysteroscopy is gaining a very important role in modern gynecology. In your opinion. What is the current role of hysteroscopy in clinical gynecology?
Pathology of the uterus and vaginal canal affect females of all ages from infants and toddlers with vaginal bleeding to women in menopause with abnormal bleeding that may be an early warning sign of malignancy. As well, abnormalities of the uterus are most often responsible for heavy menstrual bleeding which is a complaint of up to 30% of patients in the reproductive age. Other common symptoms related to uterine abnormalities include pain and infertility. In short, there is no busy gynecologist who treats women for benign conditions caused by uterine abnormalities who would not benefit from mastering the hysteroscopic tool that allows for diagnosis and treatment of intrauterine abnormalities. A gynecologist without a hysteroscope is like a urologist without a cystoscope or a gastroenterologist without a colonoscope. It is an essential tool that every gynecologist should utilize in order to provide their patients the best care possible.
You have been a leader of very important societies (Past president of the Society of Reproductive Surgeons (SRS) and the American Association of Gynecologic Laparoscopists (AAGL). How can leadership of different gynecologic societies help to expand the use of hysteroscopy around the world?
Societies such as the AAGL and SRS along with active gynecologic surgical societies in Asia, Europe and South America can play a huge role in expanding hysteroscopy around the world. They can do this through education including “hands on” courses with in vitro and cadaveric models. The organizations can sponsor workshops focused on hysteroscopy such as the AAGL is doing this summer in Toronto Canada. Promoting clinical research is key for us to determine which are the most cost efficient and clinically useful tools and techniques. Just as large societies can play a role in developing novel instruments, they should also play a role in outcomes assessment and provide manufacturers with high quality information that will lead to rapid adoption or rapid kill of a new device. On-line videos such as those on Surgery U and Websurg are very useful educational tools sponsored and vetted by key societies. The large societies often have close ties with industry which is important in helping direct industry to develop and market novel cost effective hysteroscopic tools. Lastly, the large societies can help programs that bring hysteroscopic knowledge and tools to underdeveloped countries around the world. Hysteroscopy is the original “NOTES” procedure. As we all know, it is the least invasive procedure for patients that yields excellent outcomes with minimal morbidity.