From the Guidelines
The direct visual examination of the interior of the uterus and fallopian tubes is known as Hysteroscopy (HS) and Laparoscopy (LS). This minimally invasive procedure allows physicians to directly visualize the uterine cavity and the openings of the fallopian tubes using a thin, lighted instrument called a hysteroscope 1. The procedure is typically performed to diagnose and treat various gynecological conditions such as abnormal uterine bleeding, polyps, fibroids, adhesions, or to evaluate the uterine cavity for infertility issues.
Key Points
- Hysteroscopy provides excellent views of the uterine cavity and the tubal ostia (openings) 1
- It cannot visualize the entire length of the fallopian tubes, for which laparoscopy or other imaging techniques may be required 1
- Hysteroscopy can be performed as a diagnostic procedure or as an operative procedure when surgical instruments are passed through the hysteroscope to treat identified abnormalities 1
Diagnostic Accuracy
- Compared with hysteroscopy, HSG was 52.6% accurate and SIS was 75% accurate in detecting fibroids 1
- SIS demonstrated 75% sensitivity and 93% specificity in detecting intrauterine adhesions, similar to HSG but far superior to TVUS 1
- Three-dimensional SIS was shown to be 100% accurate in classification of anomalies in women with bicornuate, septate, and arcuate uteri 1
Clinical Application
- Hysteroscopy and laparoscopy are essential tools in the evaluation and treatment of female infertility, allowing for the direct visualization of the uterine cavity and fallopian tubes 1
- These procedures can help identify and treat conditions such as intrauterine adhesions, endometrial polyps, and leiomyomas, which can impact fertility 1
From the Research
Definition of Hysteroscopy and Laparoscopy
- Hysteroscopy (HS) is defined as the direct visual examination of the interior of the uterus 2.
- Laparoscopy (LS) is a procedure that allows for the direct visualization of the fallopian tubes and other pelvic structures [(3,4)].
- The combination of hysteroscopy and laparoscopy is used to evaluate the uterine cavity and fallopian tubes in infertile women 3.
Diagnostic Procedures
- Hysterosalpingography (HSG) is a radiographic examination of the uterine cavity and fallopian tubes using a contrast medium 4.
- Sonohysterography is a procedure that uses ultrasound to evaluate the uterine cavity and is more sensitive and specific than HSG 5.
- Diagnostic hysteroscopy is a procedure that allows for the direct visualization of the uterine cavity and can be used to diagnose and treat intrauterine abnormalities [(2,6)].
Comparison of Diagnostic Procedures
- HSG has a sensitivity of 58.2% and a specificity of 25.6% in detecting intrauterine abnormalities, while sonohysterography has a sensitivity of 81.8% and a specificity of 93.8% 5.
- Laparoscopy is more accurate than HSG in detecting tubal and peritoneal abnormalities 3.
- Hysteroscopy is more accurate than HSG in detecting intrauterine abnormalities such as polyps, fibroids, and adhesions [(2,6)].