<unk>  has been carried out in hospitals, surgical centers and doctors' offices. It is best carried out when the endometrium is relatively thin, that is after a menstruation. Both diagnostic and simple operative<unk>  can be carried out in an office or clinic setting on suitably selected patients. Local anesthesia can be used. Analgesics are not always necessary. A paracervical block may be achieved using a Lidocaine injection in the upper part of the cervix.<unk> c intervention can also be done under general anesthesia (endotracheal or laryngeal mask) or Monitored Anesthesia Care (MAC). Prophylactic antibiotics are not necessary. The patient is in a lithotomy position during the procedure. Cervical dilation The diameter of the modern<unk>  is generally small enough to conveniently pass the cervix directly. For a proportion of women cervical dilation may need to be performed prior to insertion. Cervical dilation can be performed by temporarily stretching the cervix with a series of dilators of increasing diameter. Misoprostol prior to<unk>  for cervical dilation appears to facilitate an easier and uncomplicated procedure only in premenopausal women. Insertion and inspection The<unk>  with its sheath is inserted transvaginally guided into the uterine cavity, the cavity insufflated, and an inspection is performed. Insufflation Media The uterine cavity is a potential cavity and needs to be distended to allow for inspection. Thus, during<unk> , either fluids or CO2 gas is introduced to expand the cavity. The choice is dependent on the procedure, the patient’s condition, and the physician's preference. Fluids can be used for both diagnostic and operative procedures. However, CO2 gas does not allow the clearing of blood and endometrial debris during the procedure, which could make the imaging visualization difficult. Gas embolism may also arise as a complication. Since the success of the procedure is totally dependent on the quality of the high-resolution video images in front of the surgeon's eyes, CO2 gas is not commonly used as the distention medium. Electrolytic solutions include normal saline and lactated Ringer’s solution. Current recommendation is to use the electrolytic fluids in diagnostic cases, and in operative cases in which mechanical, laser, or bipolar energy is used. Since they conduct electricity, these fluids should not be used with monopolar electrosurgical devices. Non-electrolytic fluids eliminate problems with electrical conductivity, but can increase the risk of hyponatremia. These solutions include glucose, glycine, dextran (Hyskon), mannitol, sorbitol and a mannitol/sorbital mixture (Purisol). Water was once used routinely, however, problems with water intoxication and hemolysis discontinued its use by 1990. Each of these distention fluids is associated with unique physiological changes that should be considered when selecting a distention fluid. Glucose is contraindicated in patients with glucose intolerance. Sorbitol metabolizes to fructose in the liver and is contraindicated if a patient has fructose malabsorption. High-viscous Dextran also has potential complications which can be physiological and mechanical. It may crystallize on instruments and obstruct the valves and channels. Coagulation abnormalities and adult respiratory distress syndrome (ARDS) have been reported. Glycine metabolizes into ammonia and can cross the blood brain barrier, causing agitation, vomiting and coma. Mannitol 5% should be used instead of glycine or sorbitol when using monopolar electrosurgical devices. Mannitol 5% has a diuretic effect and can also cause hypotension and circulatory collapse. The mannitol/sorbitol mixture (Purisol) should be avoided in patients with fructose malabsorption. When fluids are used to distend the cavity, care should be taken to record its use (inflow and outflow) to prevent fluid overload and intoxication of the patient. Interventional procedures If abnormalities are found, an operative<unk>  with a channel to allow specialized instruments to enter the cavity is used to perform the surgery. Typical procedures include endometrial ablation, submucosal fibroid resection, and endometrial polypectomy.<unk>  has also been used to apply the Nd:YAG laser treatment to the inside of the uterus. Methods of tissue removal now include electrocautery bipolar loop resection, and morcellation.
Hysteroscopy
Hysterosalpingography
Hysterotomy
LGBT reproduction
Hormonal IUDs
Ovarian culture
Fertility testing
Postcoital test