It is a modern technique in which the uterine cavity is visualized using an Hysteroscope (Endoscope). A telescope with light is introduced through the cervix to visualize the inside of the uterine cavity. It serves as both Diagnostic and Therapeutic in the management of various gynecological problems.
Diagnostic Hysteroscopy – A telescope is introduced through the cervix and the inside of uterine cavity is inspected for any pathological / abnormal lesions.
Operative Hysteroscopy – A telescope is introduced through the cervix into the uterine cavity and surgical repair is performed according to the pathology / abnormality noted on diagnostic Hysteroscopy.
- Usually Hysteroscopy is needed for diagnosis and surgical treatment of Uterine (Cavity) pathologies-
- Abnormal Uterine bleeding (AUB) in the form of excessive menstrual flow, bleeding in between periods, bleeding after menopause (PMB), suspected malignancy or premalignant lesions.
- Endometrial Polyps.
- Recurrent pregnancy failure
- Fibroids inside the uterine cavity (Sub mucous myoma)
- Adhesions within the uterine cavity (Ashermans syndrome)
- Congenital Uterine Malformations (Intrauterine Septum)
- Misplaced / Embedded Intrauterine devices
- Evacuation of Retained bits of conception
- Endometrial ablation as treatment of AUB
- Hysteroscopic Tubal cannulation for block in the Fallopian tube
- Hysteroscopic Sterilization (Prevention of pregnancy)
Hysteroscopy has advantages over a D&C because the doctor can take tissue samples of specific areas and view any fibroids, polyps, or structural abnormalities that can be missed on D & C.
Infertility due to pathologies in the uterine cavity like Polys, Sub mucous Fibroids, Intrauterine Septum, Intrauterine adhesions, T shaped uterus can be managed by Hysteroscopic surgery.
The advantages of Hysteroscopy are –
1. Avoidance of Laparotomy / Long incision over abdomen
2. Day care surgery – Shorter hospital stay
3. Ease of the procedure
4. Less operative time
5. Reduced blood loss during surgery
6. Reduced post operative pain and faster recovery
7. Significant improvement in pregnancy rates
8. Avoidance of Caesarian section following pregnancy
Your Consultant will do a thorough evaluation of your health condition. Necessary investigations are done and Physician opinion for fitness of surgery is taken. Patient is explained about the problem she is facing and need for surgery. Advantages and disadvantages of the procedure are explained. Patient is given all the necessary information to be followed before getting admitted for the procedure.
After admission to the hospital, few medications are given before shifting to operation theater. Patient is administered General anaesthesia and necessary position is given. Preparation of the parts under aseptic condition and draping is done. Routinely cervical dilatation is not performed. Hysteroscope is connected to Camera, light cable and Saline tubing (for distension of uterine cavity). Hysteroscope is negotiated through the cervix to enter the uterine cavity. The openings of the tube (Ostia) are visualized. The inner lining of the uterine cavity (Endometrium) is thoroughly assessed to look for polyp, Fibroid, Unhealthy endometrium, adhesions. The telescope is withdrawn slowly to visualize the cervical canal.
Hysteroscopic guided endometrial biopsy is taken based on the case and sent for necessary evaluation. Vagina is toileted with antiseptics. Patient is placed in sleeping position before she recovers from anaesthesia. She is observed in OT / Recovery room till she is fully conscious and fit to stay in the room.
In the recovery room, patient is given drips for 4 hours along with analgesics. Sips of water are given after 4 hours and then liquid diet. Soft diet is started once she tolerates liquids well. Mobilization out of
It involves surgical correction of the pathology detected on Diagnostic Hysteroscopy by using Special Hysteroscope (Bettocchi’s or Resectoscope)
Patient is fit for discharge only after she is tolerating liquids well and has passed urine on her own. At discharge, all the necessary information about diet, medications, ambulation, bathing, return to work and other daily activities are explained. All the signs / symptoms which may require early return to the hospital are explained.
At the time of discharge, patient is instructed the date for follow up (usually 5-7 days). Further line of treatment will be decided based on biopsy report in certain cases.
Sexual activity can be resumed once bleeding through vagina stops and your gynecologist has told you about your recovery at follow up visit.