Hysteroscopic Surgery
A hysteroscopy procedure enables your doctor to examine the interior of your uterus to identify and treat the causes of abnormal bleeding. The cervix and interior of the uterus are examined during hysteroscopy using a hysteroscope, a tiny, illuminated tube inserted into the vagina. Polyps, fibroids, and adhesions may be removed during an operation hysteroscopy.
Before a Hysteroscopy
The week following your menstrual cycle may be a good time to schedule your hysteroscopy.
Before your procedure, your doctor may prescribe medication to help open your cervix. Carefully adhere to your doctor’s instructions.
Tell your doctor about all of your medical conditions, especially:
- Heart condition
- Diabetes
- kidney illness
Additionally, be sure to let your doctor know about any medications you are taking.
One to two weeks before your hysteroscopy, you may need to stop taking medications like aspirin, Aleve (naproxen), Coumadin (warfarin), Plavix (clopidogrel), and Advil (ibuprofen), among others.
Before having this procedure, let your doctor know if you have a cold, fever, the flu, or a herpes outbreak.
You might be instructed to go without food or liquids for six to twelve hours before your hysteroscopy.
If you have any questions about taking your regular medications on the day of the procedure, ask your doctor.
After a Hysteroscopy
Soon after that, you’ll probably be able to return home. However, if you had a local or general anesthetic, you’ll need a driver.
You may experience some light bleeding or cramping for a few days following the procedure. You could experience a watery discharge for a few weeks.
Additionally, you might have gas, which can last for about 24 hours. To relieve any pain, your doctor might prescribe medication.
After the procedure, you must refrain from sexual activity for at least two weeks.
If you experience significant bleeding, a fever, chills, or severe abdominal pain, call your doctor right away.
Your doctor will give you more information on how to care for yourself after surgery before you are released to go home.
Preparation
The patient must refrain from eating or drinking anything after midnight the night before the procedure if it is done under a routine anesthetic. When the procedure is carried out in a hospital, routine diagnostic tests may be requested. On occasion, a mild sedative is administered to help the patient unwind. The subject is asked to void her bladder. The woman is then positioned while the vagina is cleaned. Although a regional anesthetic that blocks pelvic region nerves or a general anesthetic is frequently required for many patients, an area anesthetic is typically administered around the cervix.
Risks
Diagnostic hysteroscopy rarely results in complications. Infection is the main risk. To stop persistent bleeding, a surgical hysteroscopy may be required. Another issue is the overly-forceful advancement of the hysteroscope, which can result in perforation of the uterus, bowel, or bladder. Increased fluid absorption into the bloodstream in the uterus is a rare but dangerous issue. This issue might be minimized by tracking the amount of fluid used throughout the process. The additional risks typically associated with this type of anesthesia are present during surgery under general anesthesia.
Due to the risk of worsening the condition, the procedure is not performed on women who have a severe pelvic inflammatory disease (PID). To avoid the possibility of the new pregnancy being interrupted, hysteroscopy should be scheduled after menstrual bleeding has stopped but before ovulation.
Following the hysteroscopy, patients should notify their doctor if they experience any of the following symptoms:
- abnormal discharge
- heavy bleeding
- severe lower abdominal pain
- fever over 38.3°C
Results
A healthy uterus without any fibroids or other growths is visible during a routine hysteroscopy. A septum, polyps, or uterine fibroids are examples of irregular outcomes. On occasion, cancerous or precancerous growths are discovered.
Alternatives
A patient can use a laparoscope to perform surgery on the pelvic organs or see the outside of the uterus. On occasion, laparoscopy and hysteroscopy are performed simultaneously to improve their diagnostic capabilities.
Hysteroscopy is a procedure that can be used for both diagnosis and treatment (therapeutic). Your doctor may suggest a variety of procedures to diagnose or treat abnormalities of the uterus or cervix, including hysteroscopy. Hysteroscopy cannot assess issues on the uterus’ outer surface or within the muscular wall because it only looks at the lining and interior of the uterus.
Several gynecological issues, such as the following, may be evaluated using hysteroscopy as a first step:
- Unexpected vaginal bleeding
- Retained placenta or after-birth or miscarriage products of conception
- Female genital tract congenital (inborn) anatomical anomalies
- Adhesions or scarring from previous uterine instrumentation or surgery, such as dilation and curettage (D&C)
- Polyps or fibroid tumors in the uterine cavity or the cervical canal
- Hysteroscopy can be used to perform surgical sterilization as well as to help localize areas of the abnormal uterine lining for sampling and biopsy.
On a standard exam table in the office, hysteroscopy will be carried out. The hysteroscope is gently inserted into the vagina, and sterile water is turned on to flow through it. It’s normal for there to be some water coming out of the vagina. The uterine walls, which normally touch one another, are separated by the water. Under direct vision, the hysteroscope is next carefully inserted through the cervix and into the uterus. If you’d like, you can view this on the TV monitor.
Once inside, the entire uterine cavity is inspected for any potential anomalies. This will take three to five minutes. On occasion, the cervix is difficult to open. In this instance, specialized instruments are required to dilate the cervix. A local anesthetic is injected into the cervix if the cervix needs to be dilated because the dilation can be fairly painful otherwise. On a scale from 0 to 10, where 0 equals no pain and 10 equals the worst pain ever, the average pain score during an office hysteroscopy is 2 to 3.