Dr. Pulcinella Ruggero

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Diagnostic Hysteroscopy

Indications and Technique

Diagnostic Hysteroscopy Basic Concepts

It is performed on an outpatient basis, without fasting, without any type of anaesthesia or pharmacological preparation or blood test or vaginal swab.

no speculum is applied, the cervix is not grasped with forceps and the cervix is not dilated. with these simple precautions, the examination is often painless or at most produces a slight discomfort.

  • If properly performed, it lasts 1 or 2 minutes and may leave only a cramp-like menstrual pain above the pubis that disappears in a few minutes without the need for any therapy
  • To distend the cavity of the uterus and make it possible to visualise the inside, a liquid medium (saline solution) is used.
  • The success of the examination and the acceptability to the patient depend on the use of correct technique, adequate and efficient instrumentation, the skill of the operator, which stems both from a natural predisposition and long training, and the number of examinations performed.

Diagnostic Hysteroscopy: Indications

 

  1. Abnormal uterine bleeding in puerperium, childbearing age, pre- and post-menopause and in patients being treated after breast cancer surgery
  2. transvaginal pelvic ultrasound scans suspecting the presence of an abnormality (endometrial thickening, polyps, fibroids, hyperplasia, endometrial carcinoma, isthmocele, etc.)
  3. infertility and infertility
  4. suspected uterine malformations (septum or bicornuate uterus)
  5. pap tests and altered cytological examinations
  6. suspicion of intrauterine adhesions, so-called asherman syndrome, (absent or scanty menses after abortion or post-partum haemorrhage, aspiration for voluntary termination of pregnancy)
  7. monitoring in women taking hormone replacement therapy during menopause or after breast cancer surgery
  8. Early diagnosis of low-risk endometrial hyperplasia
  9. early diagnosis of atypical hyperplasia and endometrial cancer
  10. staging of endometrial cancer
  11. cervical polyps
  12. retention of spiral
  13. postabortion or postpartum chorioplacental residues 
  14. pathological hysterosalpingograms
  15. monitoring of patients at risk of cancer (obesity, diabetes, ovarian polycystosis)
  16. control after operative hysteroscopies such as myomectomies, endometrial ablation and synechiolysis to prevent the formation of synechiae

Diagnostic Hysteroscopy: Technique of Execution

It is performed on an outpatient basis, without local anaesthesia or sedation in the vast majority of cases.

the patient assumes the same position as in a gynaecological examination.

the hysteroscopist takes the hysteroscope, which consists of a thin rigid probe, fitted with lenses and connected by a camera to a monitor that allows the uterine cavity to be viewed, through a cable connected to the light source, enlarged as it would appear in person. The instrumentation is completed by a system that dispenses the distension fluid with two inlet and outlet cables.

the liquid tap is opened and the hysteroscope is placed on the cervix waiting for the external uterine orifice to open.

The distension medium produces a slight and progressive dilatation of the cervical canal in front of the optic that allows the gradual introduction of the instrument, always under direct vision, using a precise and codified technique that allows it to make its way and penetrate inside the uterus. The basic principles for performing a diagnostic hysteroscopy with minimal or no discomfort for the patient are:

1) use a 30° optic with hole vision

2) continue without pushing the instrument but waiting for the relaxation of the portion of the cervical canal in front of the optics

Once inside, the uterine cavity is carefully observed, the entrance to the fallopian tubes, the walls of the uterus to discover any pathologies that may be causing the symptoms for which the patient has been advised to undergo the examination, the endometrium to assess its surface, thickness, colour, vascularisation, and if necessary, targeted biopsies are taken.

Photos can then be taken during the examination, which are then given to the patient together with the report, or a video recording can be made.

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