Hysteroscopy
Hysteroscopy is a method of diagnosing diseases of the uterine cavity and cervical canal using an optical instrument (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 (RDV) was used.
The advantages of hysteroscopy include direct visualization of pathological lesions and the ability to perform targeted biopsy, which is difficult with RVD. Hysteroscopy has a lower complication rate than blind RVD.
Hysteroscopy diagram
There are 3 types of this procedure:
A 2 mm diameter hysteroscope is used; dilation of the cervical canal is not required for its insertion. This eliminates the need for anesthesia, a significant advantage over other types of hysteroscopy. Fluid is introduced into the uterine cavity to allow it to expand and be visualized 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. In-office hysteroscopy allows not only the diagnosis of intrauterine pathology but also minor surgical procedures (endometrial biopsy, removal of small polyps, and dissection of uterine adhesions). This method is widely used, including for assessing the condition of the uterine scar after a cesarean section.
No special preoperative preparation is required for in-office hysteroscopy. This procedure is performed on an outpatient basis, and the patient can be discharged almost immediately afterward. In the postoperative period, the following are recommended: sexual abstinence and the use of antimicrobial vaginal suppositories for 3 days.
If office hysteroscopy fails surgical treatment, further treatment options are discussed, including operative hysteroscopy or hysteroresectoscopy.
No special preoperative preparation is required for in-office hysteroscopy. This procedure is performed on an outpatient basis, and the patient can be discharged almost immediately afterward. In the postoperative period, the following are recommended: sexual abstinence and the use of antimicrobial vaginal suppositories for 3 days.
If office hysteroscopy fails surgical treatment, further treatment options are discussed, including operative hysteroscopy or hysteroresectoscopy.
A 4 mm diameter hysteroscope is used (thicker than for office hysteroscopy), requiring general or local anesthesia. The advantage of this type of hysteroscopy is the ability to perform uterine curettage and remove larger uterine lesions.
A 4 mm diameter hysteroscope is used, with a metal loop to which the electrode is attached, and sheaths of a significantly larger diameter than those used in conventional hysteroscopy. This procedure is also performed under general or regional anesthesia. It is performed in the presence of significant uterine pathology, such as submucosal uterine fibroids, large polyps, or uterine septum. The hysteroresectoscope loop is also used to perform endometrial resection (removal) for recurrent endometrial hyperplasia in postmenopause.
Preparation and recovery
Before performing hysteroscopy or hysteroresectoscopy, preoperative preparation is required: the last meal should be no later than 6:00 PM the day before the operation, and water can be drunk until 6:00 AM on the day of the operation.
Patients are mobilized 2 hours after surgery; anesthesia is usually not required. Discharge is usually the same day or the day after surgery.
Appearance of hysteroscopes
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