Respecting Women's Anatomy in Healthcare

A woman’s body has different shapes. The internal anatomy also has variations. As a result, we require and deserve specific surgical instrumentation to perform surgery that puts pain and discomfort at a minimum. Currently, women report painful endoscopic procedures that they don’t forget easily.  Unfortunately, in the male-dominated industry we’re in, the problem persists. 

Presently, the hysteroscope instrument design dictates the way we prepare and the precautions we take, rather than focusing of the patient's varied anatomy. We want both a successful outcome, as well as one that preserves the dignity of the patient. To do that,  we must consider anatomical differences.  The following are some significant anatomical differences, as well as other medical issues encountered prior to a diagnostic or therapeutic procedure:

Patient Criteria:

1.  thinner vs. larger

2. pre-menopausal vs. post-menopausal

3.  nulliparous vs. primiparous/multiparous

Then, there are other considerations:

Procedural Criteria:

4.  diagnostic vs. therapeutic

5.  short vs. longer procedure based on patient’s needs

6.  fluid management

7.  radiofrequency application (monopolar or bipolar?)

In the development of a hysteroscope, it is critical that the above listed issues be addressed to ensure efficiency, effectiveness, safety, and patient comfort. If a woman is large, it is necessary to design a scope that is long enough and durable. If the woman is nulliparous or post-menopausal, the scope’s diameter must be small enough to effectively and safely navigate the cervix that is typically narrow or stenotic. If the procedure is short (less than five minutes), fluid management is not a concern but is a major issue in longer cases especially in therapeutic operative procedures. If we introduce a hand instrument with or without radiofrequency, the scope must be introduced easily while optimizing visualization of the cervical/intra-uterine cavity through management of adequate fluid/CO2 distention, and minimize scope movement while manipulating the hand instrumentation to successfully perform the therapeutic procedure.

At EndoVentions, they are developing three specific modular shafts: a diagnostic shaft and operative shaft, and a specialty shaft for tissue removal procedures. It is important that the length of both shafts be sufficient to cover virtually any body type. The diameter of the diagnostic scope shaft is optimal for the majority of nulliparous (women who haven’t had children vaginally) and post-menopausal women who typically have a narrow or stenotic cervix--and with it the need for dilation. For therapeutic procedures, the operative scope is designed to minimize the need for cervical dilation while still allowing introduction of appropriate-sized hand instrumentation.

Hysteroscopy is an important procedure and the majority of women do find it bearable, but that should not stop us from redesigning hysteroscopes to help physicians enhance the efficiency of the it andgive women the best possible surgical experience.

Dr. Jessica Ybanez Morano is Chairwoman of the Department of Obstetrics and Gynecology; Medical Director of Minimally Invasive Surgery; and Director of Labor and Delivery at Ohio Valley Medical Center. She is also President-Elect of the Society of Laparoendoscopic Surgeons.