Dilatation and Curettage (D&C) is a gynaecological procedure where the cervix is dilated (Hegar dilatator) and the endometrium is scraped by a curette (a metal instrument). D&C is not only used in evacuating any products of conception that may remain in the uterine cavity in miscarriage, and the diagnosis of abnormal vaginal bleeding to exclude any pathology in the uterine cavity.
The procedure is usually carried out under general anesthesia and usually takes about 15-20 minutes. Occasionally, the procedure can be done under sedation, or general anestesia. The cervix is first dilated with metal rods (Hegar dilators). After it has been dilated adequately, a sharp metal instrument called a curette is inserted into the uterus and the lining of the uterus is gently scraped systematically and the tissues obtained are sent to the pathologist for microscopic examination.
Nowadays, D&C is gradually replaced by a special examination using endosampler or endorette,pipelle,in special cases hysteroscopy.
We use in the Szent Anna surgery the endosampler method (Made in USA) to take a biopsy from the endometrium instead of classical curettage, in case of hyperplasia or bleeding disturbancy. It is a very quick and effektiv method with local anestesia. The endosampler is an unique, sterile disposable curette for sampling the uterine endometrium. It aids in obtaining clearly differentiated endometrial tissue without general anesthesia. This instrument is designed to improve the efficiency, convenience and reliability of the endometrial tissue collection and to reduce the physical discomfort of the patient. It provides liberal histologic specimens. Except for rare instances, a cervical lidocain infiltration is necessary. The semi-rigid tapered 2,3 or 5 mm cannula enables easier introduction and minimizes the possibility of perforation. The cannula features sharp slots which assure better sampling from all areas of the endometrial cavity. Backflow of the collected sample is prevented by a lock spring mechanism in the 10cc syringe.The endosampler is recommended for both pre- and post- menopausal women, for diagnostic purposes.
Adventage of quick- endosmpler curettage: It is not necessary to use iv anestesia, so it is not necessary the anestesiologist visit, the lab test before the operation and to stay one day hospital.You have not any risk of anestesia. It is 20minutes and you can go home- the hystological result is after 3-5 days in your email box. It is much cheapar than the traditional curettage. If you have insurance the traditional form is cheaper (The hungarian insurance campany is paying the old method only)
Indications, Endosampler is ideal for:
The detection of endometrial carcinoma and pre cancerous conditions.
Routine screening of selected patients(specially in obesity, perimenopausal women with hypertension , diabetes after sterility or PCOD) for early detection of pracancerousus status of endometrial carcinoma in case of hyperplasia or thick endometrium..
Monitoring the effects of hormonal therapy on the uterine endometrium.
Endometrial dating and evaluation of pathology associated with infertility.
The other possibility for the biopsy of the endometrium is :hysteroscopy what is a procedure where a thin tele endoscope is passed into the uterine cavity and the lining of the uterus or endometrium is viewed under direct vision using a camera system. Various pathology such as endometrial polyp, fibroid or cancer, can be visualized and the lesion removed and/or biopsy taken under direct vision.