A single stepto diagnoseand treatAcc. Dr. R. Ricciardi, MD.

HYSTEROSCOPY ENDO-OPERATIVE SYSTEM

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A SUCCESSFULCOMBINATION

The execution of this innovativeproject leaves nothing to chance:on one hand, the experience inthe field of hysteroscopy built upby Dr. Raffaele Ricciardi overmore than twenty-five years ofprofessional activity, with one of

the most representative track records of casesexamined in the world, and on the other handthe enthusiasm, dynamism and know-how of theFranco-German manufacturer SOPRO-COMEG,which has easily managed to interpret thetechnical instructions and the potential of thisinstrument, and which had a firm belief in theidea, transforming it into an outstanding pieceof technology.

BIRTH OF

“This was how the HEOS (HysteroscopyEndo-Operative System)was born: Anewoperatingsystem that combines traditional resectoscopysurgical capabilities, combining and integratingthem into an endoscope that also enables

laparoscopic mechanical and electro-surgicalinstruments to be used.This instrument is the subject of a patent whichoutlines the functionalities of a traditionalcontinuous flow resectoscope along with anoptical unit with an offset eyepiece, fitted witha 13 Fr (4.3 mm) operating channel which enablesthe insertion of mechanical instruments with adiameter of 3 mm (scissors, dissectors andgrasping forceps), as well as a range of straightand curved instruments and electrodes that areboth monopolar and bipolar. It continuallyguarantees an excellent continuous irrigationflow and consequently a clear operating field.All this with a view to broadening surgicalpossibilities in hysteroscopy, while reducingoperating times, which until now depended onsu rg i c a l re sec t o scopy o r t he use o fmicro-instruments using an operating channelof 5 Fr (1.6 mm), andmoreover not in a combinedway, as it is the case with the aforementionedinstrument.The HEOS constitutes a synthesis that lookslike a giant step into the future.”

Dr. Raffaele Ricciardi, MDManager of the Hysteroscopy CentreAbano Terme Polyclinic (Padova - Italy)

THE CONCEPT

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Endocavitary pathologies

Such as uterine, sessile, or pedunculated polypscan be treated with the monopolar or bipolarelectrodes. Such neoformations, up to the size ofabout 2 centimeters, after having being firmlyclasped with the appropriate grasping forceps,may be sectioned at the peduncle (if it can beidentified), and then extracted practically intactvia the cervical canal, while remaining visible at alltimes. Obviously, operating times are reduced,both compared to using a traditional resectoscopewhich requires time to achieve fragmentation byslicing the neoformation up and extracting theindividual fragments, and compared to usinghysteroscopes operating sheath with a channelmeasuring 5 Fr (1.6 mm), with which it is necessaryto fragment the neoformations multiple times usingmechanical or electrical micro-instruments, and thento remove the individual fragments, which must notbe more than a few millimeters.

Larger polyp neoformationsThey may be segmented using the electrodesprovided, breaking them into individual fragments thatare even larger than one centimeter. They are thenconveniently removed using the grasping forceps,through the external sheath which is maintained inposition throughout the cavity.

SURGICAL PROCEDURES

PEDONCULAR SECTION INCISION OF ENDOMETRIAL POLYPWITH HEOS MONOPOLAR ELECTRODE

PEDONCULAR SECTIONOF LARGE ENDOMETRIAL POLYP

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Class G0 myomasThese pathologies, which nearly always developin an intracavity context, may be treated eitherusing a resectoscope and a loop, or using theelectrodes, which can be inserted into the operatingchannel. In such a case, they may be sectionedinto segments that are also one centimeter orlarger (depending on the consistency) and takenout of the cavity. Myomas up to 2 centimeters cantherefore be sectioned into just two or threesegments.Should the myoma (class G1 or G2) have a majorintramural component, after having removed itwith the dissector, using the resectoscope loop orthe electrodes and after having identified thecleavage level, it is possible to completely enucleatethe intramural part of the myoma by cutting awayand sectioning the pseudocapsule’s connectivebridges from themyoma. If the intramural componentin the cavity turns out to be voluminous, it ispossible to section it by using scissors or electrodes,and then remove substantial fragments grabbedusing the grasping forceps, while being able tocarry out visual checks at all times. Such surgicalpossibilities obviously reduce operating times,as well as reducing the risk of intravasation ofdistention and fluid.On top of that, it is possible to

