Hysteroscopy

Hysteroscopy is a method of diagnosing diseases of the uterine cavity and cervical canal using an optical device (hysteroscope) with the possibility of simultaneous treatment under visual control. Before the advent of the hysteroscope, a standard "blind" procedure of separate diagnostic curettage of the cervical canal and uterine cavity (Dilatation and Curettage — D&C) was used.

The advantages of hysteroscopy are providing direct control of pathological formations and the possibility of performing a targeted biopsy, which is difficult with D&C. Hysteroscopy has a lower complication rate than with "blind" D&C.

Hysteroscopy diagram

There are 3 types of this procedure:

1

Office (diagnostic + therapeutic) hysteroscopy
A 2 or 2.9 mm diameter hysteroscopes are used, and their insertion does not require dilation of the cervical canal. This eliminates the need for anesthesia, which is a big advantage over other types of hysteroscopy. Fluid is introduced into the uterine cavity to straighten it and make it available for visualization during the procedure. In most cases, the procedure is painless, but some may experience a nagging pain in the lower abdomen and a feeling of distension. When performing office hysteroscopy, it is possible not only to diagnose intrauterine pathology, but also to perform minor surgical manipulations (endometrial biopsy, removal of small polyps, dissection of uterine adhesions). This method is widely used, among other things, to assess the condition of the uterine scar after a cesarean section.

No special preoperative preparation is required for office hysteroscopy. This procedure is performed on an outpatient basis, and the patient can be discharged almost immediately after its completion. In the postoperative period, sexual rest for several days is recommended.

If office hysteroscopy fails, further tactics are discussed — performing operative hysteroscopy or hysteroresectoscopy.
2

Operative (diagnostic + therapeutic) hysteroscopy
A hysteroscope with a diameter of 4 mm (thicker than in office hysteroscopy) is used, and therefore general or local anesthesia is used. The advantage of this type of hysteroscopy is the ability to perform curettage of the uterine cavity, as well as remove larger uterine cavity formations.
3

Hysteroresectoscopy
A 4 mm diameter hysteroscope with a metal loop to which the electrode is connected and sheaths of a significantly larger diameter than in conventional hysteroscopy is used. This procedure is also performed under general or regional anesthesia. It is performed in the presence of significant pathology of the uterine cavity: submucous uterine myoma, large polyps, uterine septum. Also, with the help of a hysteroresectoscope loop, resection (removal) of the endometrium is performed in case of recurrent hyperplastic processes of the endometrium in postmenopause.

Before performing surgical hysteroscopy or hysteroresectoscopy, preoperative preparation is required: the last meal should be no later than 23:00 the day before the operation, water can be drunk until 6:00 a.m. the day of the operation.

Patients are activated 2 hours after the operation, pain relief is usually not required. Discharge is usually carried out on the same day.

Appearance of hysteroscopes of different thicknesses

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