1. HYSTEROSCOPY
DR.GURURAJ DESHPANDE
MS(OBG)
ASSOCIATE PROFESSOR DEPT.OF.OBG
KAMINENI INSTITUTE OF MEDICAL SCIENCES
NARKETPALLY

2. Contents
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HISTORY
INDICATIONS
COUNSELLING
ANAESTHESIA
POSITION
EQUIPMENTS
DISTENDING MEDIA
PROCEDURE
COMPLICATIONS
CONCLUSION

3. HISTORY:PANTALEONI 1869 T0 1970
A LONG GAP

4. INDICATIONS
DIAGNOSTIC
• Unexplained abnormal uterine bleeding(AUB)
• Pre and post menopausal
• Selected infertility cases
• Abnormal HSG
• Unexplained infertility
• Recurrent pregnancy loss
• Should be used prudently only after other
investigations

5. THERAPEUTIC INDICATIONS
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IUD removal
Biopsy of intrauterine lesions
Hemangioma and A-V malformations
Resection of uterine septum
Uterine synechiae
Cannulation of fallopian tubes
Sterilization
Uterine polyps
Submucous myomas
Endometrial ablation

6. PATIENT COUNSELLING
 Benefits Vs Risks
 Other treatment options
 Realistic success rate
 Informed written consent

7. ANAESTHESIA
 Patient anxiety
 Cervix status
 Procedure
 Paracervical block and IV sedation
 Transcervical topical anesthesia
 Spinal/epidural
 GA

8. POSITION

9. EQUIPMENTS:TELESCOPES

10. VIEW

11. DIAGNOSTIC CONTINOUS FLOW
HYSTEROSCOPE

12. Operative sheaths and working
channel for accessory instruments

13. OFFICE HYSTEROSCOPE (BETTOCCHI
HYSTEROSCOPES)

14. Unipolar resectoscope consisting of
working element, 8mm resectoscope
sheath,4mm telescope

15. UNIPOLAR LOOP ELECTRODE FOR END
ABLATION,MYOMA,POLYP

16. UNIPOLAR ELECTRODES
(LOOP,NEEDLE,ROLLER,BALL)

18. DISTENDING MEDIA
 Need to distend uterus to view as uterus is
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almost closed structure.
Minimum 45mm of Hg for diagnostic
Upto 70mm of Hg for operative
If more than MAP ,more chances of overload
Gaseous and liquid
High and low viscosity medium

19. Carbon dioxide
 Neatness
 Doesn't damage instruments
 Doesn't mess up office/OR
 CO2 and bleeding incompatible
 CO2 and blood form obscuring bubbling
foam
 Cannot flush debris
 CO2 embolism rarely

20. CO2
 Insufflation should not exceed 100ml/min
 Unlike laparoscopy which are in litres/min
 Use only hysteroinsufflator
 Ideal for diagnostic office hysteroscopy

21. HYSKON
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32 percent dextran 70 in dextrose
Immiscibility with blood
Excellent visualization even in active bleeding
Compatible with electrosurgery and lasers
Outflow less due to high viscosity
Hyskon allergic reaction 0.05% treat like
anaphylaxis
 Pulmonary edema 0.11% due to overload as it
pulls water into intravascular space.

22. HYSKON
 Fibrinoplastic action leading to bleeding
diathesis
 Clogs instruments if instruments are not
washed immediately with hot water
 Remains in bloodstream for 4-6 weeks

23. LOW VISCOCITY LIQUID MEDIA
MEDIUM
OSMOLALITY mosm/kg
of water
SODIUM IN mEq/L
SERUM
290
135-145
GLYCINE 1.5%
200
SORBITOL 3%
178
MANNITOL 5%
280
GLYCINE 2.2%
280
NS
308
154
RL
273
130

24. NORMAL SALINE
 Safest
 Instilled with 2-3 litres bag from 6-8 feet
 Continuous high flow required
 Cannot use monopolar cautery as it contains
electrolytes, bipolar can be used.
 Still overload can occur which can be treated
with diuretics
 Stop if deficit is 1.5 litres

25. 1.5%GLYCINE AND 3%SORBITOL
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Taken from urology
Hypotonic
Metabolized to CO2 and free water
Female brain cells cannot pump cations due to
progesterone action so more prone for cerebral
edema.
 Check osmolality and sodium minimum pre op
intra op and 4 hr post op
 Stop if >500ml deficit,
 Can use monopolar

26. 5%MANNITOL AND 2.2%GLYCINE
 Both are safer and isoosmolar
 Mannitol is diuretic also
 Studies have shown that glycine2.2% is very
safe upto 1000ml deficit
 Can use monopolar
 Keep strict inflow and outflow
 Take into account the fluids infused by
anesthesiologist as RL commonly given is
hypoosmolar

27. CONTRAINDICATIONS
 Active PID
 Active profuse bleeding
 Recent perforation
 Pregnancy
 Cancer cervix
 Systemic disorders affecting fluid and
electrolytes

28. PROCEDURE
 Cervical priming and dilatation if needed
 Per vaginal examination to know the position
of uterus
 Vaginoscopic technique
 Systematic examination
 Operations with correct use of electrosurgery
and lasers

30. Panoramic view

31. Tubal ostium

32. Cu-T

33. DENSE ADHESIONS

34. SUBMUCOUS FIBROID

35. EXCISION WITH LOOP

36. EXCISION OF UTERINE SEPTUM

37. COMPLICATIONS
 Due to position
 Anaesthetic complications
 Due to distending media
 Uterine perforation
 Bleeding
 Bowel and bladder injury
 Septicemia
 Death

38. Bipolar resectoscopes

39. Hysteromat E.A.S.I

40. Intrauterine BIGATTI shaver

41. CONCLUSION
 Hysteroscopy is a part of every gynecological
surgeon’s armamentarium
 Generally a low risk technique using natural
pathway.
 Supersedes laparoscopy in philosophy of MIS

42. THANK YOU