Video of Hysteroscopy. To download video right click here and save target

Prof. Dr. R. K. Mishra

What is Hysteroscopy?

Hysteroscopy uses a hysteroscope, which is a thin telescope that is inserted through the cervix into the uterus. Modern hysteroscopes are so thin that they can fit through the cervix with minimal or no dilation. Although hysteroscopy dates back to 1869, gynecologists were slow to adopt hysteroscopy. Because the inside of the uterus is a potential cavity, like a collapsed air dome, it is necessary to fill (distend) it with either a liquid or a gas (carbon dioxide) in order to see. Diagnostic hysteroscopy and simple operative hysteroscopy can usually be done in an office setting. More complex operative hysteroscopy procedures are done in an operating room setting.

Visibility through a hysteroscope

This is a view through a hysteroscope during office hysteroscopy of the inside of a uterus with two fibroids (myomas) on the back wall. The upper portion of the photograph shows the top of the uterus, which is normal. Fibroids like this can cause severe cramping (dysmenorrhea), heavy menstrual periods (menorrhagia) and bleeding between periods (metrorrhagia.) This was quickly and accurately diagnosed by hysteroscopy. Using a special kind of hysteroscope, these myomas can be removed called resectoscopes. Sometime we can see a polyp in the lower part of the uterus. This type of polyp often causes bleeding between periods and is easily removed in the office. Again, office hysteroscopy allowed quick and accurate diagnosis of the cause of abnormal bleeding.

How is Diagnostic Hysteroscopy done?

Unless a woman has major medical problems, diagnostic hysteroscopy can be done in the office setting. Usually, the cervix is frozen (this is easily done and rarely uncomfortable.) and attach a video camera to the hysteroscope, so the patient can also see, and then insert the hysteroscope into the uterus under direct vision while using either saline or carbon dioxide to fill the uterus. Usually this causes mild cramping. We then can look for fibroids, polyps, and other problems that may be causing bleeding. This often takes about a minute or two.The hysteroscope is removed. A small plastic tube may be used to take a sample of the lining of the uterus.

Isn't this too painful to do in the office?

By being very gentle and using local anesthesia, there is usually minimal discomfort during hysteroscopy. Most women are able to get up and return to their normal activities immediately. If someone is very anxious, it is possible to give a short acting narcotic intravenously. This makes it very unlikely that the procedure will be uncomfortable.

What is Operative Hysteroscopy?

During diagnostic hysteroscopy the hysteroscope is used just to observe the endometrial cavity (inside of the uterus.) During operative hysteroscopya type of hysteroscope is used that has channels in which it is possible to insert very thin instruments. These instruments can be used to remove polyps, to cut adhesions, and do other procedures. With the development of better and smaller instruments, we find that it is easy to remove some polyps in addition to doing other procedures that used to require a full operating room. In many situations, operative hysteroscopy may offer an alternative to hysterectomy.

Difference between the resectoscope and the regular hysteroscope?

The resectoscope has been used for male prostate surgery for over 50 years. It has been modified so it can be used inside the uterus. The resectoscope is a hysteroscope with a built in wire loop (or other shape device) that uses high-frequency electrical current to cut or coagulate tissue. The resectoscope has revolutionized surgery inside the uterus.

When should hysteroscopy be performed?

The optimum time for hysteroscopy is during the first week after period. During this time gynecologist is better in a position to view the within the uterus. The way gynecologist be prepared for hysteroscopy. If patient is having general anesthesia in the hospital, she will be told to not eat or drink anything for a certain period of time, usually after midnight the night time before, prior to the procedure. Routine diagnostic tests might be ordered too for ladies using a hysteroscopy within the hospital. You will be inspired to empty your bladder and your genitals will be cleansed with an antiseptic. Sometimes a drug that will help you relax is ordered.

Anesthesia:

Local anesthesia: Patient will get an injection of anesthetic round the cervix to numb it, with this type of anesthesia patient remain awake and could feel some cramping.

Regional anesthesia: A drug is injected, via a needle or tube inside patient lower back, that blocks the nerves that receive sensation in the pelvic region. During this patient is awake with this type of anesthetic, but feel no discomfort. Regional anesthesia can also be called a spinal or epidural.

General anesthesia: Patient will not be conscious on hysteroscopy when general anesthesia is used. A mask over mouth and nose allows to breathe a combination of gases. When patient are under anesthesia, a tube might be inserted down throat that will help her to breathe.

When patient will be able to go home?

Patients who received a local anesthetic can usually go home soon after the procedure. Those who had regional or general anesthesia or gone through big operative procedure require a longer observation period before they are released, but can usually go home on the same day.