Introduction:
Hysteroscopy is a procedure that uses a hysteroscope to view the inside of the uterus. It is often used to diagnose conditions like uterine fibroids or endometriosis. It is done with a small scope inserted through the vagina and cervix to view the inside of the uterus. The scope examines the uterine cavity for signs of endometriosis and other abnormalities. Hysteroscopy can also be used to examine the fallopian tubes and ovaries. Hysteroscopy is done under general anesthesia, but it's considered an outpatient procedure because it doesn't require any surgery.
What Is Hysteroscopy?
Hysteroscopy is a procedure for both diagnosis and treatment. It allows the doctor to look inside the uterus to diagnose and treat abnormal unexplained bleeding. The hysteroscopy procedure uses a hysteroscope (a thin, lighted telescope-like device). Operative hysteroscopy can be used for corrective surgeries like removing polyps, fibroids, and adhesions.
Hysteroscopy procedure can be-
Diagnostic Hysteroscopy
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To diagnose problems in the uterus.
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To confirm the results of tests like hysterosalpingography (HSG). HSG is an x-ray test used for evaluating the uterus and fallopian tubes.
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Other procedures like laparoscopy, dilation, and curettage (D and C).
Operative Hysteroscopy
1. To correct an abnormal condition detected during a diagnostic hysteroscopy. Operative hysteroscopy can be performed simultaneously to avoid a second surgery if an abnormal condition is seen during the diagnostic hysteroscopy.
2. Uterine conditions that can be corrected using hysteroscopy are-
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Removal of benign growths like polyps and fibroids.
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Removal of adhesions (asherman's syndrome)- uterine adhesions are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow and infertility.
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Correction of Uterine septums (defect of the uterus present by birth).
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To identify causes of any abnormal bleeding, lengthy menstrual flow, bleeding between periods, or after menopause.
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Endometrial ablation (removal of the uterine lining).
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Biopsy.
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Adenomyosis.
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Congenital uterine abnormalities.
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To remove scar tissue from the uterus.
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To remove an intrauterine device (IUD).
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Evacuation of retained products of conception or after miscarriage.
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To implant a permanent birth control device into the fallopian tubes.
What Is a Hysteroscope?
A hysteroscope is a thin, flexible, and lighted telescope-like device. It is used in the procedure of hysteroscopy. It is inserted through the vagina into the uterus (endometrial cavity). The camera at the end transmits images to a video screen. The doctor gets a good visualization of organs by the light at its end. The doctor can save the required images for future reference.
When Can a Hysteroscopy Be Scheduled?
The doctor may recommend scheduling the hysteroscopy the first week after the menstrual period. Hysteroscopy can also determine the cause of unexplained bleeding or spotting (drops of blood) in postmenopausal women.
What Happens During a Hysteroscopy Procedure?
A hysteroscopy can be done on an outpatient basis or during hospital admission. Procedures can vary based on the patient's condition and the healthcare provider's practice.
Hysteroscopy follows the following process-
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The patient is asked to put on a hospital gown and empty the bladder before commencing the procedure. Then, Anesthesia is administered depending on the case. Anesthesia for hysteroscopy can be local, regional, or general.
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An intravenous (IV) line is put in the patient's arm, and the patient is positioned on an operating table, lying on the back with their feet in a stirrup position.
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The vaginal area is cleaned using an antiseptic solution.
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The cervix is dilated before inserting the hysteroscope into the vagina up to the uterus.
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A liquid or gas is injected through the hysteroscope to expand the uterus for a better view.
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The doctor examines the wall of the uterus for any problems.
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At this stage, the doctor can take biopsy tissues or perform any procedure, such as fibroid removal. Then, the doctor can insert the required tools through the hysteroscope.
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For more complex procedures, the doctor may use another type of scope through the abdomen (laparoscope) to simultaneously view the outside of the uterus.
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The hysteroscope is removed after the completion of the procedure.
The time taken to perform a hysteroscopy can range from five minutes to an hour. The time taken for a hysteroscopy procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is needed. Diagnostic hysteroscopy takes lesser time compared to an operative hysteroscopy.
What to Expect After a Hysteroscopy?
Recovery varies based on the type of anesthesia given during the procedure. Blood pressure, pulse, and breathing are monitored for general anesthesia until stable. After all, the parameters are stable and normal; the patient can be discharged from the hospital.
The following conditions can be experienced for a day or two after the procedure:
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Cramping.
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Vaginal bleeding.
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Gas in the digestive tract causes pain in the upper belly and shoulders.
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The patient is advised to take only recommended painkillers for soreness.
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Avoid douching and sexual intercourse for about two weeks after the procedure.
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The patient must immediately contact the healthcare team in case of- fever, severe abdominal pain, heavy vaginal bleeding, or discharge.
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The feeling of being sick.
What Are the Advantages of Hysteroscopy?
Hysteroscopy is a minor surgical procedure and minimally invasive compared to other procedures.
It has the following advantages:
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Shorter hospital stay and recovery time.
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Less medication is needed post-surgery.
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Complex and invasive procedures like hysterectomies and open abdominal surgery can be avoided.
What Are the Risks Associated With Hysteroscopy?
Hysteroscopy is a very safe procedure. However, as with any type of surgery, the following complications are possible-
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Risks associated with anesthesia.
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Infections.
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Intrauterine scarring.
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Heavy bleeding.
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Injury to the organs like the cervix, uterus, bowel, or bladder.
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Allergic reaction to the substance used to expand the uterus.
What Is the Difference Between a Hysteroscopy and Hysterectomy Procedure?
The hysteroscopy and hysterectomy procedures may sound similar but quite different.
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A hysteroscopy is a diagnostic procedure in which the doctor can view the uterus and diagnose or treat any health problems.
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A hysterectomy is a major surgical procedure done to remove the uterus.
Conclusion
Hysteroscopy is a minor surgical procedure performed with the help of a device known as a hysteroscopy. This procedure can be done for diagnostic and operative purposes. The risks are very low, and the benefits are numerous. The outcome of the procedure is almost always good. The patient must take care of herself post-surgery and follow up with the healthcare team.
