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Hysteroscopic tissue cutting steps and methods

Released on Mar. 21, 2022

Hysteroscopic tissue cutting steps and methods

1. Cutting tissue steps

(1) Place the electric cutting ring on the far side of the tissue to be excised and on the surface of the tissue to be excised. When moving the electric cutting ring to start cutting, the first step is to activate the foot switch, and when you feel the cutting effect in your hand, Then move the handle or spring of the cutter, and the electric cutting ring cuts into the tissue according to the excision requirements, and the tissue is cut off according to the required excision depth. The moving speed is generally 1cm/sec. Remember to stay in a fixed part for no more than 1 second, otherwise the electric heat radiation will cause uterine perforation.

(2) At the end of each excision, tissue should be seen to be cut from the wound surface, but it is only possible to completely cut the tissue when the electric cutting ring is moved into the endoscope sheath and the foot switch is released.

(3) The cut tissue is generally strip-shaped, slightly thinner at both ends and thicker at the center, like a boat. The thickness of the tissue piece is proportional to the depth of the cutting ring, and its length is determined by the distance of the cutting ring and the sheath.

(4) Adjust the thickness of the cut tissue with the internal cervical os as a fulcrum.

(5) When the tissue to be cut is thick, the head of the resectoscope sheath should be slightly tilted forward, so that the cutting ring can cut into the tissue, and then the cutting ring should be moved slightly in an arc to the end of the cutting. , and then raise the mirror sheath slightly to make the tissue cut off smoothly.

2. Cutting method

(1) Back-pulling method: It is the most common knife method using passive cutters. That is, after seeing the lesions at the distal end, pull the trigger back, and the cutting ring will extend forward to reach the target object. If the target object is a polyp, put the polyp into the ring, release the trigger, and the cutting ring will move from the distal end when the trigger rebounds. Move to the proximal end, that is, pull back. At this time, according to the required cutting depth, the operator uses the internal cervical orifice as a fulcrum, presses down or lifts the cutter, cuts and separates the tissue where the cutting ring passes, and pulls the cutting ring to the sheath. When the mouth is opened, the tissue block is cut off, and the basal cut surface is yellow-white due to electrocoagulation.

(2) Forward push method: Point the target object to be cut in front of the endoscope, pull the trigger back, and cut the cutting ring extending forward into the target object.

(3) Sweeping method: It is suitable for excising the diseased tissue of the fundus. Place the cutter on one side of the target object, and the cutting ring faces the target object. Pull the trigger back to make the cutting ring reach the target object, hold the trigger and hold it horizontally. Move the cutter, cut the lesions horizontally, and use this method to remove the adhesions in the lumbar cavity and the uterine septum.