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
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
18. DISTENDING MEDIA
Need to distend uterus to view as uterus is
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
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
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
37. COMPLICATIONS
Due to position
Anaesthetic complications
Due to distending media
Uterine perforation
Bleeding
Bowel and bladder injury
Septicemia
Death
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