Introduction:
Modern diagnostic and surgical techniques are based on better visualization and minimal invasion. Using different technologies in the modern medical field has reduced complications during surgical procedures and provided better treatment outcomes. Endoscopy is a modern surgical and diagnostic tool known for its minimally invasive approach. Like other branches, different endoscopic methods are used in gynecology for various purposes.
What Is Endoscopy?
Endoscopy is a procedure in which a camera-like device is inserted into the body with the help of a flexible tube-like structure. This helps in the visualization of the organs from the inside. Also, other structures can be attached to it for different diagnostic and surgical purposes. Gynecological endoscopy can be of three types. These are hysteroscopic, laparoscopic, and cystoscopic procedures.
What Is Hysteroscopy?
It is a thin telescope-like device that is inserted into the uterus. Pantaleoni first performed it in the year 1869 with a device known as a cystoscope. Hysteroscopes can be rigid or flexible with a viewing angle of 0 to 70 degrees. It consists of fluid channels, a light source, and a video monitoring system. They have provisions for attaching devices like graspers, scissors, or a tenaculum. The fluid channels contain fluid that acts as a distension medium for better visualization and irrigation. Carbon dioxide can also be used as a distension medium for surgical purposes.
Procedure:
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For this purpose, the patient is positioned in a dorsal lithotomy (supine position where legs are raised and separated).
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Vaginoscopy (examination inside the vagina) is done to enter the instrument into the uterus.
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The vagina is enlarged, and the cervix and cervical opening of the vagina is located.
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The cervix is grasped with a single-tooth tenaculum and dilated to the diameter of the hysteroscope to insert it into the uterus.
Indications:
Hysteroscopy is used mainly for two purposes these are diagnostic purposes and surgical purposes.
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It helps to locate the uterine septum (a type of malformation) and can be removed by a uterine septoplasty.
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Retained or embedded intrauterine device (IUD) device can be located through it,
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Uterine polyps and fibroids can be located and removed by this method.
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Removal of placental tissue after delivery.
Contraindications:
The contraindications are:
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Active pelvic infection.
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Cervical or endometrial cancer.
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Active genital herpes.
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Pregnancy.
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Bleeding disorders, coronary artery diseases.
Complications:
The potential procedural complications are:
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Uterine Perforation: These complications usually happen during surgical procedures like the removal of fibroids.
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Fluid Overload: Excessive fluid used during this procedure is observed and may lead to hyponatremia (low sodium balance in the blood). This may cause cerebral edema (accumulation of fluid in the brain).
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Embolism: Carbon dioxide used in this procedure may block the blood vessels and may cause cardiac failure.
What Is Laparoscopy?
Laparoscopy is a minimally invasive surgical procedure in which the abdominal cavity and pelvic area are accessed for a surgical purpose through a small incision.
Procedure:
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This procedure is performed under general anesthesia the urinary bladder should be empty, and the patient should be placed in a low lithotomy position.
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A 10-millimeter-long incision is made in the abdomen around the umbilicus area.
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At first, a Veress needle is inserted, then connected to a carbon dioxide tubing. This gas is passed inside the abdomen to distend it. This helps in better visualization and accessibility.
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A 10 mm trocar (portal to place the instruments) is placed in the umbilicus, followed by several 5 mm trocars, which are placed at the lower abdomen.
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A video camera is passed through 10 millimeters along with a powerful light source.
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Scissors, graspers, and other laparoscopic surgical devices are passed through 5 millimeters ports.
Purposes:
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Tubal Ligation: This is a process of female sterilization in which the fallopian tube is ligated, clipped, or removed.
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Ectopic Pregnancy: It is a condition in which fertilized egg is implanted outside the womb. Salpingostomy and salpingectomy are laparoscopic procedures by which ectopic pregnancy is removed.
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Hysterectomy: Partial or total removal of the uterus is known as a hysterectomy. This is done in clinical conditions like abnormal uterine bleeding, prolapse, and endometriosis. A laparoscopic hysterectomy is preferred in such cases because of fewer surgical complications.
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Cancer Surgery: Carcinoma or uterus and endometrium is treated with the help of laparoscopic surgery.
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Diagnosis of Infertility: Different causes of infertility, like the presence of scar tissue, tubal blockage, and endometriosis, can be detected by this technique.
Contraindications:
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Presence of bleeding disorders.
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Laparoscopic procedures cannot be performed in pregnant persons.
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In patients with an excessively large uterus, this cannot be performed.
Complications:
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Abdominal pain, muscle aches.
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Period-like cramps and vaginal discharge.
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The increased urge to urinate.
What Is Cystoscopy?
Cystoscopy is a procedure that helps directly visualize different parts of the urinary tract. Maximilian Carl-Friedrich Nitze and Joseph Leiter developed the first cystoscope in the year of 1878. This is a diagnostic procedure used in urology to visualize the urethra, urethral sphincter, bladder, and ureteral orifices.
Procedure:
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Rigid and flexible are two types of cystoscopes that can be used. While flexible is used only for diagnostic purposes, rigid cystoscopes are also used for therapeutic purposes.
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A sheath obturator (a device used for smooth insertion) is used to insert and implant the rigid cystoscope.
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A flexible cystoscope is inserted like a catheter.
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The lower urinary tract is visualized with the scope in the presence of irrigation.
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After that, different scopes are used to examine the urinary bladder.
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Sterile water or saline water is used as an irrigating solution. If electrocautery is used along with cystoscopy, isotonic or nonionic irrigating solutions like glycine and lactated ringers are used.
Purposes:
As already discussed, cystoscopy is mainly used for urological purposes like bladder cancer, bladder stone, and urinary tract obstruction. As the urinary tract is very closely related to the female genital tract often, gynecological problems can affect the urinary tract too. Conditions like urogenital fistula, pelvic organ prolapse, and metastases of gynecologic malignancies need cystoscopic evaluation to rule out urinary tract involvement.
Complications:
Complications related to cystoscopy are relatively less. These are:
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Urinary tract infection.
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Hematuria (presence of blood in urine).
Conclusion:
Visualization is an important aspect of modern-day treatment procedures. Direct visualization of internal organs helps in better diagnosis and treatment planning and aids in better surgical outcomes. Endoscopies procedures are very helpful for the diagnosis of different gynecological problems. Also, different disorders can be treated by using minimally invasive endoscopic techniques. These help in better healing and postoperative complications can be avoided.
