B28. Diagnostic and operative hysteroscopy

Hysteroscopy is a diagnostic and/or therapeutic procedure in gynaecology. A fibreoptic endoscope is passed transcervically into the uterine cavity, which gives a view of the uterine cavity, tubal ostia, and endocervical canal.

Procedure

The hysteroscope includes a light source and equipment to infuse uterine distending media, like gas or fluid. It also contains an operating channel through which surgical instruments may be inserted and used, like scissors, biopsy forceps, electrodes, scalpel, etc. The scope may be rigid or flexible.

Most women need mechanical cervical dilation with a Hegar dilator to undergo hysteroscopy. By administering local misoprostol to the patient the day before the procedure, the cervix will ripen, making dilation easier.

During the procedure, the uterus is distended with gas (CO2) or a fluid. The fluid used is usually Isodex, a glucose solution.

It can be performed under general anaesthesia or in an outpatient setting with regional anaesthesia. For diagnostic procedures and smaller therapeutic interventions, outpatient procedure with regional anasesthesia is usually sufficient. Regional anaesthesia usually involves either a paracervical block (injection into upper part of cervix) and/or topically to the cervix.

Diagnostic indications

Evaluation of abnormal uterine bleeding
Evaluation of endometrial polyps, myomas
Evaluation of infertility, to assess the uterine and fallopian tube patency
Evaluation of Müllerian abnormalities

Therapeutic indications

Resection of submucosal or mucosal lesions, like polyps, fibroids
Biopsy or resection of endometrium
Resection of intrauterine adhesions (Asherman syndrome)
Sterilisation
Removal of foreign body or IUD

Contraindications

Intrauterine pregnancy
Active pelvic infection
Cervical or endometrial cancer

Complications

Uterine perforation
Fluid overload
Gas embolism

Complications are rare.