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Preparation for hysteroscopy
Last reviewed: 04.07.2025
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Anesthesia
Hysteroscopy itself is painless, so the choice of anesthesia depends on the need to expand the cervical canal and perform manipulations or operations.
The optimal option for pain relief, taking into account contraindications to it, is intravenous anesthesia (diprivan, sombrevin, calypsol). It is permissible to use mask anesthesia with nitrous oxide. Paracervical anesthesia with novocaine solution is less effective, however, if general anesthesia is not possible, local paracervical anesthesia can be used.
Whatever type of anesthesia is used, the surgeon and anesthesiologist must be aware of the potential for anesthetic complications. To detect and treat them in a timely manner, it is necessary to have a fully equipped operating room.
Operating technique
To perform hysteroscopy, it is necessary to create a working space by expanding the uterine cavity. Gas or liquid is used for this. Each of these environments has its own characteristics, disadvantages and advantages. Depending on the environment, gas and liquid hysteroscopy are distinguished.
Regardless of the type of hysteroscopy performed and the nature of the medium used to expand the uterine cavity, the patient is placed on a gynecological chair in a standard position (as in minor gynecological surgeries). The external genitalia and vagina are treated with a 5% alcohol solution of iodine or alcohol. When performing microcolpohysteroscopy, the cervix is treated with alcohol. Hysteroscopy is preceded by a bimanual examination to determine the position of the uterus and its size. The cervix is fixed with bullet forceps by the anterior lip, which allows it to be pulled up, the cervical canal to be aligned and the length of the uterine cavity to be determined. This is also necessary for expanding the cervical canal with Hegar dilators, but it is important to remember that it is better not to go deep into the uterine cavity so as not to injure the mucous membrane and cause bleeding that obstructs the view. Dilation of the cervix is a very important stage, since it is at this time that perforation of the uterus most often occurs. It is advisable not to measure the length of the uterine cavity with a probe before hysteroscopy to avoid injury to the endometrium.
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