HYSTEROSCOPYHYSTEROSCOPYOVERVIEWOVERVIEW

DiagnosisDiagnosis

TreatmentTreatment

Contraindications to Contraindications to HysteroscopyHysteroscopy

Pelvic infectionPelvic infection

Cervical malignancyCervical malignancy

PregnancyPregnancy

Diagnostic HysteroscopyDiagnostic HysteroscopyAbnormal Uterine BleedingAbnormal Uterine Bleeding

Menorrhaghia (heavy cyclic bleeding) Menorrhaghia (heavy cyclic bleeding) evaluate for fibroids, polypsevaluate for fibroids, polyps

Premenopausal irregular bleeding – Premenopausal irregular bleeding – usually anovulatory (first try hormonal usually anovulatory (first try hormonal correction)correction)

Post menopausal bleeding -Post menopausal bleeding -

after negative endometrial biopsyafter negative endometrial biopsy

Diagnostic HysteroscopyDiagnostic HysteroscopyInfertilityInfertility

Usually in office, local anesthesiaUsually in office, local anesthesia Habitual Abortion – evaluate forHabitual Abortion – evaluate for

Submucous myomaSubmucous myoma

Septate uterusSeptate uterus Prior to Prior to IIn n VVitro itro FFertilizationertilization

Distending MediaDistending Media

SalineSaline

COCO2 2

Hyskon (use ½ strength)Hyskon (use ½ strength)

Mannitol/Sorbitol/GlycineMannitol/Sorbitol/Glycine

Saline Saline AdvantagesAdvantages

CheapCheap

Simple to useSimple to use

PHOTO OF SALINE INFUSION PUMPPHOTO OF SALINE INFUSION PUMP

Saline Saline DisadvantagesDisadvantages

Poor visibility if bleedingPoor visibility if bleeding

Can’t use with electrocauteryCan’t use with electrocautery

COCO22 Advantages Advantages

Excellent image qualityExcellent image quality

Extremely safeExtremely safe

Minimal discomfortMinimal discomfort

No mess – ideal for officeNo mess – ideal for office

COCO2 2 DisadvantagesDisadvantages

Bubbles - Diagnostic onlyBubbles - Diagnostic only

Cost - Special insufflator = high Cost - Special insufflator = high pressure (up to 100mm Hg), low flow pressure (up to 100mm Hg), low flow (ml/min, not liters/min)(ml/min, not liters/min)

Hyskon (Dextran) Hyskon (Dextran) AdvantagesAdvantages

Excellent optical qualitiesExcellent optical qualities

Does not mix with bloodDoes not mix with blood

No special equipment - 50 ml syringeNo special equipment - 50 ml syringe

Non conductive - electrocautery OKNon conductive - electrocautery OK

HyskonHyskonDisadvantagesDisadvantages

Very messyVery messy

Requires immediate, thorough Requires immediate, thorough washing & rinsing (difficult in office)washing & rinsing (difficult in office)

Rare anaphylactic reactionRare anaphylactic reaction

Sorbitol-Mannitol-GlycineSorbitol-Mannitol-GlycineAdvantages Advantages

Non conductive – electrocautery OKNon conductive – electrocautery OK

Can use with active bleedingCan use with active bleeding

Sorbitol-Mannitol-GlycineSorbitol-Mannitol-GlycineDisadvantagesDisadvantages

Fluid overload – dedicated person Fluid overload – dedicated person monitor I&O every 5-10 min. monitor I&O every 5-10 min. Reassess at 500ml stop at 1000ml* Reassess at 500ml stop at 1000ml*

Hyponatremia –(Na < 120 mmol/l) Hyponatremia –(Na < 120 mmol/l) most common cause of death from most common cause of death from hysteroscopyhysteroscopy

Allergic reactions – fructose (rare)Allergic reactions – fructose (rare)

Therapeutic HysteroscopyTherapeutic Hysteroscopy

InfertilityInfertility

Abnormal Uterine BleedingAbnormal Uterine Bleeding

Therapeutic HysteroscopyTherapeutic HysteroscopyInfertilityInfertility

Resection of Septation (scissors, Resection of Septation (scissors, cautery, laser)cautery, laser)

Resection of Synichiae (Ascherman's Resection of Synichiae (Ascherman's syndrome) give post op estrogen and syndrome) give post op estrogen and place IUD 4 weeksplace IUD 4 weeks

Therapeutic HysteroscopyTherapeutic HysteroscopyInfertilityInfertility

Cannulation for proximal tubal Cannulation for proximal tubal occlusion – usually done with occlusion – usually done with simultaneous laparoscopysimultaneous laparoscopy

Give intravenous glucagon (1–2 mg Give intravenous glucagon (1–2 mg IV) to help prevent tubal spasmIV) to help prevent tubal spasm

Laparoscope with tubal dye first, Laparoscope with tubal dye first, after glucagon. –problem seen at after glucagon. –problem seen at HSG may be solvedHSG may be solved