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Hysteroscopy
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Diagnostic hysteroscopy examines the uterine cavity and diagnoses abnormal uterine conditions such as internal fibroids, scar tissue (intrauterine adhesions/synaechiae), cervical stenosis, polyps, and congenital malformations. It is a useful procedure to evaluate women with infertility, recurrent miscarriage, or abnormal uterine bleeding. To evaluate the uterus before hysteroscopy, a hysterosalpingogram (an x-ray of the uterus and fallopian tubes), sonohysterogram (ultrasound with introduction of saline into the uterine cavity), or an endometrial biopsy may be performed. |
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Procedure |
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Diagnostic hysteroscopy is performed as an outpatient procedure. It is preferably done soon after menstruation ends because the uterine cavity is more easily evaluated. To begin with, a hysteroscope (a long, thin, lighted, telescope-like instrument) is gently passed into the uterine cavity through the cervical canal. If any resistance (such as cervical stenosis or presence of intracervical synaechiae) is encountered at the cervical opening while entering the cavity, the canal of cervix is slightly stretched with series of dilators to temporarily increase the size of the opening of cervix. Once the cervix is dilated, the hysteroscope is inserted through the cervix into the uterus. Skin incisions are not required for hysteroscopy. Carbon dioxide gas or special fluids are then injected into the uterus through the hysteroscope. This gas or fluid expands the uterine cavity giving a clear view of the internal structure of the uterus. |
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Operative Hysteroscopy |
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Many of the abnormalities found during diagnostic hysteroscopy can be treated using operative hysteroscopy. |
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Procedure |
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Operative hysteroscopy follows a procedure similar to diagnostic hysteroscopy. Additionally, narrow instruments are placed into the uterine cavity through a channel in the operative hysteroscope. |
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Benefits |
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 Fibroids, scar tissue, and polyps can be removed from inside the uterus. Congenital abnormalities, such as a uterine septum, |
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may be corrected through the hysteroscope. |
To treat some cases of excessive uterine bleeding, endometrial ablation can be used. It is a procedure in which the lining of the |
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uterus is destroyed. Ablation of the uterine lining is not performed in women who wish to become pregnant. |
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Medications |
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If your physician recommends it, you may have to take medications to prepare the uterus for surgery. Antibiotics and/or estrogen may be prescribed after some types of uterine surgery to prevent infection and stimulate healing of the endometrium. |
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Conditions Increasing the Risks |
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Certain conditions may increase the risk of serious complications. These include previous abdominal surgery, especially bowel surgery, and a history or presence of bowel/pelvic adhesions, severe endometriosis, pelvic infections, obesity, or excessive thinness. |
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Risks of Hysteroscopy |
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Complications of hysteroscopy occur in about two out of every 100 procedures. However, severe or life-threatening complications are very uncommon. Some complications may prevent completion of the surgery. The complications and risks of hysteroscopy are listed below:
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Perforation of the uterus (a small hole in the uterus) occurs less often with a skilled surgeon. Although perforations usually close |
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spontaneously, they may cause bleeding or damage to nearby organs, which may necessitate further surgery. |
Uterine adhesions or infections may develop after hysteroscopy. |
Fluid in the lungs, blood clotting problems, fluid overload, electrolyte imbalance, and severe allergic reactions are some serious |
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complications related to the fluids used to fill the uterus. |
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Postoperative Care |
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In cases of correction of intrauterine adhesions, based on the severity of the abnormality corrected and appearance of endometrium, estrogen may be prescribed for 3-4 cycles following surgery to stimulate the formation of a healthy endometrium and prevent reformation of scar tissue. Vaginal discharge or bleeding and cramping may be experienced for several days following hysteroscopy. You can resume most physical activities within one or two days. Ask your physician when to resume sexual intercourse. |
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Conclusion |
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Laparoscopy and hysteroscopy enable doctors to diagnose and correct on an outpatient basis many gynecological disorders which once required major surgery and several days of hospitalization. Compared to major abdominal surgeries which need large incisions, these two procedures involve significantly less recovery time and suffering. Resolve all your concerns about the procedure and risks involved by talking to your doctor before surgery. |
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