A novel optically-transparent, phase-shifting medium permits direct endoscopic vision of the uterine cavity without requiring the infusion of fluid or gas.

D. de Ziegler, Dept of Ob Gyn, Hopital de Nyon, Switzerland. ASRM 2003, San Antonio, TX

Endometrial Polyp

Uterine Synechia

Objective - Hysteroscopy (HS) was developed to directly visualize the inner aspect of the uterine cavity. The uterus needs to be artificially distended during the procedure in order to obtain panoramic visualization. Instruments used (hysteroscope) must combine optic fiber systems that provide illumination and allow viewing inside the uterine cavity, along with a device for infusing a solution or gas that distends the cavity and permit vision. Office HS, limited to diagnosis only, uses miniaturized instruments in order to minimize the discomfort associated with their insertion through the cervical canal. However, miniaturization is limited by the complexity of current hysteroscopes, notably their need to combine infusion devices coupled with optic systems. These engineering limitations cause office HS to remain fairly painful, thus hampering its expansion. To free diagnostic endoscopic (ES) exploration of the uterine cavity from the need to infuse a distending fluid or gas, an optically-transparent, phase-shifting medium (PSM) has been developed. This novel PSM has the characteristics of being quite viscous at room temperature, providing distension of the uterine cavity for the duration of the endoscopic examination. It later liquifies at body temperature and is spontaneously expelled from the uterine cavity.

Design - Prospective pilot feasibility study in women scheduled for surgical HS.

Materials and Methods - The PSM was tested in 7 women immediately before a scheduled surgical HS. 7-10cc of PSM was infused in the uterine cavity using a common embryo transfer catheter after patients underwent cervical dilatation. After the embryo transfer catheter was removed, the hysteroscope was introduced and ES exploration undertaken without connecting the infusion system. After direct visualization was completed, conventional HS was conducted using an infusion of a distending solution.

Results - The uterine cavity, slightly distended by the viscous nature of the PSM at the time of insertion, was easily explored with panoramic ES vision. The viscous nature of the PSM also prevented it from mixing with blood originating from the uterine mucosa, which would have blurred vision. Polyps and protruding sub-mucosal fibroids were identified in 1 and 3 cases, respectively. In one case, an unsuspected uterine synechia was identified. In the remaining 2 cases, no patent pathologies were seen. Progressively, as temperature of the PSM rose and reached normal body temperature (after >3min), viscosity and distension of the uterine cavity were lost, thus terminating the possibility for further ES vision of the cavity. In all cases, the subsequent conventional HS confirmed the ES findings.

Conclusion - These results provide positive pilot data that confirm the feasibility of using a PSM for obtaining ES vision of the uterine cavity without requiring a concomitant infusion of a distending fluid or gas. This innovation carries the potential of revolutionizing office ES exploration of the uterus. The possibility of freeing ES vision of the uterine cavity from the need to infuse a distending fluid or gas should lead to further simplification of ES instruments, thus rendering the procedure more tolerable and useful in office practice.