Hysteroscopy is a modern endoscopic method used for the diagnosis and treatment of intrauterine pathology. During the examination, the physician obtains a direct view of the cervical canal and uterine cavity, assesses the condition of the endometrium, determines the location of pathological lesions, and, when necessary, performs therapeutic procedures. The quality of the examination depends on the optics, lighting, instrument design, and equipment of the endoscopic system.

What Is a Hysteroscope and What Is It Used For

If the question arises, what is a hysteroscope from the perspective of a modern endoscopic system, it is an optical medical device used for visual examination of the uterine cavity and for performing intrauterine procedures.

What is a hysteroscope from a technical perspective? It is an endoscopic medical device for visual examination of the uterine cavity. Depending on its design, it can be used for diagnostic hysteroscopy, biopsy, and intrauterine procedures performed under direct visual control.

The main functions of the device include:

• examination of the cervical canal and uterine cavity;

• assessment of the endometrium;

• determining the location and size of intrauterine lesions;

• detecting pathological changes in the cervix;

• performing targeted biopsies;

• removing endometrial polyps and submucosal fibroids;

• removing foreign bodies;

• dissecting certain intrauterine septa and adhesions.

Types of Hysteroscopes

Types of hysteroscopes are determined by their intended use, design, diameter, working length, viewing direction, and viewing angle. Based on clinical application, hysteroscopes are divided into diagnostic and operative models.

The main types of hysteroscopes include:

• diagnostic — designed for visual examination of the uterine cavity and assessment of the endometrium;

• office — compact devices for diagnostic examinations in outpatient settings;

• operative — equipped with an instrument channel and used for therapeutic procedures;

• hysteroscopic resectoscopes — designed for electrosurgical procedures;

• rigid — feature a rigid optical tube and are used for both diagnostic and operative hysteroscopy.

Models also differ in diameter and optical characteristics. The product range of the Russian manufacturer of endosurgical equipment and instruments, ElePS, includes rigid hysteroscopes with diameters of 2.9 and 4 mm and viewing angles of 0°, 12°, 30°, and 70°, depending on the model. The working length of these models is 300 mm.

Hysteroscope Construction

The design of the device depends on its intended use. The basic construction includes an optical system, a light guide, and a working section inserted through the cervical canal. Operative models are additionally equipped with an instrument channel.

The optical system forms an image of the examined area and transmits it to an eyepiece or video camera. The light guide connects the endoscope to the light source and provides illumination of the working area. In operative models, the design allows instruments for biopsy and intrauterine procedures to be introduced.

How a Hysteroscope Works

The operating principle is based on direct optical visualization of the uterine cavity. After the device is inserted, the physician obtains an image of the examined area through the optical system. A liquid or gas medium may be used to expand the uterine cavity, providing sufficient space for examination and procedures. When a video camera is connected, the image is displayed on a medical monitor. The physician sequentially examines the cervical canal, endometrium, uterine walls, and uterine cornua.

During operative hysteroscopy, the required instrument is introduced through the working channel. A continuous flow of fluid may maintain visualization of the endometrium and uterine walls.

Indications for Hysteroscopy

Diagnostic examination is prescribed when pathological changes inside the uterus are suspected. Specific indications are determined by the physician based on the patient's symptoms, the results of other examinations, and the clinical objective.

Hysteroscopy may be performed in cases of:

• abnormal uterine bleeding;

• suspected endometrial polyps;

• submucosal uterine fibroids;

• intrauterine adhesions;

• uterine developmental abnormalities;

• infertility and recurrent pregnancy loss when clinically indicated;

• suspected foreign bodies in the uterine cavity;

• the need for a targeted biopsy;

• the need to monitor the condition of the uterine cavity after treatment.

If a pathological lesion is detected, the physician may proceed directly to a therapeutic procedure if the equipment configuration and clinical circumstances allow it.

Contraindications to Hysteroscopy

The possibility of performing the examination is determined individually after examining the patient and assessing the results of preliminary diagnostics. For a planned procedure, contraindications may include:

• pregnancy;

• acute inflammatory disease of the pelvic organs;

• active infectious disease;

• severe general medical condition;

• significant coagulation disorders;

• conditions in which anesthesia or surgical intervention presents a substantial risk.

The list of restrictions depends on the type of procedure. Before operative hysteroscopy, the physician additionally assesses the anticipated scope of the intervention and the patient's condition.

Preparation for Hysteroscopy

1. Undergo a preliminary examination. The physician reviews symptoms, medical history, medications being taken, and any chronic conditions.

2. Complete the prescribed tests. The required examinations depend on the patient's health status, type of anesthesia, and scope of the procedure.

