In this informative video, "How to Use Hysteroscopy Instruments: A Practical Guide for Safe and Effective Uterine Evaluation," we provide a detailed, hands-on overview of the essential tools used in diagnostic and operative hysteroscopy. This guide is designed for gynecologists, postgraduate students, and endoscopy trainees looking to master the fundamentals of instrument handling, safe uterine access, and effective visualization during hysteroscopic procedures. Whether you're performing office hysteroscopy or operative interventions in the OT, understanding the correct usage of hysteroscopic instruments is key to minimizing complications and achieving clinical success.

Overview of Hysteroscopy Instruments (Demonstrated in the Video)

Hysteroscope and Sheath

The hysteroscope is a rigid or flexible telescope (commonly 2.9 mm or 4 mm) used to visualize the uterine cavity. It is inserted through an outer sheath, which has inflow and outflow channels for distension media. Proper assembly and alignment of the scope with the sheath are essential for clear visualization and smooth entry into the uterine cavity.

Obturator

Used to facilitate atraumatic introduction of the hysteroscope into the cervical canal, the obturator is later removed to allow telescope visualization. It’s especially useful during office procedures where dilation is not required.

Distension Media System

Hysteroscopy requires continuous uterine cavity distension using normal saline (for bipolar energy) or glycine (for monopolar energy). The video explains how to connect the inflow line and regulate pressure using either a gravity bag system or an electronic hystero-pump to maintain optimal visibility and prevent fluid overload.

Operative Instruments

The video demonstrates the proper use of operative tools such as:
Hysteroscopic scissors for septal resection and adhesiolysis
Graspers for polyp and foreign body retrieval
Biopsy forceps for targeted endometrial sampling
Bipolar electrodes or loops for fibroid resection and endometrial ablation

All instruments are inserted through the working channel of the operative sheath and must be manipulated gently under direct vision.

Safety Tips and Technique Highlights

Ensure proper patient positioning in lithotomy with adequate cervical visualization.
Use cervical dilators (e.g., Hegar or Pratt) in operative cases to accommodate the sheath without trauma.
Maintain intrauterine pressure between 80–120 mmHg to avoid uterine perforation and fluid overload.
Avoid excessive manipulation and never use instruments blindly.
Always monitor fluid input and output during prolonged or operative hysteroscopy.
For postmenopausal or nulliparous patients, opt for mini-hysteroscopes to minimize discomfort.

Applications of Hysteroscopy

Diagnostic evaluation of abnormal uterine bleeding
Resection of intrauterine adhesions (Asherman’s syndrome)
Polypectomy and submucosal fibroid resection
Septum incision in congenital uterine anomalies
Targeted endometrial biopsy in infertility cases
Foreign body retrieval (e.g., IUCD removal)

Conclusion

Mastering the use of hysteroscopy instruments is essential for providing safe, effective, and minimally invasive gynecological care. This video offers a step-by-step guide to help you become proficient in assembling, handling, and using each component of the hysteroscopy set with precision. With proper training and technique, hysteroscopy can be a highly efficient tool for both diagnosis and treatment within the uterine cavity.

Watch the full video for a complete demonstration, real-time instrument handling tips, and expert commentary from faculty at World Laparoscopy Hospital.
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