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HYSTEROSCOPY
The Histeroscopy is a endoscopic
examination by means of which direct vision of the uterine cavity. Whith
hysterocopy it is possible to estimate normality of the uterine cavity and the
aspect of the endometrium.
Indications of the
diagnostic Histeroscopy:
Indications of the operative
Histeroscopy:
a generator of cold light, through a
cable to fiber optics joined together to the hysteroscope, allows to illuminate
and to examine the uterine cavity.
in natural conditions the uterine
cavity is a virtual cavity, and therefore for being able to examine it
it is necessary to supply to its distension by (arbon dioxide gas or a liquid
solution; habitually the CO2 (distributed by a hysteroinsufflator) in
the diagnostic Histeroscopy is used, reserving to the operative Histeroscopy
means of distension liquids (solution physiological or more often glicina).
the Hysteroscope is a thin (diameter
of 3-4 millimeter) tube that is inserted into the vagina to examine the cervix
and inside of the uterus, Trough the hysteroscope passes the light and the
gas for the uterine cavity distension.
Habitually to the hysteroscope small
television camera is connected, through which the relative images to the
examination are observed on a television monitor during its execution (videoHisteroscopy).
With this system it is possible to produce documentation of the same examination
by means of recording on video cassette, or photographic reproduction on press.
Such
instruments, often connect you to electric current, come use you in the
operative Histeroscopy in order to inside execute surgical actions of the
uterus (removal of fibroids or polyps endometrial, resectio of septa ,
remotion of adhesions, etc).
In this paragraph one refers
essentially to the modalities of execution of the diagnostic Histeroscopy, as the technique of the
operative Histeroscopy is obviously variable
second the indications (remotion of polyps or fibroids, resection of septa or
adhesions, endometrial ablation, etc).
Diagnostic hysteroscopy and simple operative hysteroscopy can usually be done in an office setting. In some cases the local and sometimes general anesthesia can become
useful. The anaesthesia can be necessary for the women who have not never give birth
for vaginal way, or in the women who have in the past surgical operation as
on the
uterine cervix (after cervical conisation). In these cases in fact can is
difficult pass trough cervical channel with hysteroscope, without to provoke to pain
(because of a its narrowing), and therefore it can become necessary the
anesthesia. After visualization of the cervix with speculum or
vaginal, it is proceeded to the disinfection of the
vagina. Therefore the hysteroscope is connected through a silicon cable to
the hysteroinsufflator (that it distributes the CO2 used like means of
distension of the uterine cavity) and through a cable to fiber optics to the
light source, nonthat to the television camera. The extremity of
the instrument in the cervical channel is introduced and slowly in uterine
cavity,
taking advantage itself of the action of carbon dioxide insufflated in the
cavity is pushed out in the uterine cavity from the hysteroscope. The cervical channel and the uterine cavity are stretched facilitating the
progression of the instrument and at the same time concurring the visualization
of their walls. In case it is used instead liquid means of distension, instead
of the hysteroinsufflator uses one pump that regulated the flow of the liquid in
the cavity provoking some the distension. Joints in cavity uterina, of
it observe the walls (with delicate movements that vary the guideline of the
instrument), currency the aspect of the endometrium, the falloppians hosts; the
eventual presence of eventual formations projectings in
the uterine cavity: polyps, miomi, septa. The examination concludes retracting
the hysteroscope at the same time and observing isthmus (the point of passage
between the uterine cavity and the cervical channel) and the channel. After this
phase of observation, biopsy of the endometrium can often be necessary to carry
out one, making a fragment withdrawal with opportune surgical
instruments purposely predisposed (curette or cannula of Novak). Of the
examination it is possible obviously to produce a do
These pictures are visibles by courtesy of Dr. Raffaele Paoletti.
Clic on the title for visualization of the image:
Pic. n. 1: Uterine cavity Pic. n. 2: I.U.D. in uterine cavity. Pic. n. 3: Uterus septum (visible the septum that divide the uterine cavity on tho parts). Pic. n. 4: Polyp of the cervical channel. Pic. n. 5: Mioma submucous (base on the posterior uterine wall). Pic. n. 6: Endometrial polyp. Pic. n. 7: Another picture of mioma submucous Pic. n. 8: Adhesion in the uterine cavity (adhesional britge between the uterines wals). Pic. n. 9: Endometrial cancer.
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Pagina redatta a cura del Dott. Giovanni Zerlotin |
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DEFINITION of Hysteroscopy