Hysteroscopic Surgery
Hysteroscopic Surgery
What Is Hysteroscopy
A
hysteroscopy is a minimally invasive diagnostic and therapeutic method that allows the gynaecologist to accurately examine the inside of the uterus (the uterine cavity). A thin endoscopic instrument, the hysteroscope, is used and is inserted into the uterine cavity through the vagina and cervix, without the need for incisions. Hysteroscopy makes it possible to detect problems such as
polyps,
fibroids, adhesions, or congenital abnormalities such as a
uterine septum, and also to treat them immediately, in the same session.
Why Is Hysteroscopy Performed?
Hysteroscopy is performed when there are indications or symptoms related to the uterine cavity. Specifically, it is recommended in cases of abnormal vaginal bleeding, infertility, miscarriages, thickening of the endometrium, or suspicious findings on ultrasound or hysterosalpingography. In addition, it is used to remove intrauterine pathology or old intrauterine devices.
What Is the Procedure?
The hysteroscopy procedure is performed in a properly equipped medical setting and can be done under local anaesthesia or light sedation, depending on the case. The hysteroscope is gently inserted through the cervix into the uterus and, with the help of saline solution flowing from the tip to distend the cavity, the gynaecologist can clearly view the inside of the uterus on a high-definition monitor. If pathology is identified, it can be treated immediately, without the need for a second procedure. The duration is short, and the patient returns promptly to her daily activities.
Types
Hysteroscopy is divided into two main categories, depending on the purpose of the examination: diagnostic and operative hysteroscopy.
Diagnostic
A diagnostic hysteroscopy is a simple and painless procedure used when a thorough evaluation of the uterine cavity is required for:
● cases of unexplained infertility or repeated failed IVF attempts
● ultrasound suspicion of polyps or fibroids that distort the inside of the uterus
● bleeding after menopause or between periods
● suspected intrauterine adhesions
● removal of an intrauterine device (IUD/coil) when this cannot be done easily in the usual way (the strings are not visible outside the cervix)
This is a short procedure, with no incisions, and is often performed without anaesthesia or with light sedation.
Operative
An operative hysteroscopy combines diagnosis and treatment in the same session. The gynaecologist uses specialised micro-instruments to remove abnormal formations or correct uterine deformities. It is indicated for:
● removal of a uterine polyp
● treatment of a uterine septum
● submucosal fibroids
● intrauterine adhesions (Asherman syndrome), usually after procedures inside the uterus, e.g. curettage
The procedure is usually performed under light anaesthesia and does not require hospitalisation. If tissue is removed (e.g. a uterine polyp), it is sent for histological examination.
Complications
Hysteroscopy is an extremely safe procedure, with rare complications such as inflammation or injury to the uterus or cervix from the hysteroscope, which could lead to bleeding or fluid accumulation in the uterus.
Recovery
Recovery after hysteroscopy is usually fast and straightforward. Most of these procedures are day cases. Immediately after the procedure, the woman remains under observation for a short time, and discharge from the clinic is usually permitted a few hours later. Mild bleeding and fatigue are expected for a few days, and mild painkillers may be needed. A follow-up visit takes place after the next period at the clinic, where the findings and histology results are discussed and a further plan is created depending on the clinical scenario.
The experienced obstetrician and surgeon gynaecologist D. Koleskas, MRCOG, has served as head (Consultant) of the Laparoscopy and Hysteroscopy (Minimally Invasive Surgery) surgical team at the university hospital Royal Victoria Infirmary, Newcastle, UK. He has performed a large number of hysteroscopies, providing safe and effective solutions for every gynaecological issue.
For more information about what hysteroscopy is, when it is performed, whether preparation is needed, as well as its cost, please contact the doctor and schedule your appointment.
Frequently Asked Questions
Is There Pain Afterwards?
Symptoms such as period-like pain, bloating, and cramps in the lower abdomen may occur. If deemed necessary, antibiotics may be prescribed or painkillers may be taken for the first two days.
What Are the Chances of Pregnancy After Hysteroscopy?
The chances of pregnancy after hysteroscopy increase in cases where the procedure corrects causes of infertility, such as after removal of a uterine polyp or fibroids. Hysteroscopy is not the primary method for investigating infertility, but it can help treat endometrial problems that affect fertility, thereby increasing the likelihood of pregnancy. Attempts to conceive can usually begin after the next period following the procedure.
On Which Day of the Cycle Is It Performed?
Hysteroscopy is usually performed after the last day of menstruation, ideally between day 6 and day 10 of the cycle.
Bleeding After Hysteroscopy
Light bleeding is common and usually stops no later than 7 days. To reduce the risk of infection, the use of sanitary pads rather than tampons is recommended.
Intercourse After Hysteroscopy
During bleeding or if any complication occurs, avoiding intercourse is recommended.
