Hysteroscopy

Hysteroscopy is the endoscopic visualisation of the uterine cavity

• hysteroscopy (which allows visual directed endometrial sampling) has replaced blind curettage for the diagnosis of endometrial disease (1)
• hysteroscopy can be used to detect endometrial cancer and various premalignant lesions, as well as to diagnose intrauterine polyps and submucous fibroids
  • hysteroscopic evaluation and directed biopsy has been considered to be the ‘gold standard’ in the diagnosis of intra-uterine anomalies (2)
    • diagnostic accuracy of hysteroscopy indicate sensitivity and specificity ranges of 0.84–0.97 and 0.88–0.93, respectively
• hysteroscopic examination can also be used to locate lost intrauterine devices, assess the shape and size of the endometrial cavity during an infertility work-up and to visualise intrauterine septae and adhesions
  • hysteroscopy with concomitant laparoscopy is considered to be the gold standard for diagnosis and treatment of the septate uterus (2)
  • hysteroscopic adhesioloysis can be used in the management of intra-uterine adhesions. These may occur after trauma to the basalis layer of the endometrium by vigorous diagnostic or post-partum curettage, endomyometritis, multiple myomectomies, endometrial ablation and pelvic radiation
• hysteroscopy can also be used to perform intrauterine sterilisation by occluding the tubal ostia.

Notes:

• general consensus nowadays is that the oft-performed operation of dilatation and curettage should be replaced by hysteroscopy and endometrial sampling, which can usually be performed as an outpatient procedure (1)
• traditional saline hysteroscopy requiring the use of a speculum and tenaculum, whereas 'no-touch' vaginoscopic hysteroscopy which does not require a speculum or tenaculum
• in comparison to transvaginal ultrasound (3)
  • hysteroscopy is quick, well tolerated, and more accurate in detecting intrauterine pathology than transvaginal ultrasonography
    • hysteroscopy allows direct observation of th uterine and this examination can provide a high diagnostic accuracy. Biopsy and treatment can be done at the time of the hysteroscopic examination
    • hysteroscopy is preferable to transvaginal ultrasound examination in the evaluation of intra-uterine disorders

Reference:

1. Sutton C. Hysteroscopic surgery. Best Pract Res Clin Obstet Gynaecol. 2006 Feb;20(1):105-37.
2. Vilos GA, Abu-Rafea B. New developments in ambulatory hysteroscopic surgery. Best Pract Res Clin Obstet Gynaecol. 2005 Aug;19(5):727-42.
3. Feng L, Li S. Evaluation of intrauterine disorders by hysteroscopy and transvaginal sonography. Gynaecol Endosc. 2002; 11 (6): 401-404.