Hysteroscopy

Introduction

Hysteroscopy is an imaging technique with which we perform real time visualization of the endometrial cavity, as well as of the endo-cervical canal and of the internal os of the fallopian tubes (Figure 1). Thus, the physician has a more precise diagnosis concerning pathologic conditions concerning mainly the endometrial cavity, which results after gynecologic symptoms, clinical examination, or after exploration of the female genital tract by transvaginal ultrasonography (TVUS) or by hystero-salpingography (HSG). The diagnostic hysteroscopy, can be followed by the therapeutic hysteroscopy, using the suitable hysteroscope such as Bettocchi (Figure 2), or resectoscope (monopolar or bipolar) (Figure 3).
ysteriskopisi1
Figure 1
ysteriskopisi2
Figure 2
ysteriskopisi3
Figure 3
Indications

Diagnostic hysteroscopy
  • Abnormal Uterine Bleeding (AUB) from the female genital tract
  • Endometrial pathology after:
   Transvaginal ultrasound (TVUS)
   Hystero-salpingography (HSG)
  • Exploration of subfertility

Therapeutic hysteroscopy
  • Endometrial polyps (Figure 4)
  • Endometrial myomas (Figure 5)
  • Endometrial adhesions (Asherman syndrome)
  • Congenital anomalies of the Mullerian duct (uterine diaphragm, bicornuate uterus, etc)
  • Residual tissue from previous pregnancy
  • Stuck intrauterine device (IUD, uterine spiral)
Υστεροσκοπική αφαίρεση ενδομήτριου πολύποδας με ρεζεκτοσκόπιο
Figure 4. Hysteroscopic excition of endometrial polyps by resectoscope
Υστεροσκοπική αναγνώριση υποβλεννογόνιου λειομυώματος
Figure 5. Hysteroscopic visualazation of submucosal leiomyoma
Complications

The most often complications after diagnostic or therapeutic hysteroscopy are:
  • Uterine perforation (0.5-1%).
  • Endometritis (infection of the endometrial cavity)
  • Pulmonary embolism
  • Liquid overloaded systematic circulation 
The last two complication are very rare and they are noted after prolonged hysteroscopic procedure (more than 15 minutes) especially in case of therapeutic hysteroscopy, as well as after overpressure of the endometrial cavity (>100 mmHg) from the liquid that was used during the hysteroscopy for the dilatation of the corpus uterus.

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Kalogiannidis doctor

IOANNIS Α. KALOGIANNIDIS MD, PhD

Associate Professor
Obstetrics Gynecology -
Gynecologic Oncology

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