use saline solution with bipolar electrodes andmechanical instruments.Obviously the operating technique andmethodology,in relation to the sizes and the extent to which themyoma has an intramural component, depend onthe operator’s experience, although such a system,using more intuitive operating techniques, enablesa faster learning curve.

SURGICAL PROCEDURES

COAGULATION OF THE PEDONCULARBASE OF AN ENDOMETRIAL POLYP

INSTRUMENTS VIZUALISATIONWITH HEOS UNIVERSAL HYSTEROSCOPE

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Operations such ashysteroscopic metroplastyThese operations, by sectioning uterine septumsmay make purely mechanical use of the scissors,which undoubtedly have a greater cutting capacitycompared to 5 Fr (1.6 mm) microscissors, or 3 mmmonopolar or bipolar electrodes. From the conceptsoutlined, it may be deduced that using such a systemmakes it possible to obtain undoubted advantagesin terms of treatment of large-volume endo-uterinepathologies compared to using hysteroscopic surgicalmini-instruments which enable surgical operationsthat can be resolved within 10 to 15minutes at most(always depending on the operator’s level ofexperience), if dealt with in an outpatients’ clinic, andwithout resorting to analgesia or anaesthesia.The HEOS system, which requires cervical dilationof 9.5 - 10 mm by using a Hegar set, may be usedwith intravenous sedation and assisted breathingwith a mask or, as an alternative, by resorting toparacervical plexic analgesia which, by eliminatingthe pain relating to cervical dilation and the distentionof the uterine cavity, makes it possible to carry outvery effective work inside the cavity, particularly withmechanical instruments that do not cause electricalor thermal stimulation with action on the muscularstructures.

To conclude, with such a system, avenues thathave already been explored may be coveredmore easily, and areas and techniques that havenot yet been explored may be opened up, witha broadening of the surgical possibilities in thefield of hysteroscopy.

The HEOS is a truly universal endoscope, consistingof an external sheath measuring 27 Fr (9 mm) towhich it is possible to fasten both an internal sheathcombined with a passive working element and astraight-line optical and viewing system, with all thetraditional handled resectoscopic tools available,and an optical unit with an offset eyepiece featuringan operating channel of 13 Fr (4.3 mm), whichenables the use ofmonopolar and bipolar electrodes,aswell asmechanical andpower-operated instrumentsfor cutting, dissecting and grasping.

The therapeutic possibilities range from the removalof polyp formations (including voluminous ones),with a reduction in operating times, to the removalof myomas of various masses and sizes, whetherthey are intracavity or intramural ones (Classes G0,G1 and G2). HEOS allows the use of variousinstruments in order to break them into fragments,achieve enucleation of the intramural segments, andpossible removal from the uterine cavity, whichreduces the risks of sequelae, of trauma or ofintravasation.

GRASPING OF ENDOMETRIAL POLYPWITH HEOS GRASPING FORCEPS

FRAGMENT EXTRACTION OF ENDOMETRIAL POLYPSUNDER HEOS VISION

HIGH VISIBILITY SAFER

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393 310 251 • 3 mm curved Metzenbaum scissors insulated, double action jaw33 cm working length, dismantableincluding plastic handle without ratchet ref. 393 011 100and insulated insert/shaft ref. 393 300 251

393 310 243 • 3 mm Kelly grasping forceps insulated, double action jaw33 cm working length, dismantableincluding plastic handle without ratchet ref. 393 011 100and insulated insert/shaft ref. 393 300 243

