Hysteroscopy

Question 1

What is a hysteroscopy?

Answer 1

Inspection of uterine cavity by inserting a fine scope through the cervix (3-12mm)
Visualization of both ostia (point of fallopian tube joining uterus) confirms hysteroscope in correct location
A curette may be used after removal of hysteroscope to remove biopsies

Question 2

Are all hysteroscopies diagnostic?

Answer 2

Some can be interventional
If biopsies are positive, the surgeon may choose to perform a transcervical removal of fibroid (TCRF) using an operative hysteroscope and a monopolar/bipolar diathermy to remove submucosal fibroids or polyps, or the endometrium (TRCE, transcervical resection of endometrium)

Question 3

What are the indications for hysteroscopy?

Answer 3

Investigation of abnormal vaginal bleeding
May be for treatment purposes e.g. endometrial polypectomy, removal of small submucosal fibroids, endometrial ablation, removal of lost IUCDs, transcervical sterilisation

Question 4

Why is saline the preferred method for distending the uterus?

Answer 4

Better view
Reduced vasovagal episodes
Reduced procedure time
Ability to use cautery

Question 5

What complications are associated with hysteroscopy?

Answer 5

Big four
Perforation of uterus
Damage to cervix (if stenosed, entry to uterus may be difficult)
Injury to surrounding organs (bowel, bladder, blood vessels)
Infertility (rare)

Question 6

What may be necessary if complications occur in hysteroscopy?

Answer 6

Conversion to laparoscopy or laparotomy

Question 7

What kind of anaesthetic is used for hysteroscopy?

Answer 7

GA, LA or none

Question 8

What is D&C?

Answer 8

Cervical dilatation with steel rods (Hegar dilators) of increasing size; endometrium then curetted for biopsy
Diagnostic procedure, and inferior to hysteroscopy because cavity not inspected
(dilatation and curettage)