Microhysteroscopy.

Abstract

This article describes the features and uses of the recently developed microhysteroscope, which offers a combination of panoramic hysteroscopy, contact hysteroscopy, and microscopy. The cervical canal can be crossed under strict visual control without traumatizing the mucosa, no premedication or anesthesia is required, and the amount of CO2 used is reduced to 40 ml. Multiple magnifications (X1, X20, X60, and X150) present new diagnostic opportunities by combining the data offered by hysteroscopy, colposcopy, and cytology. Aspects of microhysteroscopy that are common to other hysteroscopic techniques include timing, clinical history, positioning of the patient, physical exam, Pap smear, and ruling of pregnancy or infection. The technique of insertion of the microhysteroscope and the observations that can be made at different magnifications are detailed, and the various means of observation of the cervix and uterus are compared in a table. Current or recent pelvic infection is an absolute contraindication to hysteroscopy, and heavy bleeding is a relative contraindication. Few lethal complications related to hysteroscopy have been reported in the literature, and they followed faulty technique and the use of inappropriate distention in devices that delivered 1 or more liters of CO2/minute. Failure to perform microhysteroscopy because of severe postmenopausal cervical atresia occurred in 16 cases out of 680 attempted procedures. Microhysteroscopy was completely painless in 410 cases, similar to menstrual discomfort in 215, and moderately painful in 39. Microhysteroscopy allows collection of data on the normal aspects of the cervix and uterus, abnormal bleeding which is the most common indication, infertility investigation, adenocarcinoma, early antenatal diagnosis, salpingoscopy, and minor intrauterine operative procedures. Microhysteroscopy in conjunction with cytology, offers promise of better treatment of cervical cancer.