To date the evaluation of the uterine cavity and of possible intra-uterine pathology is done through vaginal ultrasound, SIS/GIS (Saline infusion Sonography/Gel Infusion Sonography) imaging and through hysteroscopy. The main advantages of diagnostic hysteroscopy (with new generation small-diameter hysteroscopes) are a direct visualisation of the cervical canal and the uterine cavity and the possibility to perform targeted biopsies and even small surgical procedures in an office setting without using any type of anaesthesia or dilatation of the cervical canal.
This article focuses on the equipment and the technique of diagnostic hysteroscopy and how to take an endometrial biopsy.
Introduction
To date the evaluation of the uterine cavity and of possible intra-uterine pathology is done through vaginal ultrasound, SIS/GIS (Saline infusion Sonography/Gel Infusion Sonography) imaging and through hysteroscopy (1). To be able to actually ‘see’ inside the uterine cavity, and even perform targeted biopsies or small surgical procedures, we need specific equipment including a hysteroscope, a cold light source and fibreoptic light cable, a viewing system (with a camera control unit, a video camera and a monitor) for adequate vision and a system for uterine distension (2-6). Specific designed instruments will allow simple procedures – mainly biopsies – which will be addressed subsequently.
Equipment in diagnostic hysteroscopy
We will focus both on the delivery of distension media and on the most commonly used hysteroscopes.
Delivery of distension medium
In modern diagnostic hysteroscopy uterine distension is done using isotonic saline solution. Simple delivery using a syringe (of 50ml) or delivery using gravity with 3L bags 90 – 120cm above the uterus works perfect for simple diagnostic procedures. For small operative procedures in an office setting the slightly higher intra-uterine pressure can be obtained using a manually operated pressure-bag or using an electronic irrigation device/pump (4-6).
When using an electronic irrigation device it is possible to keep a constant pre-defined intra-uterine pressure and it is possible to readjust the different parameters related to the delivery of the distension medium (pressure, flow, suction) during the procedure if needed. When using an electronic irrigation device in a simple diagnostic hysteroscopy we set the pressure as low as 40 – 70mmHg. An intra-uterine pressure <70mmHg prevents passage of the distention medium into the peritoneal cavity and thus lowers the risk of vagal reaction or/and pain (9,10).
