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Preparation for hysteroscopy
Last reviewed: 23.04.2024
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Anesthesia
Hysteroscopy itself is painless, so the choice of anesthesia depends on the need to expand the cervical canal and carry out manipulations or operations.
The optimal variant of anesthesia taking into account contraindications to it is intravenous anesthesia (diprivan, sombrevin, calypsoil). It is permissible to use mask anesthesia with nitrous oxide. Paracervical anesthesia with a solution of novocaine is less effective, but in the absence of general anesthesia, local paracervical anesthesia can be used.
Whichever type of anesthesia is used, the surgeon and anesthesiologist should be aware of the potential for anesthetic complications. For timely detection and treatment, you must have a fully equipped operating room.
Operating technology
To conduct hysteroscopy, it is necessary to create a working space by expanding the uterine cavity. To do this, use gas or liquid. Each of these environments has its own peculiarities, 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 on the gynecological chair in the standard position (as in the case of small gynecological operations). The external genitalia and vagina are treated with 5% alcohol solution of iodine or alcohol. When carrying out microline gyroscopes, 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 at the front lip, which allows tightening it, aligning the cervical canal and determining the length of the uterine cavity. It is also necessary for the widening of the cervical canal by Gegar dilators, but it must be remembered 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. Expansion of the cervix is a very important stage, since it is at this time that the uterine perforation most often occurs. Measurement of the length of the uterine cavity by the probe should preferably not be done before hysteroscopy to avoid injury to the endometrium.
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