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Hysteroscopy
DEFINITION of 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 Histeroscopy
Indications of the diagnostic Histeroscopy:
- Abnormal uterine bleeding,
- Sterility and infertility,
- Diagnosis of cytological doubts reports,
- Control of the endometrium in menopause,
- Control of the endometrial hyperplasia,
- Intrauterine Stadiation of the endometrial carcinoma.
- Extraction of “lost IUD” (in case of breach of the thread),
- Resection of septa, submucous fibroids and polyps,
- remotion of endometrial Adhesions.
INSTRUMENTATION
Source of light:
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.
Means of distension of the cavity uterina:
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).
Optical system:
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.
For the operative Hysteroscopy a hysteroscope of 7-8 milimeter is used, through which to introduce also the smalls instruments operatives.
System of documentation of the examination:
Habitually to the hysteroscope a small television camera is connected, through which the images of the examination are observed on a television monitor during its execution (videoHisteroscopy). With this system it is possible to produce documentation of the examination by recording system (CD, DVD or photographic printer).
Instruments operatives (resectoscope, handles, scissors, etc):
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).
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.
For the operative Hysteroscopy a hysteroscope of 7-8 milimeter is used, through which to introduce also the smalls instruments operatives.
System of documentation of the examination:
Habitually to the hysteroscope a small television camera is connected, through which the images of the examination are observed on a television monitor during its execution (videoHisteroscopy). With this system it is possible to produce documentation of the examination by recording system (CD, DVD or photographic printer).
Instruments operatives (resectoscope, handles, scissors, etc):
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).
EXECUTION of Hysteroscopy
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).
Hysteroscopic image of the uterine cavity
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 documentation by means of a system of VCR or digital recording (CD or DVD) or instantaneous photographic of meaningful images.
10 Settembre 2005