this presentation speaks about hardships for beginners in hysteroscopy,complications of hysteroscopy and consent taking for hysteroscopy

1. Basic Hysteroscopy
Dr.K.G.Hewawitharana

2. Challenges to beginners and measure to
overcome
• 1.Identification of different parts of hysteroscope
• 2.Assemble and disassemble hysteroscope
• 3.Machine settings for procedure
• 4.Difficulty in negotiating hysteroscope
• 5.Vaginiscopic entry

3. • 6.Orientation in side uterine cavity
• 7.Fear of complications
• 8.Inability to identify impending complications and when to stop/call
for assistance
• 9.Proper consenting
• 10.Keep on performing procedure

4. Complications of Hysteroscopy
• Every intervention carries risk of complications despite of its benefit
• There are defined statistics/data about how frequent these risks are
• Clinicians always should stratify these as frequent to rare or minimal
to severe
• This knowledge will help when counselling/consenting for procedure

5. However
• Certain patient factors as well as non patient factors can alter these
numbers
• It is well known that complication rates are high (or varies)when
BMI
Significance or severity of pathology
Pre-existing medical conditions
Previous surgeries
Lack of experience of surgeon
Difficulty level of intended operative procedure

7. Complication Frequency As a number
Pain Frequent
Infection Frequent
Bleeding Frequent
Overall serious Uncommon 2/1000
Failure to entry and complete SX Uncommon
Uterine injury Uncommon
Major vessel/bowel injury
Or infertility
Rare
Death Very Rare 3-8/100000

8. Consenting prior to hysteroscopy
• Like any other procedure-minimize medical terms and explain in a
manner that patient can understand and ask questions for further
clarifications
1-Tell what is the procedure-invasive test to diagnose or intervene
is it diagnostic hysteroscopy to see any abnormality ?
is it operative hysteroscopy to treat identified pathology?

9. 2- who perform?
3-where it will perform?
ward/clinic as outpatient diagnostic or at surgical theatre as operative
4-What sort of analgesia or anaesthesia use?
simple analgesics for diagnostic scope
SA or GA by anaesthetists for operative scope

10. 5- what really happens in this procedure?
Vagina approach and insertion of camera/ lenses system to visualize
inside uterus for diagnosis purpose
Additional treatment measure for identified abnormalities such as
polyp resection…
6-Benefits to patient
Diagnosis of certain conditions (eg-Polyps in AUB)
Treatment for Symptom relief (eg-Polypectomy to treat AUB)

11. 7-what are the disadvantages?
Mention about risks and complications including failure to complete SX
8-Any extra procedures that may be necessary
Eg-laparoscopy or laparotomy if inadvertent injury occurs
9-Alternative options. if any, (with their efficacy)
Eg-Non guided biopsies – missing focal pathologies
10-Document consent ,provide leaflets for further reference,Let patient
ask questions.

12. Summery
• 1-challenges to beginners and measure to overcome
• 2-complications and how frequent they are?
• 3-consenting for basic hysteroscopy