Dr. Preeti Tandon
(Specialist Obstetrics & Gynaecology Laparoscopic & Robotic Surgeon. )

MBBS, MD(Obs/Gynae), F.MAS(Laparoscopic Surgeon), FICOG
Diploma in Adv Gynae Endoscopy (France), Certified Robotic Surgery Training (USA).

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Hysteroscopy

hysteroscopy?

Hysteroscopy is a medical procedure to allow a surgeon to take an inside look of the uterus in order to keen examination. Helps in diagnose and treating causes of abnormal bleeding. The procedure of Hysteroscopy is done by using a hysteroscope – a very thin, lubricated tube that is inserted into the vagina to identify the cervix and inside of the uterus.

Why is hysteroscopy done?

One of the most common uses for hysteroscopy to identify the exact cause of abnormal uterine bleeding.  Abnormal bleeding or excessive bleeding may mean that a woman’s menstrual cycle is distorted, like – longer than usual or more often than normal. Abnormal bleeding between menstrual periods is also considered abnormal. In nature, hysteroscopy may be either operative or diagnostic.

What is diagnostic hysteroscopy?

Diagnostic hysteroscopy is used for diagnostic problems of the uterus, such as abnormal uterine bleeding, repeated miscarriages, fibroids, infertility, polyps, or to locate displaced intrauterine devices. It is also generally used to confirm the results of other related tests like hysterosalpingography (HSG). Other pertinent techniques or instruments, like dilation and curettage (D&C) and laparoscopy, are generally with the hysteroscopy.

What is operative hysteroscopy?

Operative hysteroscopy is used to treat ab abnormal situation that has been identified during a diagnostic hysteroscopy. The need of second surgery can be avoided through this. During the course of operative hysteroscopy, small instruments are taking into use to correct the condition are inserted through the hysteroscope.

When is operative hysteroscopy used?

Hysteroscopy may be performed to correct the following uterine conditions:

1. Polyps and fibroids – Hysteroscopy is recommended to remove the non-cancerous growth with the uterus.   

2. Adhesions – also referred as Asherman’s Syndrome, uterine adhesions are bands of scar tissue that can make their place in the uterus and pave the way for some changes in menstrual flow as well as infertility. Hysteroscopy can also assist to locate and remove the adhesions. 

3. Septums – Hysteroscopy assists in determining whether you are having a uterine septum, a malformation of the uterus that is inherent with the birth. 

4. Infertility –  it is the tubal blockage at uterine end and can be opened through hysteroscopy by cornual cannulation

5. Abnormal bleeding –  Hysteroscopy can also assist to identify the main reasonfor heavy or lengthy menstrual flow, as well as the frequent bleeding during the course of cycle. 

6. Postmenopausal bleeding – Hysteroscopy is also recommended to identify the cause of frequent bleeding or spots in post-menopausal women 

7 .  Removal of Unwanted body or missing IUCD 

What are the attributes of hysteroscopy?

In comparison with other, more invasive procedures, hysteroscopy provides the following attributes:

1. Short time stay at hospital 

2. Short recovery time

3. Much less  pain medicines  needed after surgery

4. Avoid of hysterectomy

5. Great Chance of avoidance of "open" abdominal surgery

How safe is Hysteroscopic procedure?

Hysteroscopy is always consider as safe procedure. Though, with any type of surgery, some of the complications are likely to happen. With hysteroscopy, complications appear in less than 1 percent of cases and can comprises of:

1.Risks with anesthesia

2. Minor Infection

3. Excessive bleeding

4. Short Injury to the cervix, uterus, and adjacent organs

5.Intrauterine scarring

When should be the optimal time for the procedure be performed?

It is highly recommended to schedule the hysteroscopy in the first week after the menstrual period. This time period enables the doctor with the inside view of the uterus.

What type of anesthesia can be used for hysteroscopy?

Anesthesia for hysteroscopy may be local, regional, or general:

How is hysteroscopy performed?

Prior to the wholeprocedure, one may be recommended a medication to help in relax. Then you will be prepared for anesthesia procedure. The hysteroscope is well inserted through vagina and cervix into the uterus. Afterward, Saline is inserted into the uterus through the hysteroscope, it is for the expansion and to clear away any blood or mucus. A light shone through the hysteroscope enables the doctor to access an inside view of the uterus and the openings of the fallopian tubes into the uterine cavity. Finally, when surgeon performs the surgery, some small instruments are inserted into the uterus through the hysteroscope. The total time it takes to perform hysteroscopy can be from less than 5 minutes to more than an hour. The entire time span of the procedure depends on whether it is diagnostic or operative in nature and whether it require an additional procedure, such as laparoscopy, is implemented at the same time.

How will I be prepared for hysteroscopy?

If one is taking general anesthesia in the medical facility, you will be advised not to eat or drink anything for a fixed period of time (usually after midnight the night before) before the procedure. Frequent lab tests may be prescribed as well for women having a hysteroscopy in the hospital. You will be then advised to empty your bladder and your vaginal area will be cleansed through medication.

What can I expect after the procedure?

If some local or general anesthesia is used during the operation, you may have to be in the observation for a certain time before going home. After the whole surgery, one can feel some cramp or bleeding (less) for 2 to 3 days. Though this symptoms are practical but consult with your surgeon if experience any of themr:

1. Fever

2. Severe abdominal pain

3. Heavy vaginal bleeding or discharge

Will I have to stay in the hospital overnight?

Hysteroscopy is considered as minor surgery and generally, not require an overnight stay in the medical facility. However, in some of the cases, like if your doctor is concerned about your reaction to anesthesia an overnight stay may be advised by him/her.

Who is a candidate for this procedure?

However, there are many attributes associated with the hysteroscopy, but it may not be fit for some specific cases. A doctor who has specialized in this procedure will consult with the primary care physician to determine whether it is fit for a patient or not.