Hysteroscopy
It’s the endoscopic inspection of the uterine cavity and cervical canal by means of specially designed optical instruments. It’s associated with high values of sensitivity and specificity in the diagnosis and with high probabilities of success in the treatment of various endometrial and intrauterine pathologies.
It is called diagnostic when thin caliber instruments are used, which only allow the passage of the lens and thus visualize the endometrial cavity; and operative, when using of a larger caliber shirt, instruments can be introduced to carry out surgical procedures, whether scissors, tweezers, or even electrodes to use monopolar or bipolar energy.
It’s “office-based” when it is performed on an outpatient basis, and may not carry out minimal procedures that are accompanied by some form of anesthesia-analgesia.
Technique
- A Speculum is inserted into the vagina. The hysteroscope is then inserted and moves gently through the cervix into the uterus.
- To expand the uterus, carbon dioxide gas or a liquid, such as saline, is injected through the hysteroscope.
- The lining of the uterus and the openings to the fallopian tubes can be seen through the hysteroscope.
- A biopsy or other procedure, using small instruments, can be performed through the hysteroscope.
Indications
- Abnormal pre or post-menopausal uterine bleeding.
- Endometrial hyperplasia or polyps.
- Submucosal Myomatosis.
- Intrauterine synechiae.
- Mullerian Anomalies.
- Retention of an IUD or other foreign body.
- Parity satisfied.
- Endocervical lesions.
Contraindications
- Viable intrauterine pregnancy.
- Acute pelvic infection.
- Known cervical or uterine cancer.
- Recent uterine perforation.
- Inability to receive anesthesia.
- Heavy uterine bleeding (may limit visualization during the procedure, not an absolute contraindication).
Complications
- Uterine Perforation.
- Cervical laceration.
- Fluid overload (acute heart failure, pulmonary edema, dilutional anemia).
- Electrolyte imbalance (hyponatremia, hypo-osmolality, hyperammonemia, hyperglycemia, acidosis).
- Gas Embolism.