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Hysteroscopy

Hysteroscopy is the visual examination of the canal of the cervix and interior of the uterus using a thin, lighted, flexible tube called a hysteroscope. The device is inserted through the vagina. Hysteroscopy may be used for both diagnostic and therapeutic purposes.

The hysteroscope allows for easy visual access to the interior of the cervix and uterus to assess the lining of these structures. Therapeutic maneuvers, such as taking a tissue sample (biopsy), removal of polyps or fibroid tumours, or preventing bleeding with cautery (destruction of tissue by electric current, freezing, heat, or chemicals) may be performed during a hysteroscopy procedure.

Hospital Stay: Hospital Stay: 30 mins - 1 hr
Duration: Duration: 5-30 mins
Cost Estimate: Cost Estimate: 715 USD - 880 USD These are indicative prices in Indian Hospitals

Hysteroscopy may be performed in women who have an abnormal Pap test, abnormal uterine bleeding, or postmenopausal bleeding. It may be used to help diagnose causes of infertility or repeated miscarriages. Hysteroscopy may also be used to evaluate uterine adhesions (Asherman’s syndrome), polyps, and fibroids, and to locate and remove displaced intrauterine devices (IUDs). Hysteroscopy is also used to place small inserts in the fallopian tubes that are a permanent method of birth control.

Therapeutically, hysteroscopy may be used to help correct uterine problems. For example, small adhesions, polyps, or fibroids may be removed through the hysteroscope, often eliminating the need for open abdominal surgery. Endometrial biopsy or ablation (removal of the endometrial lining) may be performed via hysteroscopy. The term “operative hysteroscopy” may be used in these situations.

Hysteroscopy cannot be performed during pregnancy.  The procedure is best performed about 1 week after menstruation.

Female Pelvic Organs

The organs and structures of the female pelvis are:

  • Endometrium: This is the lining of the uterus.
  • Uterus (also called the womb): The uterus is a hollow, pear-shaped organ located in a woman’s lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
  • Ovaries: Two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones oestrogen and progesterone are produced.
  • Cervix: The lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body.
  • Vagina (also called the birth canal): The passageway through which fluid passes out of the body during menstrual periods. The vagina connects the cervix and the vulva (the external genitalia).
  • Vulva: The external portion of the female genital organs.
  • Fallopian tubes: Two thin tubes that extend from each side of the uterus toward the ovaries as a passageway for eggs and sperm.

Before the Surgery

  • The doctor will explain the procedure to the patient/family and offer the opportunity to ask any questions about the procedure.
  • The patient will be asked to sign a consent form that gives permission to do the surgery. The patient/family must read the form carefully and ask questions if something is not clear.
  • For certain more invasive hysteroscopy procedures, in addition to a complete medical history, the doctor may perform a complete physical examination to ensure that the patient is in good health before undergoing the procedure. The patient may also undergo blood tests or other diagnostic tests.
  • Depending on the type of procedure to be performed, the patient may be asked to fast before the procedure if she is to receive local or general anaesthesia. The procedure may be performed with local or regional anaesthesia or without anaesthesia depending on what other procedures are to be performed at the same time.
  • The patient / attendant should notify the doctor if she is sensitive to or allergic to any medications, iodine, latex, tape, or anaesthetic agents (local and general).
  • The patient / attendant should notify the doctor of all medications (prescription and over-the-counter) and any herbal supplements that she may be taking.
  • The doctor should be notified if the patient has a history of bleeding disorders or if she is taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop these medications prior to the procedure.
  • The patient should change into hospital gown.  Any excessive hair at the surgical site will be clipped off or shaved.
  • An antibiotic may be given the day before the procedure.
  • The patient should not use tampons, vaginal creams or medications, douche, or have sexual relations for 24 hours before the test.
  • Depending on the procedure to be performed, the patient may receive a sedative prior to the procedure to help her relax
  • Based on the patient’s medical condition, the doctor may request other specific preparation.

