The Hysteroscopy Encyclopedia

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The history of endoscopy really begins in the early years of the 19th century. Philip Bozzoni, 1805, invented an instrument that conducted light within the hidden cavities of the body. He used his device to inspect the nasal cavity, vagina and the rectum (Van der Pas, 1983).
    Credit for performing the first visualisation of the interior of the uterus is generally given to Panteleoni, 1869, who used the cystoscope described by Desormeaux to visualise and cautarize with silver nitrate a polypoidal endometrial growth of a 60 year old woman with intractable uterine bleeding (Seigler, 1984).

    The first modern endoscope, using these principles was designed and produced by Nitz, 1879.  In 1893, Moris used a straight silver and brass tube 9 mm in diameter and 22cm long, an obturator inside the tube was withdrawn once the instrument has been introduced into the uterine cavity leaving the hollow tube to serve as an endoscope. With this method he was able to observe the tubal ostia and the endometrium  (Valle and Sciarra, 1979).

    The next advance in hysteroscopy occured in 1908 by David who adapted Nitze’s cystoscope by applying an optical system permitting magnification of the field of observation. He used this instrument as hysteroscope and began describing the intra-uterine pathology. A continuous irrigation system using water to remove blood to prevent it from obscuring the distal lens was introduced by Heineberg,1914. (Gardner, 1983).

    Advances in HSG in the 1920s  resulted in a decline in further development and interest in hysteroscopy. Difficult in maintaining uterine distension was what primarily hampered the early hysteroscopist. (Dunn,1994).

    In 1925, Dr. Rubin reported utilizing insufflation to distend the uterine cavity and combined this with adequate illumination. He found  that distension of the uterus could be maintained for as long as gas was introduced into the cavity at a constant pressure. He used CO2 as the distension medium because of its rapid absorption from the peritoneal cavity. Rubin’s uteroscope was a modification of a cystourethroscope device by McCarthy. ( Russell,1988).

    In 1934, Schroder developed an endoscope with an external diameter of 10 mm. It had an excellent optical system with 180 degree angle of vision permitting direct visualisation of a large field, distension was provided with water irrigation under pressure. Schroder reported that a pressure of 35 mmHg was necessary to distend the uterine cavity and that 55mmHg was needed to open the fallopian tube. (Lindemann , 1984).