Hysteroscopy and hysteroscopic surgery

Abstract

Hysteroscopy is the technique used to view the inside of the uterine cavity and cervical canal by means of illumination and some form of lens system. It was first performed in the latter half of the 19th Century, but it was not until the advent of adequate illumination and an accurate lens system that it became a technique with widespread usage. Although it has been used diagnostically over the last 40 years, its use as a diagnostic modality and, especially, a therapeutic modality has only come about with further improvements in light sources, video hysteroscopic systems and a wider range of therapeutic options for subsequent treatment. This increase in hysteroscopic surgery has gone hand in hand with the increase in laparoscopic surgery. The last 10 years have seen enormous improvements in equipment and techniques. It would now be very unusual for a gynaecological department not to have access to adequate hysteroscopic equipment. Hysteroscopy can be performed both as an outpatient (or office) procedure and an inpatient, normally day-case, procedure. Both therapeutic and diagnostic options are possible in both of these settings. Treatment for menorraghia, congenital abnormalities and intrauterine synechiae can now be performed successfully without any abdominal incision, and no overnight stay is necessary. This has important considerations in terms of cost benefit and convenience for the patient. The use of both diagnostic and therapeutic hysteroscopy will be discussed in an outpatient as well as an inpatient setting. The importance of training and audit of results is emphasized.