Hysteroscopy Surgery

What is Hysteroscopy:  A  procedure where an endoscope is used to visualize the uterus and the uterine tubes.  Several pathologies of these organs can be identified and treated. Indeed some of these disorders may be the cause of infertility in the female. Hence this is a good diagnostic and therapeutic  (operative) tool for female infertility. It is normally done immediately after the menstrual periods during which time the uterine lining is thin and access to uterine cavity is better.

Common indications for hysteroscopy:

• Heavy or abnormal uterine (like bleeding in between normal cyclical bleeds)  and severe abdominal cramps.
• Unusual vaginal discharge
• To check the size and shape of the uterus during investigation of infertility. Congenital uterine malformations can also be diagnosed
• Diagnosis and evaluation of polyps and fibroids in the uterus. Polyps can be removed through the procedure. Biopsied can be taken through appropriate instruments inserted through the Hysteroscope. Thus malignancies can be diagnosed and appropriate treatment strategies planned in due course.
• Repeated miscarriage
• For routine investigation of infertility
• As a part of a therapeutic procedure like dilatation and curettage, laparoscopy

How is the procedure performed:

It is preferable to undergo the procedure in the pre-ovulatory phase as possibility of an established pregnancy is zero and hence there is no question of disturbing it, especially if investigating for infertility.  A date is taken immediately after the monthly menstrual bleed is over.  The doctor will ask details of any medicines being taken, any allergies to specific drugs and if any anticoagulants like aspirin is being taken.  Recent pelvic infection and the details of the treatment must be brought to the attention of the doctor.  The patient will be advised not to use any tampons in the vagina for 24

Hours..A local, regional or general anesthesia can be used for this procedure, besides a sedative and a painkiller. The doctor will decide which is best for the case. The patient will change to the OT gown provided in the operation theatre.  The bladder must be emptied before the procedure.  The patient is made to lie on her back with the legs wide apart and raised and supported by table footrests. This is called the lithotomy position and offers the doctor the best view and access to the external and internal genital organs. The external genitals will be thoroughly cleaned with an antiseptic solution that will remove all microbes and reduce any local infection. . A speculum will be inserted into the vagina to provide a clear view of the cervix.  The tip of the hysteroscope is gently inserted into the cervical opening and guided upwards until it reaches the uterine cavity.  The illuminat or ensures that the interior of the uterus is clearly visible and the camera transmits real time images to the TV screen which is viewed by the doctor and team.  The tip of the hysteroscope can be moved in different directions so that no part of the wall is missed and also the tubal openings are visualized. The procedure take about half an hour following which the patient is rested for some three to four hours  in the recovery room  and then asked to go home. The exception is when general anesthesia is used where a post operative stay for a longer duration is done.  Patient is advised to abstain from sex and the use of vaginal tampons for some days.  There may be mild abdominal cramps and light bleed from the vagina, but this will stop in a few days.