Hysteroscopy

This presentation tells about hysteroscopy procedures where different Intra uterine pathologies would be diagnosed.

1. Hysteroscopy Dr.Chaduvula Suresh Babu Professor Department of OBGYN GIMSR Visakhapatnam, AP, India

2. Hysteroscopy It is a procedure in which cervical canal and uterine cavity is visualised through a telescope called Hysteroscope . An important minimally invasive surgery [MIS] Combination of Laparo and Hysteroscopy is called ‘ Pelvicoscopy ’.

3. Introduction 1869 – Pantaleoni 1970 – Improvement in optic system, availability of distension media 1980- 1990 – office hysteroscopy 2014 – Stefano Bettocchi – from Italy invented latest and safe techniques

4. Types Rigid Hysteroscope Flexible Hysteroscope Contact Hysteroscope Micro Hysteroscope

5. Media 1. Carbon dioxide 2. Normal Saline 3. 1.5 % Glycine 4. Hyskon 5. 5% Dextrose 6. Ringer lactate

6. Timing Postmenstrual or Preovulatory Emdometrium will be thin Bleeding will be less

7. Endometrium appearance Proliferative phase – thin, smooth, less vascular and few glands are seen Ovulation – oedematous, glands are present Secretory phase – thick, oedematous and more vascular and more glands are seen Postmeopausal – thin, shiny, less vascular and no glands

8. What structures can be seen? Vagina – foreign bodies like coins and seeds and forgotten tampoons , any growths, lacerations etc., Cervix - Cervical growths, polyps, erosions and incompetence cervix and stenosed cervix Uterus – Uterine cavity, bilateral ostia , septate uterus, adhesions, polyps and fibroids and misplaced IUCDs.

9. Anaesthesia Office Hysteroscopy – No anaesthesia Rigid and flexible – local like Paracervical block Operative hysteroscopy – General anesthesia

10. Preoperaive preparation 4-6 hours before Vaginal Misoprostol tablet is inserted to soften the cervix for free insertion of hysteroscope . For TCRE and Myomectomy procedures – 2-3 months before onwards Inj. GnRH analogues, Danazol or Progestins are given to reduce vascularity and to reduce the the thickness of endometrium .

11. Indications Diagnostic : 1. Endocervical study 2. Uterine Malformations 3. Asherman syndrome 4. Uterine septum 5. Sub-mucus fibroid 6. Sub- mucu polyp 7. Postmenopausal endometrial biopsy

12. Diagnostic indications 8. Misplaced IUCD 9. Contraception 10. Falloscopy 11. Endometrial TB ? 12. AUB 13. Cancer staging – endometrial 14. Preinvasive lesions from endocervix

13. Therapeutic : 1. Myomectomy 2. Polypectomy 3. Tubal canulation 4. Tubal Sterilization 5. Endometrial Ablation – TCRE, roller ball coagulation

14. Therapeutic Indications 6. Septal resection 7. Metroplasty 8. Asherman syndrome – Adhesiolysis 9. Retrieval of misplaced IUCD 10. IVF – insemination 11. Ballonoplasty

15. Contraindications 1. Acute pelvic Infection 2. Pregnancy 3. Allergic to Glycine 4. Scarred Uterus ? 5. Uterus larger than 12-14 weeks 6. Cervical stenosis ? 7. During menstruation

16. Rigid telescopes

17. Sheath

18. Resectoscope

19. Operative Resectoscope

20. Energy source Monopolar or Bipolar energy source depending which type of media you are using

21. Light Source Xenon or Halogen light - elicits cold light

22. Camera

23. Ostium and Uterine cavity

24. Submucous Polyp

25. Septate Uterus

26. Sub Mucus fibroid

27. Submucus Polyp

28. Submucus fibroid

29. Uterine septum

30. Asherman Syndrome

31. Endometrial Cancer

32. Complications 1. Vasovagal shock 2. Anaesthesia complications 3. Perforation 4. Fluid overload 5. Electrical Injury 6. Incomplete entry 7. Incomplete diagnosis 8. Incomplete surgery

33. complications 9. Allergy to Glycine 10. Hyponatremia and coma due to Glycine toxicity 11. Gas or Air embolism 12. Organ Injury 13. Bleeding 14. Sepsis 15. Hematometra

34. Salpingoscopy or Fimbrioscopy Entry through Fimbria by laparoscopy

35. Falloscopy or Falloposcopy Entry of cornual end by hysteroscopy

36. Thank You All