Hysteroscopy😊

Hysteroscopy

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  • Position of patient:
    • Lithotomy
  • Hysteroscopy:
    • Diagnostic: Paracervical block.
    • Therapeutic: GA/regional anaesthesia.

Distention Media in Hysteroscopy

Electrolyte Rich Media
Electrolyte Deficient Media
Can be used only with bipolar instruments
Can be used with bipolar & unipolar instruments
Can lead to uterine perforation
Can lead to uterine perforation
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↑↑ Chances of water intoxication:
C/o nausea, vomiting, headache
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All electrolyte deficient media except mannitol are hyposmolar 

→→ Hyponatremia (Delirium, confusion)
Stop procedure if fluid deficit 

≥≥ 2.5 Litre
Stop procedure if fluid deficit 

≥≥ 1 Litre
Eg: 
Ringer's lactate,
normal saline
Eg: 
3% mannitol,
1.5% glycine
  • Fluid deficit:
    • Amount of fluid given - Amount of fluid comes out

TURP (Transurethral Resection of Prostate)

Irrigation Fluid

  • 5% Dextrose.
  • Distilled water.
  • Isotonic glycine (Most common).
  • Normal saline (Used only with bipolar cautery).

TURP Complications

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  • Retrograde ejaculation (Most common): Due to bladder neck injury.
  • Hemorrhage: Due to Badenoch arteries.
  • Clot retention: Prevented by 3-way Foley’s catheter.
  • Incontinence: 
    • Due to resection beyond verumontanum or bladder injury.
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Uses of Hysteroscopy:

  • Asherman's syndrome.
  • Septate uterus.
  • Endometrial polypectomy.
  • Type 0, 1 Fibroid.
  • Hysteroscopic tubal ligation using Essure (Permanent sterilisation).

Hysteroscopic Tubal Ligation by Essure:

  • Hysteroscope:
    • Outer cylinder: Nickel + titanium
    • Inner cylinder: Stainless steel
    • Mnemonic: Akathe stainless steel () kanathirikkan → wear nicker tightly (Nickel, titanium) outside
  • Essure:
    • Inserted in intramural/interstitial part of fallopian tube.
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  • Mechanism of action:
    • Irritates fallopian tube → Tissue reaction → Inflammation & blockage of tube.
  • Contraceptive efficacy:
    • Contraception: Not immediately effective.
    • Back up contraception necessary for 3 months post-procedure.
    • After 3 months → Do HSG → Confirm B/L blockage →Stop back up contraceptives.
    • Success rate: 99%.

Contraindications of Hysteroscopy

  • Pregnancy
  • Pelvic infections
  • Cervical cancer
  • Cardiopulmonary disease
    • Increased risk of fluid overload
      • Pulmonary embolism
      • Congestive cardiac failure
      • Pulmonary edema