Gynecology

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

The hysteroscope is an optical instrument connected to a video unit with a fiber optic light source.
The uterine cavity is a potential cavity and needs to be distended to allow for inspection. Thus during hysteroscopy either fluids or Carbon Dioxide gas is introduced to expand the cavity. The choice is dependent on the procedure and the patient’s condition. Fluids can be used for both diagnostic and operative procedures. Electrolytic solutions include normal saline and Ringer’s.
A hysteroscope is in fact a modification of the traditional resectoscope, which is used for transurethral resection of the prostate. It has a double-channeled sheath allowing for continuous flow of fluid or gas media into the uterus through the larger channel, while allowing for fewer outflows through the smaller channel. This results in the distention of the uterine cavity. With modern optical technologies, hysteroscopes are getting smaller in diameter yet able to provide larger and brighter images for surgeons' convenience and they can be used for office procedures too.
After dilating the internal cervical os, the hysteroscope is guided into the uterine cavity and an inspection is performed. If abnormalities are found, an operative hysteroscope with a channel to allow specialized instruments to enter the cavity is used to perform the surgery. Typical procedures include endometrial ablation, fibroids resection, and endometrial polypectomy.

Indications

Hysteroscopy is useful in a number of uterine conditions:
Adhesions in the uterus cavity(Asherman’s syndrome)
Polyps
Gynecologic bleeding
Fibroids Submucosal
Uterine malformations(septum)

Complications

Uterine perforation
bowel perforation
cervical laceration
intrauterine infection (especially in prolonged procedures)
electrical and laser injuries