Hysteroscopy is an inspection of the uterine cavity which can help diagnose uterine maladies that could possibly be contributors to infertility issues. It is a valuable diagnostic tool in the treatment of infertility. Its role in the treatment process is also evolving as other benefits are being discovered. It was traditionally used to diagnose and operate upon sub-mucous, pedunculated myxomas and endometrial polyps, among others. Nearly half of all infertility cases are diagnosed using hysteroscopy, which is best performed in the post menstrual proliferative stage. A hysteroscope is a miniature, fibre optic telescope of sorts, which can be rigid or semi-flexible, depending on the need of the procedure. It comprises various ‘channels’ that serve different purposes, like providing light to allow examination, and facilitating the flow of fluids that hold open the uterine walls. Some more advanced tools also have channels that allow insertion of tools to carry out minimal surgical tasks inside.
Locations for a hysteroscopy can vary from a surgical clinic or a hospital operating room, and popular media of the same are carbon dioxide gas, sorbitol, glycine, etc, while endoscopes or hysteroscopes used for the procedure vary from 2mm to 6.5mm in size. Patients in need of a hysteroscopy procedure are identified using other adjunctive procedures such as sonohysterography and hysterosalpingography, which can then help determine the location, medium and instrument chosen for the final procedure.
Carbon dioxide gas remains the most favoured medium, for its safety and clarity in usage. It does, however, pose the risk of gas bubbles forming, which can obscure the surgeon’s view. Carbon dioxide is also used solely for diagnostic hysteroscopies, and a minor chance exists that the system would absorb the gas, causing complications. Substances like sorbitol and glycine can be put to effective use in cases of resectoscope in treating large intrauterine lesions, such as myomas. This too, has some possibly serious complications like pulmonary edema, fluid overload accompanied by an electrolyte imbalance, cardiovascular collapse, neurologic toxicity, and anaphylactic shocks. While most physicians will already have one preferred medium of choice, it is best to consult someone who is familiar enough with all possible options and use the one best suited to your needs.
The choice of instrument depends on the selected medium. Larger ones are reserved for operative intervention, and would require larger doses of anaesthesia as well. Anaesthetic relief too, can come in various manifestations, from simple non-inflammatory drugs and anxiolytics to conscious sedation, intravenous medication, general anaesthesia or epidurals.
Contraindications are present in the case of hysteroscopy, as they do for all medical procedures. Some absolute contraindications include pelvic infections, endometrial cancer, and relative contraindications prevail in the form of severe vaginitis, pregnancies, or cardiovascular disease. 1-3% of hysteroscopy cases report complications, which include bleeding, uterine perforation or cervical lacerations. Long-term complications can occur in the form of femoral injury, which could cause intrauterine scarring, or even permanently injure contiguous organs.
