Hysteroscopy
Last reviewed: 23.04.2024
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Hysteroscopy - examination of the walls of the uterine cavity by means of optical systems. This method serves both for diagnosis and for the treatment of various gynecological diseases.
The main advantage of the method is the ability to detect intrauterine pathology (hyperplastic processes and polyps of the endometrium, myomatous nodes, etc.). In modern clinic use hysteroscopes, giving an increase of 5 times or more. Apply gas and liquid hysteroscopy. When pelvic - examination of the uterine cavity is carried out in a gas environment (carbon dioxide). To use gas, a special adapter is needed to seal the neck. Conditions for the application of the adapter are absent in cases of cervical erosion, hypertrophy, its ruptures and deformations. In addition, when using a gas medium, it is not possible to monitor the quality of diagnostic curettage, polyp removal, and unscrewing of the myomatous node because of the danger of gas embolism through damaged vessel walls.
At present, due to the improvement of the quality of optical systems, equipment and instruments, the accuracy of hysteroscopic diagnostics has been increased, and the possibilities of operative hysteroscopy have been expanded.
Of particular importance is hysteroscopy in the identification of various types of pathology of the endometrium. Only visual control allows to remove from the uterus all pathologically altered mucous membrane of the uterus, which is extremely important, since the remaining tissue in the future can trigger a relapse of the disease. This, in turn, leads to the choice of wrong tactics of patient management.
In endometriosis, based on the visualization of the inner surface of the uterus, the diagnosis and the form and stage of the disease can be determined.
Hysteroscopy is of great help in diagnosing submucous myomatous nodes, intrauterine synechia, malformations of the uterus, and the detection of foreign bodies in its cavity.
Thanks to the introduction of electrosurgery in hysteroscopy, new surgical directions have been created in gynecology. A number of operations performed with a hysteroresectoscope, allows to avoid laparotomy, and sometimes the removal of the uterus. This is of great importance for women of reproductive age who plan to have a baby in the future, as well as for elderly patients with concomitant somatic pathology and a high risk of an unfavorable outcome of extensive operations.
Like any invasive method, hysteroscopy requires great surgical skill, appropriate skills and compliance with the rules for its implementation.
Since the publication of the first monograph on hysteroscopy (Phillips) has passed more than 30 years. During this time in the foreign literature was published many monographs on the visualization of the inner surface of the uterus and the technique of intrauterine surgery. However, there are few works devoted to hysteroscopy in the domestic literature.
Over the years, hysteroscopy has moved far ahead in terms of diagnostic capabilities. Along with this, in operative gynecology, a whole direction arose - intrauterine surgery.
History of development of hysteroscopy
Hysteroscopy was first performed in 1869 by Pantaleoni with a device similar to a cystoscope. A 60-year-old woman managed to detect polypoid growth, which caused uterine bleeding.
History of development of hysteroscopy
Hysteroscopic equipment
Hysteroscopy requires expensive equipment. Before starting to perform hysteroscopy, the specialist must undergo special training on the use of apparatus and medical manipulation. Endoscopes and endoscopic instruments are very fragile and require careful treatment to avoid their damage. Before starting work, a specialist should carefully inspect all equipment to identify possible malfunctions.
Hysteroscopic equipment (hysteroscopes)
Diagnostic Hysteroscopy
Methodology
Hysteroscopy can serve to diagnose intrauterine pathology, as well as for surgical interventions in the uterine cavity. The authors of the book consider it expedient to describe the technique of diagnostic and operative hysteroscopy in separate chapters.
Diagnostic hysteroscopy is the method of choosing the diagnosis of intrauterine pathology. The usual separate diagnostic curettage of the mucous membrane of the walls of the uterus without visual control in 30-90% of observations is inefficient and of little informative.
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