Hysteroscopy
What is a hysteroscopy?
Hysteroscopy is a surgical procedure in which a small telescope (the size of a pencil)
is used to inspect the inside of the uterus. A camera is attached to
the end of the telescope and the image is viewed on a video monitor.
Surgery is carried out while looking at this monitor.
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
gynaecologist 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 recurrent abortions are
also evaluated by hysteroscopy
abnormal
findings on a hysterosalpingogram, ultrasound, or pelvic exam may
also require a hysteroscopy for further evaluation
uterine
fibroids, polyps and septums [divisions] are evaluated as well as
treated hysteroscopically
Hysteroscopy is performed under general anaesthesia. 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.
This can allow natural conception again.
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.
Advantages of a
hysteroscopy over a plain D&C
Nowadays a D&C should
NEVER be done alone. It should always be combined with a hysteroscopy. Insist on it with your gynaecologist.
This
is because it is conclusively proven that a D&C [which is really
a "blind" procedure] even in the best of hands gets only
about 50% of the lining of the uterus while there may be a disease in
the remaining portion which has been missed. A hysteroscopy allows
the gynaecologist to view the inside of the uterus and take a biopsy
from the area which is worst affected and to localize the area and
extent of the disease too.