Hysteroscopy

Hysteroscopy at a glance

• Hysteroscopy involves inserting a hysteroscope, a thin tube with a camera, through the vagina so a physician can view the uterus to diagnose a problem and to perform surgical procedures to correct it.
• Hysteroscopy is often used to evaluate and treat women with infertility, unusual uterine bleeding or recurrent miscarriage.
• Infertility physicians use diagnostic hysteroscopy to identify abnormal uterine structure, uterine fibroids, polyps and scarring.
• Operative hysteroscopy occurs when the surgeon corrects such problems using special instruments inserted through the hysteroscope, most often at the same time as diagnosis.
• Hysteroscopy’s benefits over other surgeries include less recovery time, complications and pain medications.

What is hysteroscopy?

Hysteroscopy is a means of viewing problems in the uterus and often correcting them surgically at the same time, using a hysteroscope inserted through the vagina. This thin tube has a small camera and light that relays a video image of the uterine cavity to the surgeon.

Once a uterine problem has been identified in this manner, known as diagnostic hysteroscopy, it can be surgically corrected, known as operative hysteroscopy. Operative hysteroscopy may also be used to treat conditions identified by other means, such as sonohysterogram (an ultrasound using fluid injected into the uterus), hysterosalpingogram (X-rays and dye) or biopsy of endometrium (uterine lining) tissue.

Hysteroscopy is very useful in diagnosing and treating conditions that can cause infertility. These problems include uterine fibroids, polyps, scarring and birth defects in the structure of the uterus such as a uterine septum. Hysteroscopy is also used to:

• Discover the cause of abnormal uterine bleeding
• Diagnose possible causes of recurrent miscarriage (two or more miscarriages in a row)
• Remove scarring due to infection or a previous surgery
• Find and remove an intrauterine device (IUD) that has become misplaced
• Perform endometrial ablation to destroy the uterine lining
• Sterilize a woman by placing implants in her fallopian tubes.

How is hysteroscopy performed?

The procedure can be done in a doctor’s office or in a hospital. Benefits of hysteroscopy over other forms of surgery include:

• No or minimal hospital stay
• Faster recovery time
• Less need for pain medications
• Less chance of complications than in an open abdominal surgery.

The patient may be given medication to help her relax. Local anesthesia may be used to block pain, or general anesthesia can be used, in which case the patient is not awake. No incisions are made in hysteroscopy.

The surgeon may also use dilators or medication to slightly stretch the cervix canal before gently passing the hysteroscope through the vagina, cervix and into the uterus. Carbon dioxide gas or a fluid solution will be used to expand the uterus, affording the surgeon an excellent view of the cavity, the uterine lining and the ends of the fallopian tubes. This fluid or gas is carefully monitored during the procedure.

After a careful visual examination during this diagnostic hysteroscopy, the surgeon may take a biopsy or perform surgery to correct a problem, such as remove a uterine fibroid projecting into the uterus that may be causing infertility. In an operative hysteroscopy the surgeon passes special operating instruments through the hysteroscope tube and conducts the surgery. In some instance prior to operative hysteroscopy, the surgeon may have the woman take medication to prepare her uterus for the operation.

Following operative hysteroscopy, the patient may receive antibiotics, estrogen or a combination of the two to prevent infection and to promote proper healing of the uterine lining (endometrium). It’s normal for women to have a small amount of vaginal bleeding after the procedure. If fluid was used, it may change the level of sodium in the woman’s blood, as well as cause a bloated feeling.

The patient will usually be able to go home within 1-4 hours after the procedure. In cases where general anesthesia was used, the patient will need to wait until the anesthesia has worn off.

Risks of hysteroscopy

The procedure, like most all surgeries, has a risk of complications. These include:

• Infection
• Injury to pelvic organs and tissue
• Blood loss
• Normal risks from anesthesia.