3. Inform the physician about medications. Particular attention should be paid to medications that affect blood clotting.

4. Confirm the procedure date. The physician determines the appropriate time based on the menstrual cycle and the clinical objective.

5. Follow pre-anesthesia instructions. If the procedure is planned under anesthesia, follow the medical facility's instructions regarding food and fluid intake.

Preparation is completed immediately before hysteroscopy after the patient's condition has been assessed.

How Hysteroscopy Is Performed

The patient is positioned in a gynecological examination chair. After preparation, the physician carefully inserts the hysteroscope through the cervical canal. If necessary, a distension medium is introduced into the uterine cavity to provide adequate visualization. The physician then performs a systematic examination, assessing the endometrium, uterine walls, uterine cornua, and any pathological lesions.

If an intervention is required, biopsy forceps, scissors, or another compatible instrument can be introduced through the instrument channel. When a hysteroscopic resectoscope is used, electrosurgical procedures may be performed, including removal of polyps and submucosal fibroids, dissection of adhesions, and certain types of endometrial treatment.

What the Physician Sees on the Monitor

When a video system is connected, an image of the uterine cavity is displayed on the monitor in real time. The physician assesses:

• the condition and surface pattern of the endometrium;

• the color and structure of the mucosa;

• the walls of the uterine cavity;

• the uterine cornua and tubal ostia;

• the shape and size of detected lesions;

• polyps, fibroids, adhesions, and other pathological changes;

• the results of the intrauterine procedure performed.

The quality of visual diagnostics depends on the optics, lighting, camera, and monitor.

What the Patient Sees and Feels

The patient usually does not directly view the image from the hysteroscope during the procedure: it is primarily intended for the physician and is displayed on a medical monitor.

Sensations depend on the type of examination, the diameter of the instrument, the method of anesthesia, and the extent of the procedure. During a diagnostic procedure, moderate discomfort or cramping sensations may occur. During operative hysteroscopy, anesthesia is used according to the physician's choice and the nature of the intervention.

Possible Complications After Hysteroscopy

Hysteroscopy is considered a minimally invasive procedure, but complications cannot be completely excluded. After the procedure, patients may experience moderate lower abdominal pain or cramping and minor bloody discharge.

Rare complications include injury to the cervix or uterine wall, bleeding, infectious complications, and, when a liquid distension medium is used, fluid and electrolyte disturbances. The risk of complications depends on the patient's condition and the extent of the procedure. Severe pain, heavy bleeding, fever, or a sudden deterioration in well-being require medical attention.

Postoperative Recovery

The recovery period depends on the type of hysteroscopy and the extent of the procedures performed. After a diagnostic examination, patients generally return to their usual activities more quickly than after surgical intervention. If a biopsy, polyp removal, myomectomy, or adhesiolysis was performed, the patient should follow the physician's individual recommendations. Histological examination results are evaluated separately and taken into account when determining further treatment.

Modern Technologies and the Future of Hysteroscopy in Russia

The development of hysteroscopy is directly associated with improvements in optics, video systems, instruments, and equipment for managing the distension medium. A modern endoscopic system combines a hysteroscope, light source, video camera, monitor, fluid inflow and outflow system, and, for surgical procedures, working instruments and electrosurgical equipment. Compatibility between all components affects the physician's workflow and the quality of visual control during the procedure.

ElePS is a Russian manufacturer of medical endoscopic equipment and instruments that has been operating since 1991. The company develops and manufactures products for diagnostic and operative endoscopy, including rigid hysteroscopes, instruments, and components of endoscopic systems. In-house manufacturing allows the company to control product quality at every stage, from design development to the production of finished equipment.

For healthcare organizations, ElePS offers equipment for outfitting examination rooms and operating rooms according to the specific needs of each facility. The company's specialists can help select compatible components of an endoscopic system, configure the required equipment package, and arrange delivery. Equipment can be supplied to medical institutions in Russia and the CIS countries, including for equipping new rooms and upgrading existing equipment.

The company provides a full cycle of work with medical equipment, including development, manufacturing, sales, and service support. ElePS, a manufacturer of endoscopic equipment, complies with the requirements of the international ISO 13485 standard for medical device quality management systems. For clinics, this means the opportunity to work with a Russian manufacturer throughout the entire equipment lifecycle, from selection and purchase to technical maintenance.

The future of hysteroscopy in Russia is associated with the continued development of domestic optics, video systems, and surgical instruments. ElePS continues to improve endoscopic technologies and expand domestic manufacturing capabilities, providing healthcare organizations with equipment for accurate diagnosis.