Hysteroscopy is a surgical procedure, in which the uterine cavity is inspected by a small telescope. The end of the telescope that is inserted has a camera which captures intrauterine images which in turn is projected on a monitor. This procedure can be used for diagnostic as well as therapeutic purposes. Surgeries can be carried out with the help of the images obtained on the monitor. A hysteroscope is basically an endoscope which is inserted in a sheath that contains inflow and outflow channels which are used for insufflations of the uterine cavity. In addition to this, there may be an operative channel enabling insertion of scissors and biopsy instruments. The uterine cavity needs to be insufflated with a suitable medium in order to be inspected hysteroscopically. Either fluid or carbon dioxide gas can be used to expand the cavity. However carbon dioxide gas is not used routinely as a medium as there is a risk of developing gas embolism.
Fluids like electrolyte solutions – normal saline and lactated Ringer’s solution can be used for insufflations. Electrolyte solutions are good conductors of electricity hence should not be used with electrosurgical devices. Non electrolyte fluids may be used in such cases, but it can increase the risk of hyponatraemia. Solutions like glucose, mannitol, sorbitol, dextran or a mannitol and sorbitol mixture are examples of non electrolyte fluids. If the patient suffers from fructose malabsorption, sorbitol and sorbitol mixtures must be avoided.
Procedure: Hysteroscopy is done in a hospital setup. Patient is put in the lithotomy position. The procedure can be done under general anaesthesia or paracervical block may be used for the procedure. The cervix is dilated first to enable passage of the scope. The scope is introduced with its sheath. The cavity is then insufflated with a suitable medium. The uterus is then inspected for any abnormalities. The procedure is best done just after menstruation as the endometrium is just shed out and is thinned out. Any operative procedure may be carried out through the operative channel. Most commonly carried out procedures are endometrial ablations, resection of an endometrial polyp or resection of a submucosal fibroid.
Indications: It is useful in a number of conditions such as: Endometrial ablation, endometrial polypectomy, removal of impacted intrauterine devices, myomectomy for uterine fibroids, certain congenital malformations of the uterus like septate uterus, evacuation of the retained products of conception, intrauterine adhesions in cases of Ashermann’s syndrome.
Complications: If hysteroscopy is done in cases of endometrial cancers, there may be spread of the cancer cells to other parts. Another common complication of this procedure is perforation of the uterus. The hysteroscope may damage the uterine walls. In some cases it can perforate through the uterus and damage the bowel walls. Bowel wall perforation as well as uterine wall perforation may lead to peritonitis which means infection in the peritoneal cavity. Other complications are cervical lacerations and intrauterine infections and complications due to the medium used for insufflation. Fluid mediums may cause embolism and fluid overload with electrolyte disturbances.
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