Co2 insufflators used for laparoscopy, should never be used for Hysteroscopy.
In laparoscopy the flow of Co2 is in litters, while in hysteroscopy it is in ccs, with 100mm pressure to distend, uterine cavity. Patients have died in past due to wrong use of instruments.
For hysteroscopy one is sitting on a low level stool while operation table Is to be raised, for the surgeon to be comfortable, as shown in picture.
For introduction of Hysteroscope with sheath, one may need occasionaly cervix to be dilated up to 7 Hegar. Be very gentle in dilating Cx.As any bleeding will interfere in your vision.
If you are using saline or ringer lactate, let fluid run from proximal end of scope, before you introduce it, in the cavity.
Once in uterine cavity, one should
pause momentarily until mucus bubbles have dissipated and vision is clear.
To look into endocervix
To look Into uterine cavity
To look at endometrium
To look at tubal osteium
Indications of Diagno.Hysteroscopy
locate submucous myoma.
diagnose uterine septum.
locate & remove lost I.U.C.D.
locate Endometrial polyp.
locate uterine synechae.
detect endometrial cancer
With more and more use of carbon dioxide as a distending media and avabilty of sophisticated instrument like Hysterflator,Dignostic hysteroscopy has almost become an office procedure.which can be done without anesthesia or some times with local anesthesia.
It is most important to insure prevention of complications and their recognition, and their management, if they occur.
Complication may occur due to