Hysteroscopy

Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy).A hysteroscope is an endoscope that carries optical and light channels or fibers. It is introduced in a sheath that provides an inflow and outflow channel for insufflation of the uterine cavity. In addition, an operative channel may be present to introduce scissors, graspers or biopsy instruments. A hysteroscopic resectoscope is similar to a transurethral resectoscope and allows entry of an electric loop to shave off tissue, for instance to eliminate a fibroid. A contact hysteroscope is a hysteroscope that does not use distention media.Hysteroscopy has been carried out in hospitals, surgical centers and doctors' offices. It is best carried out when the endometrium is relatively thin, that is after a menstruation. Both diagnostic and simple operative hysteroscopy can be carried out in an office or clinic setting on suitably selected patients. Local anesthesia can be used. Analgesics are not always necessary. A paracervical block may be achieved using a Lidocaine injection in the upper part of the cervix. Hysteroscopic intervention can also be done under general anesthesia (endotracheal or laryngeal mask) or Monitored Anesthesia Care (MAC). Prophylactic antibiotics are not necessary. The patient is in a lithotomy position during the procedure. Hysteroscopy is useful in a number of uterine conditions: A possible problem is uterine perforation when either the hysteroscope itself or one of its operative instruments breaches the wall of the uterus. This can lead to bleeding and damage to other organs. If other organs such as bowel are injured during a perforation, the resulting peritonitis can be fatal. Furthermore, cervical laceration, intrauterine infection (especially in prolonged procedures), electrical and laser injuries, and complications caused by the distention media can be encountered.