Contact hysteroscopy.

Abstract

In 1907 innovations in optics and illumination made by Maximilian Nitze were applied to hysteroscopy by Charles David, who wrote a treatise of hysteroscopy. David improved illumination by placing an electric incandescent bulb at the intrauterine end of his endoscope and also sealed the distal end of the tube with a piece of glass. The history of the contact endoscope that the authors personally used is connected to the invention by Vulmiere (1952) of a revolutionary illumination process in endoscopy--the "cold light" process. The components of cold light consist of a powerful external light source that is transmitted via a special optical guide into the endometrial cavity. The 1st application of his principle (1963) was an optical trochar contained in a metallic sheath. This simple endoscope was perfected, and in 1973 Barbot and Parent, in France, began to use it to examine the uterine cavity. Discussion focuses on methods, instrumentation, method for examination (grasping the instrument, setup, light source, anesthesia, dilatation, technique, and normal endometrium); cervical neoplasia; nonneoplastic lesions of the endometrium (endometrial polyp, submucous myoma, endometrial hyperplasia); intrauterine device localization; neoplastic lesions of the endometrium; precursors (adenocarcinoma); hysteroscopy in pregnancy (embryoscopy, hydatidiform mole, postpartum hemorrhage, incomplete abortion, spontaneous abortion, induced abortions, and amnioscopy); and examinations of children and infants. The contact endoscope must make light contact with the structure to be viewed. The principles of contact endoscopy depend on an interpretation of color, contour, vascular pattern, and a sense of touch. These are computed together and a diagnosis is made on the basis of previously learned clinical pathologic correlations. The contact endoscope is composed of 3 parts: an optical guide; a cylindric chamber that collects and traps ambient light; and a magnifying eyepiece. The phase of the menstrual cycle may be identified on the basis of the endometrial pattern. This pattern diagnosis is dependent on color, contour, and physical adhesiveness of the tissue. Cervical intraepithelial neoplasia (CIN) is the most common neoplastic lesion of the cervix. When atypical epithelium extends into the cervical canal beyond the view of the colposcope, the 6 mm contact hysteroscope has been helpful in determining the extent and severity of the lesion as well as to direct biopsy equipment to the site of the pathologic condition.