During the Surgery

A hysteroscopy may be performed on an outpatient basis or as part of stay in a hospital. Procedures may vary depending on the patient’s condition and the doctor’s practices.

Generally, a hysteroscopy follows this process:

  • The patient will be asked to undress completely or from the waist down and put on a hospital gown.
  • The patient will be instructed to empty the bladder prior to the procedure.
  • An intravenous line may be inserted into the arm of the patient.
  • Patient will be positioned on an examination table, with her feet and legs supported on stirrups
  • The vaginal area will be cleansed with an antiseptic solution.
  • The cervix may be dilated prior to the insertion of the hysteroscope.
  • The hysteroscope will be inserted into the vagina, through the cervix, and into the uterus.
  • A liquid or gas will be injected through the hysteroscope to expand the uterus, allowing for better visualization.
  • The wall of the uterus will be examined for abnormalities. Photographs or video documentation may be made. Biopsy specimens may be taken.
  • If a procedure, such as fibroid removal, is to be performed, instruments will be inserted through the hysteroscope.
  • For more detailed or complicated procedures, a laparoscope (a type of endoscope inserted through the abdomen) may be used to view the outside of the uterus simultaneously.
  • When the procedure is completed, the hysteroscope will be removed.

After the Surgery

The recovery process will vary depending on the type of anesthesia that is given. If general anesthesia or a sedative was used, blood pressure, pulse, and breathing will be monitored until they are stable and the patient is alert. When stable, the patient will be discharged home. Hysteroscopy is usually performed on an outpatient basis.

Rehabilitation

There is generally no special type of care following a hysteroscopy. The patient may experience cramping and vaginal bleeding for a day or two after the procedure. In case the patient observes any of the following symptoms, it should be reported to the doctor:

  • Fever
  • Severe abdominal pain
  • Heavy vaginal bleeding or discharge.

The patient may experience flatulence (gas in the digestive tract) and pains resulting from the gas administered during the procedure for about 24 hours. Patient may also feel pain in the upper abdomen and shoulder.  Pain relievers can be taken for soreness as recommended by the doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Hence, recommended medications should be taken. The patient may be instructed to avoid vaginal douching and sexual intercourse for two weeks after the procedure, or for an alternate period of time recommended by the doctor. Other activities and normal diet may be resumed unless the doctor advises differently.

Risks / Complications

As with any surgical procedure, complications may occur. Some possible complications of hysteroscopy may include, but are not limited to, the following:

  • Infection
  • Bleeding
  • Pelvic inflammatory disease
  • Perforation of the uterus (rare) or damage to the cervix
  • Complications from fluid or gas used to expand the uterus

The patient may experience slight vaginal bleeding and cramps for a day or two after the procedure.There may be other risks depending on the patient’s specific medical condition. Certain factors or conditions may interfere with a hysteroscopy. These factors include, but are not limited to, the following:

  • Pelvic inflammatory disease
  • Vaginal discharge
  • Inflamed cervix
  • Distended bladder

You should be able to go home shortly after the procedure. If you had general anaesthesia, you may need to wait until its effects have worn off.

It is normal to have some mild cramping or a little bloody discharge for a few days after the procedure. You may be given medication to help ease the pain. If you have a fever, chills, or heavy bleeding, you should consult with the doctor

Dilation and curettage (D&C) is a surgical procedure. Your cervix is opened (dilated) and an instrument is used to remove some of the lining of your womb (curettage). Hysteroscopy is where your doctor uses a camera to look at the inside of your womb. They may then use special instruments to take a sample of tissue or treat a gynaecological condition. You would usually have a hysteroscopy first to examine the womb, with the D&C then following this if necessary.

D&C can be used to take a sample of the lining of your womb. This can help to diagnose and treat a condition that may be causing any abnormal bleeding. You might also have a D&C after a miscarriage, to remove any tissue that’s left behind in your womb.

D&C is used less and less, now that newer techniques have replaced it.

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