technique

This link was last updated on October 01, 2000 and review on July 20, 2005.


This text should be cited as:

Afonso JS. E-book hysteroscopy. In: http://www.histeroscopia.med.br/. Access in:


José Sebastião Afonso

Diagnostic:

The examing can be done in the first as in the second phase of the menstrual cycle, in the second phase of the menstrual cycle the examiner should check for pregnancy. The examing in first phase has as advantage due to more limpid mucus and channel hypotonic. The second phase provides stabler images that are adapted for the study, mainly of the functional alterations. No previous preparation is necessary when it`s not intended to associate an anesthetic procedure. In gynecological position, is done the vaginal examination, insertion of the vaginal speculum, asepsis of the cervix and it is grasped or not with the Pozzi. The examing starts passing the histeroscope through the cervical channel, visualization of the uterine cavity (panoramic view and with details in the increase of 20 x) and cervical revision. The examing should always be under constant visualization. The patient postmenopausal with atresia cervical is prepared with topic estrogen for 10 days prior the procedure. The biopsy with the Novak is a great help in some cases. 

Operative:

Under anesthesia the dilation of the cervix uterine is accomplished with the dilator of Hegar from number I to 10. The ressectoscope is introduced that will allow the accomplishment of the procedure in a similar technique used in urology. The complete group is formed by the joining of the endoscope of 4 mm (Hamou II), of the cold light supply, of the microcamera, of the video monitor, of the documentation system, of the electric unit of high frequency, of the irrigation and of the vacuum. The electric potency can be adjusted in a cut of 100 watts and coagulation of 50 watts. We use solution of sorbitol and manitol as distension liquid medium (185 mOsm/l). The irrigator is placed at 190,4 cm of height in relation to patient, providing a hydrostatic pressure from 76 mm Hg to 140 mm Hg (the density of the water is 1 g/ml and of the mercury is 13,60 g/ml ).

Medical history and physical examination.

Basic and specific exams in according to the case.

The patient has to be informed about expectations, flaws and potential complications.

Previous preparation in the cases of endometrial ablation and larger myoma, with GnRH or similar for 8 weeks.

To schedule the surgery just after menstruation.

Always to execute the ressection under clear and constant visualization.

Check the fluid deficit every 5 min, tolerating until 1000 ml.

The surgical procedure should be short, a good one from 15 to 20 minutes.

Not to surpass the miometrium more than 4 mm in depth.

Be careful with electric potency, mainly with electrocoagulation.

Not to use electrocoagulation near of ostium of the tuba (due to smaller thickness of the miometrium in these points).

In the cases of myoma with interstitial portion when the external maneuver can not help it, the procedure should done in two steps, with an interval of 8 weeks. The USG shows us in this interval that the interstitial portion moved to the uterine cavity.

The cut will be made from the uterine fundus to the cervical channel. The exception is in the cases of septum and adhesions.

In the section of septum and adhesions it is advisable to use the USG control, allowing a residual thickness of the uterine fundus of 1 cm. Bleeding is warning that you have reached the miometrium.

The skill and full knowledge in the use of instruments is essential.

Antibiotics are administered.

Cleaning of the endoscope before sterilization by Endo Russer Systems

To prevent contaminants from drying on the endoscopes, they should be cleaned, if possible, immediately after use.

All surfaces should be cleaned with warm water and mild soap. Never scratch dirt off with hard objects. If stains are still present, a mixture (1:1) of methyl alcohol and acetone may be used. A fine woven cloth or lens tissue should be used for cleaning. Dry with a soft woven cloth.