Hysteroscopy Clinic
Description
Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy).
A hysteroscope is an endoscope that carries optical and light channels or fibers. It is introduced in a sheath that provides an inflow and outflow channel for insufflation of the uterine cavity. In addition, an operative channel may be present to introduce scissors, graspers or biopsy instruments.
A hysteroscopic resectoscope is similar to a transurethral resectoscope and allows entry of an electric loop to shave off tissue, for instance to eliminate a fibroid. A contact hysteroscope is a hysteroscope that does not use distention media.
Cervical dilation ď ś Hysteroscopy has been done in the hospital, surgical centers and the office. It is best
done when the endometrium is relatively thin, that is after a menstruation. Diagnostic can easily be done in an office or clinic setting on suitably selected patients. Local anesthesia can be used. Simple operative hysteroscopy can also be done in an office or clinic setting. Analgesics are not always necessary. A paracervical block may be used using a Lidocaine injection in the upper part of the cervix. ď ś The patient is in a lithotomy position during the procedure. Hysteroscopic intervention can also be done under general anesthesia (endotracheal or laryngeal mask) or Monitored Anesthesia Care (MAC). Prophylactic antibiotics are not necessary. ď ś The diameter of the hysteroscope is generally too large to conveniently pass the
cervix directly, thereby necessitating cervical dilation to be performed prior to insertion. Cervical dilation can be performed by temporarily stretching the cervix with a series of dilators of increasing diameter. Misoprostol prior to hysteroscopy for cervical dilation appears to facilitate an easier and uncomplicated procedure only in premenopausal women.
Indications f 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, submucosal fibroid resection, and endometrial polypectomy. Hysteroscopy has also been used to apply the Nd:YAG laser treatment to the inside of the uterus. Methods of tissue removal now include electrocautery bipolar loop resection, and morcellation. Hysteroscopy is useful in a number of uterine conditions: Asherman's syndrome (i.e. intrauterine adhesions). Hysteroscopic adhesiolysis
is the technique of lysing adhesions in the uterus using either microscissors (recommended) or thermal energy modalities. Hysteroscopy can be used in conjunction with laparascopy or other methods to reduce the risk of perforation during the procedure. Endometrial polyp. Polypectomy. Abnormal uterine bleeding Adenomyosis
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