Hysteroscopy: When is it Necessary?

" harmonious thank you for being with us today. We are discussing how history Oscar that he has become an alternative to hysterectomy in treating abnormal you Ryan deleting. Don't walk us through this procedure and its effectiveness is a gynecologist and one of his patients we appreciate your being here. Doctor Marvin Goldstein is associate clinical professor of obstetrics and gynecology at mount Sinai hospital. And next to him is -- he is a fifteen year old mother of two who has agreed to share her story though because of the sensitive nature. She does not want her safe sound thank you both for being here. -- goes in let's talk again about his roster what exactly is it."

" There's -- to be a technique which can be either diagnostic. Or therapeutic. Trust -- the United States in the 1970s. Initially as a dying not procedures. In the mid 1980s. We links sister I speak to research how things which is a way of using any surgical instruments. To be able to cut fiber is out of the uterus or remove polyps commuters. I'll by removing -- from within these central cavity of the uterus without making an abdominal incision. We have the option to do conservatives. Minimally invasive surgeries and -- patient to get back to her normal function. Usually within one or two days and we're talking about a sudden coastal cyber is that right at about how. Many you know what percentage of women have the site this site somewhere between thirty and 50% of the Mormon Mormon population in the United States has fiber. Most of these hybrids that do not create any problems. People have you heard heavy bleeding usually is due to -- said the proposal vibrant. -- An actual number of W is Barbara. In the United States is much fewer than -- 40% of people who have overall -- Probably. Two to 5% of people with five -- might have a a news conference the dollar when you went to see doctor Goldstein like symptoms that we were experiencing at the time."

" I had been weak and tired and I had a Anemia. And I was not aware. How heavy. -- my periods where it felt the last months."

" Now is that common not to -- a woman would not aware that he's actually bleeding more heavily than -- either she used to work she should -- most of us are creatures of habit. And if we're accustomed to really usual circumstance we mean I think that's abnormal. Unless you would compare your story forward compared how many and she went through during your period with a neighbor's attention my. -- fumbling twice as much as my neighbors. And Ari do you give us a sense if you're comfortable with this how much to a bullying I'm obviously this would accomplish the doctor but may help some of the went out -- Subsequent you haven't discussed what -- you realize why are amply more than miniature."

" well my periods where. Always like clockwork every 28 de Silva had no change and that's what they had a change in northern links. My period. It -- intensity in the flow. There was a frequency of changing I -- it. But once more and I ask me questions. Putin's -- week. Two hours and then. And I look back I must have been maybe even an hour -- past. 4824. Hour period."

" You don't see you do you do a long work up and asked to come to conclusion that she has said these commercials vibrant deadlocked. We presented the options of treatment to Valerie and we found what was I deal struck -- and Valerie wanted to maintain her uterus because women who want to do. Riding this program we found that the -- rumors in -- location that was amenable to mr. Scott degree section. Reason usually mentioned a loop on up salary from bleeding to decrease the blood supply -- the uterus include decreased the amount of bleeding during the procedure. Harlem schedules a procedure that. Let's talk about procedure. Okay we have addressed some video of it and this is actually. Valerie -- out we should tell our audience that our he had a tennis ball size of your calls -- lord warns that we can do what we say nowadays scope that you joined --"

" Are now looking through history scope which is attached to a television camera and the wire loops that you're seeing things and it's wrinkled reset the scope which goes through its Crisco you seek to structures here directly in front of being touched by the respect to scope. This -- small polyps. And instruction were now touching his a large and you can -- you -- a large blood vessels on the surface of the five permanent. Are you also see blood vessels on the surface of the parliament. Do you respect scope is attached to a television screens of the image that I see when I'm doing surgeries same as you see on the monitor now. -- the last of these -- we're removing here's the opening of celestial being true. Values intersect the scope -- very cutting aren't. We are cutting -- pop out and removing it. That is now accomplished we're now looking to have your -- firebird which occupies about it. Half of these. The volume of the universe is this the largest that you're innocent. Knowing that some of the farmers that were similar in -- arsonist. But this is -- chairman -- disarmament. What is our feeling at this point it Valerie is an innocent -- at this point of owners not to leave anything. These respects so there's no. Pressing on the Yugoslav refusal currently we are shaping the fire broke away. -- it is almost like. Cutting you want -- through cheese it's been an electric current going through the wire loop allows us to cut it also cordially vessels as -- cutting."

" We're seeing a lot of auto service he had a question that most people without looking after this is a patient in danger of bleeding to death for all of these that's being. I didn't have. During the procedure this is done under control as we're cutting the vessels -- current co regulate the vessels as we remove this segment of Barbara that hasn't vessels -- it. We do not see any bleeding when we get to the base of the fiber in the -- part of the fibroid. It comes from the muscle wall of the uterus we get into the blood supply fiber that you -- now. The -- a muscle tumor and personal to muscle of the uterus. We're now using color regulating current of different frequency took away -- the blood vessels that are feeding trying to bring this stuff. Tell us about the fluid -- ever want to get you liquid were uses such calls like him which then stretch some of the uterus. -- itself -- a potential cavity rather than a true cavity so we do something to stretched a cavity of the uterus won't be able to see they're taking something out is this the actual. In the social work area that's coming out removing segments -- because -- fiber and as removes segments of the semi -- ports -- the -- bring that are within the muscle wall intramural component."

" He's going to be further pushed into the cavity of the uterus so there are doing this and continuous fashion. We can remove -- fiber that may only be 50% of mucus and 50% intramural. You can't take the instrument and push it into the most of the uterus because you run the risk that you may go through the outer wall. But if -- loudly muscle of the uterus to contract. As a muscle contract. And pushes the fibroid into the cavity so we can safely shave away more court. -- fiber and -- taking time undoing the carefully we can remove. Former entire fiber in most cases in the entire Barbara you have the instrument in your hands so that you tell us about it it looks. -- like almost like hey stapled out of sorts it's no --"

" Early. In that I had a history scope. And introduce her sculptures and -- curator solid center. Each patient to -- pre dilated brings -- eleven area. So we get an operating room. -- is open I'm able to gently placed this instrument. Threw me cervix into the uterus and Bob. So this is my fingers with -- cervix complacent instrument through the cervix. Into the uterine cavity. Once in your ministry the cervix. And I would remove the alternative. And replace the arbitrator. With intersect scope. -- There's an instrument that has sent viewing port which will have a television camera attached to it. A light source which provides light through fiberoptic source. Through the instrument into the uterus a so we can see it. And then -- the wire -- respect scope that it allows that his permit me to remove the -- back and forth and shave."

" and this is what he had the end of this is this wire loop that has electrical charge and that's what's cutting right there -- is the operative part of an instrument aren't very good information about our thanks a lot for joining us again we RO. Clearing your face to -- a sense of nations is what we do appreciate you. Turn up on our program today and die tomorrow and Goldstein who it is the clinical associate professor of obstetrics and gynecology had not and I thanks for your time as well. I'm Paul -- thanks for joining us and remember that twentieth 50% of all women have fibroid. If you believe you have one and even if you think causing any problems. They want to talk little with the doctor and I would suggest is if there are problems get a second after it."