393 310 218 • 3 mm universal grasping forceps insulated, double action jaw33 cm working length, dismantableincluding plastic handle without ratchet ref. 393 011 100and insulated insert/shaft ref. 393 300 218

393 310 203 • 3 mm micro scissors straight insulated, single action jaw33 cm working length, dismantableincluding plastic handle without ratchet ref. 393 011 100and insulated insert/shaft ref. 393 300 203

195 800 035 • HEOS 27Fr Quick-Lock hysteroscopy sheathwith surrounding perforationwith one rotatable stopcockwith Quick-Lock connecting system for easier and quicker useto use with universal hysteroscope ref. 165 800 010or with resectoscopy inner sheath ref. 195 030 501including Quick-Lock standard obturator

393 310 201 • 3 mm claw grasping and extracting forceps insulated,2 + 3 teethsingle action jaw33 cm working length, dismantableincluding plastic handle without ratchet ref. 393 011 100and insulated insert/shaft ref. 393 300 201

165 800 010 • HEOS Straight forward universal hysteroscope 0°with parallel eyepiece8.3mm x 6mm outer size, length 222 mmwith rod lenses optical systemautoclavable, with fiber optic light transmission incorporatedwith 13Fr. Working channelwith Quick Lock connection for use with Quick-Lock hysteroscopy sheath.color code:

HEOS P

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* HEOS PACKAGE : REF. 191 306 000391 306 000 • Plastic sterilisation container for HEOS

390 843 000 •Bipolar cable300 cm lengthwith 4 mm banana probesto use with bipolar electrodes

395 502 507 •Monopolar cable300 cm lengthwith 4 mm banana plugsto use with monopolar electrodes

392 999 659 • 2.8 mm monopolar hook electrode36 cm working length

392 999 658 • 2.8 mm monopolar loop electrode36 cm working length

392 999 657 • 2.8 mm monopolar button electrode36 cm working length

w

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392 993 127 • 3 mm bipolar needle electrode36 cm working length

392 993 126 • 3 mm bipolar V-hook36 cm working length

392 993 125 • 3 mm bipolar L-hook36 cm working length

S PACKAGE* INCLUDES THE FOLLOWING DEVICES

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ADVANCED

ZAC Athélia IV • Avenue des Genévriers • 13705 La Ciotat cedex • FRANCE • Tel +33 (0) 442 98 01 01 • Fax +33 (0) 442 71 76 90E-mail: info@sopro-comeg.com • www.sopro-comeg.com

We are suggesting to complete your package with a complete resectoscopyset to allow the main gynecologic operative procedures.This optimized package is named (ref. 191 306 100) and includes the following devices :

ADVANCED

195 020 000 • Quick-Lock passive working elementto use with 4 mm telescope 12° ref. 163 412 981

191 306 000 • package

195 030 501 • 24Fr. Inner sheath with ceramic tip insulationwith one fix stopcockwith Quick-Lock connecting system for easier and quicker use to usewith 27Fr. Quick-Lock outer resectoscopy sheath ref. 195 040 540or with HEOS Quick-Lock hysteroscopy sheath ref 195 800 035

163 412 981 • Straight forward telescope 12°Ø 4mm - length 301 mmwith rod lenses optical systemautoclavablewith fiber optic light transmission incorporatedColor code:

195 101 000 • Sterilisation tube for electrodes

195 100 000 • Cutting loop, angled, 24Fr.wire diameter 0.35 mm

195 100 001 • Cutting loop, straight, 24Fr.wire diameter 0.35 mm

195 100 010 • Coagulating electrode, pointed, 24Fr.

195 100 050 • Coagulating electrode, ball shaped Ø 3 mm, 24Fr.

195 200 004 • Monopolar High Frequency cable300 cm length for Sopro-Comeg monopolar electrodes andmonopolar resection working elementwith 4mm banana plugto connect with electro surgery units model Martin, Berchtold, Erbe Tand others

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