Distension Media

Abstract

To obtain a clear panoramic view of the uterine cavity, it is necessary to dilate the uterine cavity suitably with transparent media. Two kinds of media are now available for distension of the uterus, either liquid or gas. One liquid media is a physiologically isotonic solusion such as saline and 5% dextrose in water, and another is a highly viscous solution such as 32% dextran in dextrose (Hyskon). On the other hand, CO₂ has been used for gas hysteroscopy in Europe and America. The merits and demerits of each medium are described in Table 2. We personally prefer liquid hysteroscopy, particularly by dextrose solution or saline, for the following reasons: (1) a saline or dextrose solution is more efficient than gas for removal of blood, mucus, and debris that obstruct the view; (2) the detailed view of the lining of the uterine cavity when dilated by CO₂ insulation is obscured by the glare of the reflected light and by blood and mucus covering the surface of the lesions; (3) leakage of fluid through the fallopian tubes into the abdominal cavity is less than that of CO₂ because of its higher viscosity; and (4) because isotonic fluid media are used, soft structures such as an endometrial polyp and endometrial carcinoma appear vividly, swaying in the media, while CO₂ insufflation makes these tissues stick to the uterine wall, giving an unreliable view. On the other hand, a gas makes it easier to see the lesions in the right perspective.