In cases of doubt or detection of pathology after performing a hysterosalpingogram or ultrasonogram, there may need to proceed to the performance of hysteroscopy and/or laparoscopy as parts of the diagnostic investigation.
It is a diagnostic as well as an operative tool for the management of pathologies of the uterine cavity. It is performed after the end of menstruation or prior to menses, gives us a precise visualization of the cervical canal and the uterine cavity together with the tubal ostia. It is a simple procedure done under mild sedation. After sedation Hysteroscope (a long, thin optical instrument) is inserted through the cervix with no use of any other instruments and with or without performing any cervical dilatation until it advances to the uterine cavity which is simultaneously filled with normal saline to enable visualization.
Pathological findings can be treated in the same sitting by operative hysteroscopy using hysteroscopic instruments.
It is an overgrowth of a uterine inner line called Endometrium. They vary in size, attaching to projecting in the endometrial cavity by a large base or thin stalk. Polyps are usually benign in nature.
These are noncancerous outgrowths of uterine musculature. They can be located on the outer side of the uterus (subserosal), in uterine musculature (intramural) or projecting in the uterine cavity (submucosal). Submucous fibroids can cause decreased fertility by affecting the blood supply of endometrium or can increase the chances of miscarriages.
Submucus fibroid can be removed by Electro resection via hysteroscopy. Larger intramural or subserosal component requires laparoscopic management.
It is the formation of scar tissue inside the uterus and/or cervix. Adhesions can occur in small portions of the uterus or in severe cases walls of the uterus can be stuck to each other. Adhesions can be thick or thin, spotty in location or confluent. They are generally nonvascular.
Operative hysteroscope along with scissors (resectoscope in severe cases) can be used for excision of adhesions. Fertility outcome post surgery depends upon the amount of endometrium present.
Septate uterus is congenital malformation in which the uterine cavity is divided by longitudinal septum. Outside of uterus has a normal shape. The septum can be in the superior part of the cavity – Incomplete or subseptate uterus or cavity can be divided in total length – complete septum. It can result in the inability to conceive or repeated abortions.
The septum can be excised by Hysteroscopic scissors, Bipolar Diathermy or resectoscope.
Can be due to tubal spasm, Fibrotic obliteration, endometriosis or corneal polyp, Mucous agglutination.
In the case of proximal tubal obstruction without any other tubal abnormality, Hysteroscopic cannulation of tubal ostia can help.
