Gynaecological Endoscopy and Vaginal Surgery Workshops
Minimally Invasive Therapy Unit & Endoscopy Training Centre
University Department of Obstetrics and Gynaecology
Royal Free Hospital Pond Street
Hampstead
London NW3 2QG, UK
H
Pipelle®
Delegates attending the 3 Day "Hands On" Gynaecological
Endoscopy Skills Workshop are taught the technique
of vaginoscopic or "no touch" hysteroscopy
(NTH) in the outpatient clinic. NTH means that speculums,
tenaculums and other instruments are not used, and
the procedure is done solely with the hysteroscope
using liquid distension. You can see an example of
NTH if you go to Movies.
Until
now, the only way to take an endometrial biopsy after
NTH was to use a speculum to visualise the cervix,
and often a tenaculum to facilitate insertion of
the biopsy instrument. In collaboration with Laboratoire
C.C.D. (France), we have developed a modified
version of the Pipelle de Cornier® for use at NTH, so
that there is no need to instrument the vagina. The
new H Pipelle® is long enough to be passed through
the diagnostic sheath of the hysteroscope once the
optic has been removed at the end of the hysterosocopy.
The ability to obtain an endometrial biopsy without
needing to instrument the vagina increases patient
comfort. Owing to its length, a high suction pressure
is produced and a greater volume of material is aspirated
ensuring that sufficient endometrium is collected
at the first attempt even after hysteroscopy using
a liquid distension medium.
1. Once the hysteroscopic examination of the uterine cavity is finished, the tip of the hysteroscope is withdrawn into the lower uterine cavity.
2. The optic is unlocked and removed completely from the diagnostic sheath.
3. The H Pipelle® is threaded through the sheath into the uterine cavity and up to the fundus.
4. Once the H Pipelle® is in position in the uterus, the hysteroscopic sheath is slid along it to the outside the vagina.
5. A biopsy is then taken in the usual fashion by withdrawing the piston to the end of the biopsy cannula to create negative pressure, and rotating the H Pipelle® while gently moving it back and forth.
All delegates attending the 3 Day "Hands On" Gynaecological Endoscopy
Skills Workshop will also have the opportunity to use the H Pipelle. In the UK, H Pipelle is now available from Eurosurgical Limited.
Reference
Di Spiezio Sardo A, Sharma M, Taylor A, Buck
L, Magos A. A new device for "no
touch" biopsy
at "no
touch" hysteroscopy:
the H Pipelle. Am J Obstet Gynecol.
2004 Jul;191(1):157-8.
