With the advent of medical fiberoptics, diagnostic tools for gynecologic endoscopy were augmented not only in intraperitoneal visualization by laparoscopy and culdoscopy, but also in the visualization of the interior of the uterus and tubal ostia.Hysteroscopy is the technique of visualization of the cervical canal and uterine cavity by means of an instrument that includes a metallic sheath and a telescope receiving light through a fiberoptic bundle from an external illuminating source.A solution or gas is used to distend the uterine cavity during the procedure.
Maintaining distention of the uterine cavity has been difficult, and endometrial bleeding has obscured visualization.
Since the work of Edstrom and Fernstrom in Sweden first performed hysteroscopy in a living patient when he used his “endoscope” for visualization of the uterine cavity, and chemically cauterized a polypoid growth in a 60-year-old woman with postmenopausal bleeding. Interest was renewed by several investigators, especially Rubin, worked for more than 30 years with several models of hysteroscopes, including one with a water-rinsing system and one with a rubber balloon attached to its distal part and inflated with air. In 1962, Silander introduced a hysteroscope that had a latex rubber balloon attached to the distal portion for distention of the uterine cavity with normal saline instead of air.
This provided acceptable visualization, but the uterine cavity remained inaccessible for biopsy or any other surgical intervention.
In 1970, Edstrom and Fernstrom published their results with 32% dextran (molecular weight, 70,000) for distention of the uterine cavity.
Applications include removal of polyps and submucous leiomyomas, resection of uterine septa, division of thick connective tissue adhesions, and ablation of the endometrium to treat abnormal bleeding.
A resectoscope includes a straight (0°) telescope with an outer diameter (OD) of 3.5 to 4 mm, which can be encased in different-sized sheaths (OD, 8 or 9 mm).
The instrument has a built-in system that provides motion by means of a spring that moves the distal cutting loop forward and backward to shave and resect lesions by cutting.
The use of 32% dextran allowed both excellent visualization and biopsy of lesions and surgical manipulation within the uterine cavity.
Since then, several media have been used successfully for distention of the uterine cavity, such as 32% dextran, 5% dextrose (D5W), COHysteroscopic instrumentation consists of a telescope 2 to 4 mm in diameter, with Foroblique vision; a metallic sheath for the telescope and accessory channels to deliver the distending medium and introduce operating instruments; a connecting bridge with special channels to introduce manipulating instruments; a cold light fiberoptic bundle to transmit the light; an external light source for illumination; and when electrocoagulation is to be used, an appropriate electrosurgical source (Figs. Hysteroscopes are made commercially by various companies: Storz (Karl Storz Endoscopy-America, Culver City, CA), Wolf (Richard Wolf Medical Instruments, Rosemont, IL) (Fig.
3), Olympus (Melville, NY), and Circon (Stamford, CT).
The urologic resectoscope and the techniques for treating the urinary bladder (particularly for resection of prostatic enlargement) have been adapted for hysteroscopy.