Performing Hysteroscopy: A Practical Approach

Hysteroscopy is a common procedure utilized by gynecologists to investigate and treat various conditions affecting the uterus. It allows for a direct visualization of the uterine cavity and provides valuable diagnostic and therapeutic benefits. In this article, we will delve into the practical aspects of performing hysteroscopy, highlighting the key steps and instruments involved in this procedure.

Preparation is crucial before performing hysteroscopy. The patient’s medical history, especially any previous uterine surgeries or acute infections, should be thoroughly evaluated. A detailed discussion with the patient about the procedure, its risks, benefits, and possible outcomes is essential to obtain informed consent.

To begin the procedure, the patient is placed in a lithotomy position and a speculum is gently inserted into the vagina, allowing for visualization of the cervix. A cervical dilator, such as a Hegar dilator or a cervical dilator set, may be used to gently dilate the cervical canal, facilitating the introduction of the hysteroscope.

The hysteroscope, a slender instrument with a light source and video camera at its tip, is then inserted into the uterine cavity through the dilated cervix. There are two main types of hysteroscopes: rigid and flexible. Rigid hysteroscopes provide a better image quality, but require a larger cervical dilation. Flexible hysteroscopes, on the other hand, allow easier access to the uterine cavity in patients with a stenotic cervix.

Once the hysteroscope is in place, saline or another suitable distention medium is infused into the uterine cavity to expand it and improve visualization. The fluid can be infused under pressure using a pump or gravity-fed using a bag system. Continuous monitoring of fluid balance and pressure is crucial to minimize complications such as fluid overload or uterine perforation.

During hysteroscopy, the uterine cavity is carefully evaluated for abnormalities such as polyps, fibroids, adhesions, or uterine septum. These findings can be further substantiated using instruments like forceps or scissors for tissue resection or biopsy. The hysteroscope can be rotated and moved to explore different angles and regions of the uterus, ensuring a thorough examination.

Before concluding the hysteroscopy, it is vital to carefully inspect the endometrium. Any suspicious lesions or areas of concern should be biopsied to rule out malignancy or other pathological conditions. This biopsy is often performed using a specialized instrument called a curette or with the aid of a biopsy forceps.

After completing the necessary diagnostic or therapeutic interventions, the hysteroscope is carefully removed from the uterine cavity. The cervix is inspected for any bleeding or trauma, and appropriate measures are taken to mitigate these issues, such as applying pressure or using a cervical stitch.

Post-procedure care involves ensuring the patient’s comfort and addressing any potential complications. Patients may experience mild cramping or vaginal bleeding after hysteroscopy, but these symptoms usually resolve within a few days. Pain medications or nonsteroidal anti-inflammatory drugs can be prescribed to alleviate discomfort if necessary.

In conclusion, performing hysteroscopy requires meticulous planning and execution. Adequate patient preparation, careful instrument selection, and methodical examination of the uterine cavity are essential to maximize the benefits of this procedure. With an emphasis on patient safety and optimal clinical outcomes, practicing hysteroscopy with a practical approach will undoubtedly contribute to the effective management of uterine pathologies.