Hysteroscopy, fractional curettage

The positioning of the patient during hysteroscopy is in the lithotomy position using leg holders. The patient lies on her back, and her legs are bent at the hip joints approximately 90°. The knees are also significantly bent. The lower legs are positioned on the leg holders so that the legs are slightly spread apart. This arrangement allows optimal access to the vaginal and uterine area for the procedure.

The external genitalia and the vagina are treated with a mucosa-friendly, iodine-free disinfectant. This is followed by emptying the bladder with a single-use catheter.

A complete sterile drape is not necessary.

Optionally, a collection bag for the irrigation fluid can be attached.

The bimanual palpation is performed after disinfection or shortly before (ensure sterility). One hand remains in the vagina while the other is placed on the lower abdominal wall. With the vaginal hand, the uterus and adnexa are gently pressed against the abdominal wall. The external hand acts as a counterbalance and provides the palpation findings. For the examination of the adnexa, the vaginal vault is lifted laterally. This is important to assess the position and size of the uterus.

The Scherback speculum is available in various designs with different blades and rims. By attaching a weight to the lower blade, it becomes a self-retaining speculum. Examination with this instrument allows for the observation of the entire vagina up to the posterior vaginal vault and the cervix.