Everything you need to know about hysteroscopy
Surgical hysteroscopy is a procedure to explore the inside of the uterus and, if necessary, remove abnormalities in the uterine cavity. It is useful for diagnosing and treating certain conditions.
Everything you need to know about hysteroscopy
Surgical hysteroscopy is a procedure to explore the inside of the uterus and, if necessary, remove abnormalities in the uterine cavity. It is useful for diagnosing and treating certain conditions.
This quick and painless protocol may be indicated if you have gynecological problems such as repeated bleeding or pain. It may also be offered following a pelvic ultrasound that has revealed a disorder of the uterus. This procedure is also often performed as part of an infertility evaluation or assisted reproductive treatment.
What exactly is the principle of hysteroscopy? What is the difference between diagnostic and operative hysteroscopy? What are the consequences and risks of this procedure? In this article we present all the information you need to know about hysteroscopy.
The definition of hysteroscopy
Hysteroscopy is an intervention into the uterus using an endoscope. The endoscope is a long, thin tube with optical lenses and a miniature camera at the end. In practice, the endoscope (called a hysteroscope) is inserted into the uterine cavity by the natural route, with or without a speculum.
The patient then lies on her back in the gynecological position. The images transmitted by the device are visible on a video screen placed near the patient. The uterus is irrigated with a fluid throughout the procedure to distend the walls and facilitate observation (e.g. physiological fluid or a glycocolloid solution).
Diagnostic hysteroscopy
There are two types of hysteroscopy: diagnostic hysteroscopy and operative hysteroscopy. Diagnostic hysteroscopy involves exploring the uterus to visualize the inner wall. It may also involve taking tissue samples from the endometrium. The endoscope has a very small diameter (a few millimeters), which usually allows the procedure to be performed without anesthesia.
The patient may feel a slight spasm when the device is inserted, which will dissipate very quickly. She may also feel the fluid used to dilate the uterus pass through the vagina. Diagnostic hysteroscopy is performed in an office or, eventually, in an operating room for reasons of asepsis. It is a quick operation, lasting an average of ten minutes.
Surgical hysteroscopy
Operative hysteroscopy is a surgical procedure performed under general or local anesthesia by a gynecologic surgeon. It is performed with a larger diameter endoscope than diagnostic hysteroscopy (about 10 mm).
The procedure requires the use of a speculum and sometimes dilatation of the cervix. In addition to a camera, the hysteroscope has instruments at its tip, such as an electric scalpel or microscissors. They allow the practitioner to operate on abnormalities inside the patient's uterine cavity. Surgical hysteroscopy is most often performed on an outpatient basis (day hospitalization), and usually does not involve a hospital stay.
After hysteroscopy
Hysteroscopy does not cause any special pain and does not require any specific care. Slight bleeding may occur after the operation for a variable period of time (up to 48 hours after a diagnostic hysteroscopy and up to a week after an operative hysteroscopy). In the case of an operative hysteroscopy, your doctor will usually advise you to take a period of rest after your return home. Bathing, swimming and sexual intercourse should be avoided for a few days after the operation. However, you can shower without any problems.
You will have a postoperative visit with your regular gynecologist (or possibly your surgeon) in the next week or month. If tissue fragments or lesions were removed during the hysteroscopy, they will be sent to the laboratory for analysis. As with any surgical procedure, hysteroscopy surgery carries risks: risks associated with anesthesia, risks of uterine infection, etc. However, the occurrence of serious complications is unlikely. However, the occurrence of serious complications is extremely rare.
Indications for surgical hysteroscopy
Diagnostic hysteroscopy is useful to verify the absence of pathology of the uterus, when the patient observes symptoms such as abdominal pain or unusual bleeding. It is also indicated if a lesion or abnormality in the uterine cavity is suspected, especially after a pelvic ultrasound.
It is used to establish or complete the diagnosis. Surgical hysteroscopy is recommended to remove adhesions (synechiae), remove uterine polyps and small fibroids (benign tumors), section a uterine septum or perform an endometrectomy when necessary.
Hysteroscopy and fertility
Diagnostic hysteroscopy is one of the classic tests in the evaluation of infertility. It makes it possible to look for possible abnormalities responsible for difficulties in conceiving. This procedure is also indicated in the context of medically assisted reproduction, to check the normality of the uterus before initiating an in vitro fertilization (IVF) treatment, for example.
Surgical hysteroscopy can be used to address certain fertility problems, when it is used to remove lesions that prevent the embryo from nesting and the pregnancy from developing smoothly (such as adhesions or malformations of the uterine cavity).
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