Diagnostic Hysteroscopy
Instrumentation
Diagnostic Hysteroscopy Instrumentation
- Optical system (optics, camera, monitor)
- Relaxation media (gaseous and liquid)
- Lighting system (cold light source and transmission cable
- Image and video archiving system )
Optical system:
The optics can be of various calibre (4 mm, 2.9 mm and 2 mm). The 4 mm one, better known by the name Hamou1, being of a larger calibre is less used today and reserved only for major hysteroscopic surgery.
N.B.: it is not the calibre of the instrument but a correct execution technique, adequate experience and proven and certified training that makes the examination easy to perform, repeatable and well-tolerated by the patient without resorting to local or general anaesthesia!!!!
The optics consist of a lens system and all have a 30° bore-oblique view with a 'clarinet beak' end. This is essential to be able to pass through the cervical canal without trauma and to allow a complete and panoramic view of the uterine cavity without moving the instrument but simply rotating it on its axis.
The 2.9 and 2 mm optics can be combined with an oerative sleeve into which micropliers, microscissors and electrodes can be introduced to perform ambulatory surgery
Means of Relaxation:
They can be gaseous or liquid. among the gaseous media, only CO2 (carbon dioxide) is used as a means of relaxation that has almost been abandoned, partly because it does not allow for outpatient hysteroscopic surgery.
The ideal liquid distension medium is a saline solution (saline). It is delivered either by means of a squeeze bottle in which the pressure is regulated with a pressure gauge, or an electronic peristaltic pump in which the delivery pressure, flow rate and suction pressure can be predetermined in order to keep the distension of the uterine cavity and its subsequent visualisation constant during the examination. in addition, the use of saline enables diagnostic and operative hysteroscopy to be performed even in the presence of blood.
Source of Light:
It is characterised by 2 elements:
1) A cold light source consisting of a miniaturised optical system with a xenon lamp, which is brighter and has a longer life than halogen lamps.
2) a fibre-optic transmission cable connecting the light source to the optics.
Video and image detection and archiving systems:
Modern hysteroscopy cannot do without the use of the camera, which has now replaced the human eye and allows the operator to look directly into the monitor which, connected to the camera by a cable, reproduces the hysteroscopic image greatly enlarged and in colour, unlike in ultrasound, where the image is in black and white and mediated by ultrasound and not direct.
There are various types of cameras that differ in their resolution (pixels), sensitivity (lux) and quality of video image reproduction depending on whether they are mono or 3CCD. They are equipped with a zoom and a focus knob. The monitor must have a high definition (full HD) to contribute, together with the camera, to a sharp image and near-natural colour reproduction.
The system is completed by a video recorder and a video printer now digitised and capable of both archiving and photographing or recording the operation.
English 
Italian