Dealing with problems inside the uterus – Hysteroscopy Case Capsules

There was a time when people would raise their eyebrows and ask” What is hysteroscopy and what good is it ?” Today, we cannot even think of a gyne examination and a satisfactory diagnosis without Hysteroscopy. When you can see inside the uterus directly through a small telescope introduced via the cervix (mouth of the uterus), why would anyone want to do a ‘blind’ Dilatation & Curettage (D&C) today? In fact, D&Cs are outmoded procedures and have absolutely no place in gyne practice. In April 2001, this was the comment in the prestigious journal, Fertility and Sterility : ‘D&C is an inadequate diagnostic and therapeutic tool for all disorders inside the uterus: it misses 62.5% of major intrauterine disorders.’

More than 100 years ago, Pantaleoni performed the first hysteroscopy using a tube and a candle as a light source to remove a nasal polyp and an endometrial polyp in the same woman. Hysteroscopy has come a long way since then. With increasing sophistication of instrumentation and enhanced operator expertise, the indications for diagnostic and operative hysteroscopic surgery cover a wide variety of conditions. Currently, hysteroscopy is the gold standard for the diagnosis and surgery of several intracavitary lesions. Additionally, hysteroscopy gives an extremely good clue to endometrial pathology and is diagnostic of atrophic endometritis even when ‘no tissue obtained’ on curettage, strongly indicative of tuberculosis (Nettle’s syndrome) and adenomyosis depending on specific findings on directly looking inside the uterus.

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Q1. What is Hysteroscopy?

Examination of a woman’s internal organs can be very useful for diagnosis and treatment of various problems. Directly seeing the outer aspect of the internal organs is done via laparoscopy which inserts a small telescope through a small one centimetre incision in the abdomen and few half centimetre incisions for the operating instruments. However, if we want to see the inside of the uterus, we need to insert a long, lighted telescope, the size of a straw, from below, the vagina, into your uterus. This is a natural passage through which the telescope enters the uterus. A camera is screwed over the outer end of the telescope and a beautiful, magnified view of the inside of the uterus is projected on a monitor. The telescope is covered by a sheath through the side of which can be passed thin operating scissors, forceps and cautery instruments. This procedure is called Hysteroscopy (hystero means uterus and scopy refers to telescopy). No cut is made on the body, either the abdomen or the vagina for Hysteroscopy.

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