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Hysteroscopy

 

Hysteroscopy is the inspection of the uterine cavity b endoscopy. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical inter­vention (operative hysteroscopy). Hysteroscopic procedures were first described by Pantaleoni in 1869. Although it was one of the first endoscopic procedures to be performed, it took over 100 years for refinemems in instruments, distension media, electronic hystero-flators before hysteroscopy was excepted as a modalitv of treatment for intrauterine pathology.

 
Advantages

Operative hysteroscopy has in many ways superceded laparoscopy in meeting the minimal invasive criteria. Ii uses the endocervical canal, the bodies natural passage, to gain entry into uterine cavity. Non-hysteroscor:c techniques to treat intrauterine septa and adhesior -obsolete. Submucous mvoma removal no longer require a hysterotomv. Cornual and interstitial tubal obstn : is also managed hvsteroscopicallv. Endometria' abb:

or resection is considered an acceptable alternative to Hysterectomy for treatment of abnormal uterine bleed­ing.
Since the 1990s hysteroscopy has finally found its proper niche, and every practicing gynaecologist must learn the skills of hysteroscopy.

 

Disadvantages

If used properly there are no disadvantages of this procedure.

 

Indications

Diagnostic hysteroscopy is indicated in evaluation of the uterine cavity in patients with:

  • Infertility (to evaluate abnormal hvsterosalpingo-grams - filling defects, adhesions)
  • Abnormal Uterine Bleeding (menorrhagia, irregular bleeding, postmenopausal bleeding)
  • Mullerian abnormalities (in patients with recurrent pregnancy loss - septate uterus, "T" shaped uterus I
  • Lost or misplaced IUD's

Indications of Operative Hysteroscopy

  • Targeted endometrial biopsy (suspected tuberculosis, endometrial carcinoma)
  • Removal of polyps, sub-mucous myoma
  • Adhesiolysis
  • . Metroplasty (incision of uterine septum)
  • Removal of misplaced IUD or foreign body
  • Tubal cannulation in cornual or interstitial block
  • Treatment of DUB (Endometrial ablation, TCRE)
  • Sterilisation (electrocoagulation or tubal plugs to block the tubes)
 
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