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Hysteroscopy
Medical expert of the article
Last reviewed: 05.07.2025
Hysteroscopy is an examination of the walls of the uterine cavity using optical systems. This method is used both for diagnostics and for the treatment of various gynecological diseases.
The main advantage of the method is the ability to detect intrauterine pathology (hyperplastic processes and endometrial polyps, myomatous nodes, etc.). Modern clinics use hysteroscopes that provide magnification of 5 times or more. Gas and liquid hysteroscopy are used. In pelvic hysteroscopy, the uterine cavity is examined in a gas environment (carbon dioxide). To use gas, a special adapter is needed to seal the cervix. There are no conditions for applying an adapter in case of cervical erosion, hypertrophy, ruptures and deformations. In addition, when using a gas environment, it is not possible to control the quality of diagnostic curettage, polyp removal, and myomatous node unscrewing due to the risk of gas embolism through damaged vessel walls.
Currently, thanks to the improvement of the quality of optical systems, equipment and instruments, the accuracy of hysteroscopic diagnostics has increased, and the possibilities of operative hysteroscopy have expanded.
Hysteroscopy is of particular importance in identifying various types of endometrial pathology. Only visual control allows removing all pathologically altered uterine mucosa from the uterus, which is extremely important, since the remaining tissue can subsequently provoke a relapse of the disease. This, in turn, leads to the choice of the wrong tactics for managing the patient.
In the case of endometriosis, based on visualization of the inner surface of the uterus, not only the diagnosis can be clarified, but also the form and stage of the disease can be determined.
Hysteroscopy is of great help in diagnosing submucous myomatous nodes, intrauterine adhesions, malformations of the uterus and detecting foreign bodies in its cavity.
Thanks to the introduction of electrosurgery into hysteroscopy in gynecology, new surgical directions have been created. A number of operations performed using a hysteroresectoscope allow avoiding laparotomy and sometimes even uterine removal. This is of great importance for women of reproductive age planning to have a child in the future, as well as for elderly patients with concomitant somatic pathology and a high risk of an unfavorable outcome of extensive operations.
Like any invasive method, hysteroscopy requires great surgical skill, appropriate skills and adherence to the rules for its implementation.
More than 30 years have passed since the publication of the first monograph on hysteroscopy (Phillips). During this time, many monographs devoted to visualization of the internal surface of the uterus and the technique of intrauterine surgery have been published in foreign literature. However, there are few works devoted to hysteroscopy in domestic literature.
Over the past years, hysteroscopy has made great strides in terms of diagnostic capabilities. Along with this, a whole new direction has emerged in operative gynecology - intrauterine surgery.
History of the development of hysteroscopy
Hysteroscopy was first performed in 1869 by Pantaleoni using a device similar to a cystoscope. A polypous growth was discovered in a 60-year-old woman, which caused uterine bleeding.
History of the development of hysteroscopy
Hysteroscopic equipment
Expensive equipment is required to perform a hysteroscopy. Before starting to perform a hysteroscopy, the specialist must undergo special training in the use of equipment and medical manipulations. Endoscopes and endoscopic instruments are very fragile and require careful handling to avoid damage. Before starting work, the specialist must carefully inspect all equipment to identify possible malfunctions.
Hysteroscopic equipment (hysteroscopes)
Diagnostic hysteroscopy
Methodology
Hysteroscopy can be used to diagnose intrauterine pathology, as well as for surgical interventions in the uterine cavity. The authors of the book consider it appropriate to describe the methods of diagnostic and surgical hysteroscopy in separate chapters.
Diagnostic hysteroscopy is the method of choice for diagnosing intrauterine pathology. Conventional separate diagnostic curettage of the mucous membrane of the uterine walls without visual control is ineffective and uninformative in 30-90% of cases.
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