The Procedure
Hysteroscopy is an outpatient surgical procedure in which a small telescope (the size of a pencil) is used to inspect the inside of the uterus.
- The first step involves cervical dilatation. The cervical opening must be enlarged to allow passage of the hysteroscope.
- Once inside the uterus, gas or fluid is used to distend the cavity.
- Your physician may then inspect the uterine walls, openings of the fallopian tube, and overall architecture of the womb.
- Hysteroscopy may be recommended for evaluation for abnormal uterine bleeding, recurrent pregnancy loss, or abnormal findings on a hysterosalpingogram, ultrasound, or pelvic exam.
- Patients with birth defects involving the uterus tubes and ovaries may also benefit from this type of examination.
Diagnostic Hysteroscopy
Diagnostic Hysteroscopy can be performed in the out patient setting. This procedure is generally shorter and can be done under mild sedation. The procedure is quick and inexpensive, yet only minor abnormalities can be corrected if encountered.
Operative Hysteroscopy
Operative Hysteroscopy is performed under general anesthesia. This will allow the physician to both diagnose and treat most findings, which are encountered at the time of the procedure.
The Operative Hysteroscope has ports, which allow the physician to insert operating tools, such as, scissors, cautery devices or a laser fiber. These may be used to resect or cauterize specific abnormalities under direct visualization. The Hysteroscope is also valuable in treating some forms of tubal occlusion. Many patients with a blockage in the fallopian tube may have an obstruction at the junction between the uterus and fallopian tube. The Hysteroscope is used to pass a small catheter through this contracted area under direct visualization. Occasionally, scar tissue can be disrupted and allow passage of sperm as the result of the procedure.
A physician will be able to evaluate the cervical canal, the contour of the uterus, and the quality of the endometrial lining. The tubal ostia are the openings of the fallopian tube into the uterine cavity. They should be easily seen with the hysteroscope.
After Your Hysteroscopy
Complications are infrequent from Hysteroscopy. Some patients may experience mild cramping. This usually is the result of the need to dilate the cervix for insertion of the scope. In general, patients are able to return to their normal activity level in 1-2 days after surgery.
Possible Risks
The possible risks of Hysteroscopy include bleeding, infection and uterine perforation. Fortunately, these risks are infrequent. Occasionally, your physician will utilize a simultaneous Laparoscopy to aid in the prevention of uterine perforation if extensive Hysteroscopy surgery is planned.
The Value of a Hysteroscope
In some patients, intrauterine adhesions may be so extensive that menstrual flow is absent or significantly reduced. These patients also will have difficulty in achieving or maintaining a pregnancy. The Hysteroscope is of great value in diagnosing and treating this condition. Endometrial scar tissue can be removed through the Hysteroscope in the post-operative period. Hormones are given which are very successful in promoting regrowth of healthy endometrium. Most patients experience a return of normal menstrual flow and restoration of fertility period.
Hysteroscopy has also demonstrated value in evaluation of patients with repeated unsuccessful IVF cycles. Your physician will discuss the need for this evaluation with you.
Conditions treated by Hysteroscopy
- Uterine Fibroids
- Intrauterine Adhesions
- Uterine septum
- Endometrial Polyps
- Tubal Occlusion