This presentation tells about hysteroscopy procedures where different Intra uterine pathologies would be diagnosed.

1. Dr.Chaduvula Suresh Babu
Professor
Department of OBGYN
GIMSR
Visakhapatnam, AP, India

2.  It is a procedure in which cervical canal and
uterine cavity is visualised through a
telescope called Hysteroscope.
 An important minimally invasive surgery
[MIS]
 Combination of Laparo and Hysteroscopy is
called ‘ Pelvicoscopy’.

3.  1869 – Pantaleoni
 1970 – Improvement in optic system,
availability of distension media
 1980- 1990 – office hysteroscopy
 2014 – Stefano Bettocchi – from Italy
invented latest and safe techniques

4.  Rigid Hysteroscope
 Flexible Hysteroscope
 Contact Hysteroscope
 Micro Hysteroscope

5.  1. Carbon dioxide
 2. Normal Saline
 3. 1.5 % Glycine
 4. Hyskon
 5. 5% Dextrose
 6. Ringer lactate

6.  Postmenstrual or Preovulatory
 Emdometrium will be thin
 Bleeding will be less

7.  Proliferative phase – thin, smooth, less
vascular and few glands are seen
 Ovulation – oedematous, glands are present
 Secretory phase – thick, oedematous and
more vascular and more glands are seen
 Postmeopausal – thin, shiny, less vascular and
no glands

8.  Vagina – foreign bodies like coins and seeds
and forgotten tampoons, any growths,
lacerations etc.,
 Cervix- Cervical growths, polyps, erosions
and incompetence cervix and stenosed cervix
 Uterus – Uterine cavity, bilateral ostia,
septate uterus, adhesions, polyps and
fibroids and misplaced IUCDs.

9.  Office Hysteroscopy – No anaesthesia
 Rigid and flexible – local like Paracervical
block
 Operative hysteroscopy – General anesthesia

10.  4-6 hours before Vaginal Misoprostol tablet is
inserted to soften the cervix for free
insertion of hysteroscope.
 For TCRE and Myomectomy procedures – 2-3
months before onwards Inj. GnRH analogues,
Danazol or Progestins are given to reduce
vascularity and to reduce the the thickness
of endometrium.

11.  Diagnostic:
 1. Endocervical study
 2. Uterine Malformations
 3. Asherman syndrome
 4. Uterine septum
 5. Sub-mucus fibroid
 6. Sub-mucu polyp
 7. Postmenopausal endometrial biopsy

12.  8. Misplaced IUCD
 9. Contraception
 10. Falloscopy
 11. Endometrial TB ?
 12. AUB
 13. Cancer staging – endometrial
 14. Preinvasive lesions from endocervix

13.  Therapeutic:
 1. Myomectomy
 2. Polypectomy
 3. Tubal canulation
 4. Tubal Sterilization
 5. Endometrial Ablation – TCRE, roller ball
coagulation

14.  6. Septal resection
 7. Metroplasty
 8. Asherman syndrome – Adhesiolysis
 9. Retrieval of misplaced IUCD
 10. IVF – insemination
 11. Ballonoplasty

15.  1. Acute pelvic Infection
 2. Pregnancy
 3. Allergic to Glycine
 4. Scarred Uterus ?
 5. Uterus larger than 12-14 weeks
 6. Cervical stenosis ?
 7. During menstruation

20.  Monopolar or Bipolar energy source
depending which type of media you are using

21.  Xenon or Halogen light - elicits cold light

33.  1. Vasovagal shock
 2. Anaesthesia complications
 3. Perforation
 4. Fluid overload
 5. Electrical Injury
 6. Incomplete entry
 7. Incomplete diagnosis
 8. Incomplete surgery

34.  9. Allergy to Glycine
 10. Hyponatremia and coma due to Glycine
toxicity
 11. Gas or Air embolism
 12. Organ Injury
 13. Bleeding
 14. Sepsis
 15. Hematometra

35.  Entry through Fimbria by laparoscopy

36.  Entry of cornual end by hysteroscopy

37. Thank You All