Hysteroscopy

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Hysteroscopy belongs to endoscopic methods. It is either a diagnostic method where the cervical canal and uterine cavity are examined using a hysteroscope, followed by a tissue sample (biopsy). But it can also be a surgical method, when it is possible to remove, for example, a polyp, a fibroid from the uterine cavity, and break up smaller adhesions. Extensive procedures in the uterine cavity are then called transcervical surgery.

Scheme of hysteroscopy

Indication[edit | edit source]

Hysteroscopic image of myoma
  • Abnormal uterine bleeding - irregular, atypical, heavy. (e.g. uterine polyp or myoma).
  • Abnormal ultrasound image of the uterine cavity.
  • Secondary dysmenorrhoea – new pains during menstruation.
  • Postmenopausal bleeding - always a reason for hysteroscopy (early diagnosis of uterine cavity cancer).
  • Infertility and sterility - uterine causes in up to 5-7 % of cases (finding of a polyp, myoma, chronic inflammation, adhesions, etc.).
  • Localization, positioning and extraction of the intrauterine body.
  • Control after operations on the uterus.
  • Removal of residues after abortion and childbirth.
  • Hysteroscopic sterilization – the introduction of spirals into the fallopian tubes on both sides, which will scar and cause the fallopian tubes to be blocked.
  • Vaginoscopy - without breaking the hymen (for virgins), possible extraction of foreign bodies from the vagina.

Implementation[edit | edit source]

Instrumentation is also adapted to individual types of hysteroscopy depending on the scope, from thin diagnostic hysteroscopes to hysteroscopes with a working channel or directly resectoscopes with a resection loop. Due to its minimal invasiveness, the method is used in gynecology for a number of reasons. It can be performed under general anesthesia during a one-day hospitalization or, since 2009, in outpatient mode, when the procedure is performed without anesthesia in civilian clothes, and therefore with absolutely minimal burden on the patient. Procedures with a smaller scope are suitable for outpatient procedures, they make up about 95 % of all procedures. The others are suitable for their larger scope to be completed under general anesthesia.

Performing a hysteroscopy


Diagnostic hysteroscopy with findings


Contraindications[edit | edit source]

Absolute: overall bad condition of the patient not allowing the procedure, vaginal or pelvic infection, pregnancy.

Relative: heavy uterine bleeding (impossible to visualize and localize the source).

Complications[edit | edit source]

Iatrogenic mechanical injuries, fluid overload syndrome, in connection with anesthesia


Links[edit | edit source]

External links[edit | edit source]

References[edit | edit source]

  • HOLUB, Zdeněk – KUŽEL, David, et al. Minimálně invazivní operace v gynekologii. 1. edition. Praha : Grada, 2005. ISBN 80-247-0834-5.
  • PÉREZ-MEDINA, Tirso – FONT, Enrique Cayuela. Diagnostic and operative hysteroscopy. 2. edition. New Delhi : Jaypee Brothers Medical Publishers, 2012. ISBN 978-93-80704-69-2.
  • KOVÁŘ, P. Hysteroskopie v ambulantním režimu v podmínkách gynekologické ordinace. Čes Gynek. 2010, y. 75, vol. 6, p. 506-512, ISSN 1210-7832. 
  • KOVÁŘ, P – KUČEROVÁ, J – SZEWCZYK, M. Ambulantní hysteroskopická sterilizace systémem Essure – nová technologie permanentní antikoncepce. Prakt Gyn. 2013, y. 17, vol. 3, p. 220-225, ISSN 1801–8750. 
  • DAŇKOVÁ KUČEROVÁ, J – KOVÁŘ, P. Hymen, výhra či prokletí? Operační ambulantní hysteroskopie s použitím vaginoskopického přístupu u virginálních pacientek. Prakt Gyn. 2014, y. 18, vol. 1, p. 71-74, ISSN 1801–8750.