Hysteroscopy means an “optical inspection of the uterine cavity” using a hysteroscope (optical instrument). During hysteroscopy, the doctor assesses the shape of the uterine cavity, the mouth of the fallopian tubes and the mucous membrane of the uterine body and cervix. At the same time, hysteroscopic examination enables a sample to be taken for histological examination and eventually the performing of microsurgery. This is a method that expertly overcomes the blind curettage of the uterine cavity. Curettage (abrasion of the uterine lining, the “scraping” of the uterine cavity) is less time consuming, but it has very low accuracy for diagnosing the type and location of uterine cavity disease than controlled hysteroscopy. At the same time, a micro-insertion outpatient hysteroscopy removes the necessity for general anaesthesia and the need for surgical (mechanical) dilatation of the cervical canal. At the Centre for Foetal and Gynaecological Diagnostics, we use the most advanced micro-insertion hysteroscope – a CAMPO TROPHYSCOPE® from KARL STORZ. This compact hysteroscope was specially designed for procedures directly in the outpatient clinic of a doctor – endoscopic specialist. It provides the patient with maximum comfort and safety. It is especially suitable for the examination of patients with fertility disorders, non-birthing women and menopausal patients. The specially designed tip of the instrument ensures access to the uterine cavity through the cervical canal without trauma, reducing the risk of injury to almost zero. In addition, the risk of so-called “blurred vision” is eliminated by this type of hysteroscope by sticking tissue to the tip – the optics of the instrument. Brilliant image quality is achieved by the 2.0 mm HOPKINS® rod optics and an improved light beam. The outer diameter of the CAMPO TROPHYSCOPE® is only 2.9 mm, which enables examination of the uterus without the need for surgical dilatation (widening) of the cervical canal, thus eliminating patient pain and the need for anaesthesia. Atraumatic hysteroscopy is especially important for non-birthing patients. Elimination of anaesthesia in outpatient hysteroscopy is also beneficial for patients with metabolic syndrome (high blood pressure, diabetes, obesity, varicose veins, etc.) who are at high risk of complications with general anaesthesia.
Indications for carrying out hysteroscopy include:
- suspicion of synechiae (mucous membranes), polyps, myoma, foreign bodies
- suspicion of leftover residues after childbirth or abortion
- repeated abnormal vaginal bleeding
- repeated abortions (infertility, habitual abortion)
- pregnancy complications (subfertility)
- optical evaluation of a finding with carcinomas of the uterine body and cervix
We perform hysteroscopy without the need for general anaesthesia (narcosis). A thin hysteroscope – a TROPHYscope with a diameter of 2.9 mm (designed by expert Prof. Dr. Rudi Camp from Belgium) – is inserted without trauma through the cervix into the uterus, where the solution that enables the uterine cavity to be observed is introduced. The examination lasts for 10 to 30 minutes. After the examination and after 30 minutes of observation, the patient goes home; she does not remain in bed unnecessarily for several hours (almost one day), as is done in one-day surgical care facilities, where you remain for observation mainly due to the use of anaesthesia. Slight spotting or bleeding may then occur over the following 14 days.
During hysteroscopy, the doctor may:
- take a tissue sample for microscopic histological examination
- remove polyps
- remove uterine synechiae (mucosal growths)
- remove a submucosal myoma
- locate and remove foreign bodies (intrauterine contraceptive device, a so-called “DANA”, etc.)
What happens during outpatient hysteroscopy?
- Trauma-free insertion of a hysteroscope through the cervix.
- Dilatation of the uterine cavity with a solution.
- The diagnosis of the uterine cavity itself using the light and optics of a hysteroscope camera.
What is it for?
Outpatient micro-inserting hysteroscopy can be diagnostic or surgical. Diagnostic hysteroscopy seeks the cause of the patient’s difficulties (e.g. subfertility, amenorrhea, suspected defective wound after a caesarean section), or is necessary for confirming or rejecting a diagnosis (e.g. suspicion of congenital malformation). Surgical outpatient hysteroscopy is a state-of-the-art mini-invasive endoscopic technique, where larger structures, such as polyps (the most common), submucosal myxomatous nodules, suspicious structures (malignant tumour), remnants of abortions and after giving birth as well as uterine growths, are removed using advanced coagulation tools. The great advantage of this operation is its gentleness and precise targeting of the site of the uterine cavity to be treated microsurgically.