Hysteroscopy

Hysteroscopy is the inspection of the uterine cavity by endoscopy. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy).

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Method

The hysterocope has an optical system usually now connected to a video system, a light bearing system with fiberoptics, and a channel for delivery of a distention medium. The uterine cavity is a potential cavity, for inspection it needs to be distended. Thus during hysteroscopy either fluid (saline, sorbitol, or a dextrane solution) or CO₂ gas is introduced to expand the cavity. After cervical dilation, the hysteroscope is guided into the uterine cavity and an inspection is performed. If abnormalities are found, an operative hysteroscope also has a channel to allow specialized instruments to enter the cavity and perform surgery. Typically hysteroscopic intervention is done under anesthesia, but a diagnostic procedure can be performed without anesthesia with instruments of smaller caliber.

Indications

Hysteroscopy is useful in a number of uterine conditions:

• Asherman syndrome
• Endometrial polyp
• Gynecologic bleeding
• Uterine fibroids
• Uterine malformations

Complications

The most common problem is a uterine perforation when the instrument breaches the wall of the uterus. This can lead to bleeding and to damage to other organs. Distention media also can lead to an embolus or water intoxication.

Variations

A contact hysteroscope is a hysteroscope that does not use distention media. A resectoscope is a variation of a hysteroscope that contains an electric loop to resect a submucous leiomyoma.