Hysteroscopy is a surgical procedure involving a small scope placed through the cervix into the uterine cavity. This allows for diagnostic as well as operative procedures to be performed. The procedure begins with or without cervical dilation. The scope is then introduced into the cervix. A distending medium such as saline or glycine is used to separate the walls of the uterus as the scope is advanced into the uterine cavity. The uterine cavity can then be inspected for things such as fibroids, polyps, abnormal endometrium, and uterine anomalies. Instruments can be inserted through some of the operative introducers to allow for surgical removal of polyps and fibroids as well as resection of a septum. A curettage (scraping) procedure may be combined with the hysteroscopy to assist in removing abnormal tissue.
Hysteroscopy can be performed in the clinic or as an outpatient procedure in the operating room. Recovery time for practically any hysteroscopic procedure is minimal. Mild bleeding or cramping may be experienced. Most patients are able to resume full activities the following day.
Below are some photographs demonstrating findings through a hysteroscope.
Normal endometrial cavity with a normal tubal ostia (opening to the tube)
Uterine septum. This results from the incomplete fusion and regression of early fetal tissues of the reproductive tract. Uterine septations have been associated with recurrent fetal loss.
Sonohysterography
Sonohysterography, or saline contrast hysterography, is a diagnostic test involving the use of saline as a contrast agent inside the uterine cavity. This contrast is visualized by vaginal ultrasound in the clinic. The contour of the endometrial cavity can be assessed using this technique. Other types of contrast media have been tried in evaluation the fallopian tubes but most of these methods are less reliable than a hysterosalpingogram when the tubes need testing. Below you will find an image of a normal endometrial cavity during a sonohysterography procedure. Click on the image for a closer look.
The black area in the center of the image is the saline within the uterine cavity. The white speck that can be seen is the tip of the balloon that is used to block the opening of the cervix. Notice the smooth lining around the intrauterine cavity.