A hysteroscope is a long and thin instrument with a scope at its tip. The instrument may be connected to a monitor, which enables easier viewing for the physician and patient. The hysteroscope allows the physician to view the inside of the uterus and immediately locate uterine complications, such as
- Structural abnormalities of the uterus
- Polyps
- Fibroids
- Uterine scar tissue
Procedure for Diagnostics
The hysteroscopy is performed after the patient’s menstruation has ended, but before ovulation occurs. The procedures vary depending on the purpose. The more simple procedures may take place in the doctor’s office. More complex operations will most likely be performed in the hospital operating room. The patient will either disrobe from the waist down or completely (and wear a provided robe). She will position herself on a table with stirrups. The doctor will then:
- Insert a speculum into the vagina
- Insert the hysteroscope through the vagina and cervix and into the uterus
- Inject a gas or liquid through the hysteroscope and into the uterus (to expand it for better viewing)
During the procedure, the doctor may also dilate the cervix to aid in allowing the hysteroscope into the uterus.
Procedure for Anesthetics
Depending on complexity of the procedure, the doctor may administer some type of anesthesia.
- Local Anesthetic: The doctor numbs only the area around the cervix.
- Regional Anesthetic: The doctor numbs the entire pelvic region with a spinal injection.
- General Anesthetic: The doctor applies a gas mask, and the patient is unconscious during the procedure. She may also be intubated (a tube is placed down her throat to establish an airway as a preventative measure).
Procedure for Operations
Once the desired level of anesthesia has been achieved, the doctor will follow the basic procedures, as in diagnostics. When the hysteroscope is in place in the uterus, the physician will be able to place the necessary tools through the hysteroscope to
- Remove polyps, fibroids or scar tissue
- Correct structural abnormalities
- Biopsy endometrial tissue
Preparing for the Hysteroscopy
It is important that the patient is not pregnant or suffering from an infection, thus the doctor may require testing before the procedure. If the patient is undergoing a more complex procedure, the hospital may also require fasting for a directed time period before the procedure. For these more complex procedures, the patient should be prepared to have a longer stay after the procedure. In both types of procedures, most patients are released within a half hour to a few hours. Regardless of the type of procedure, the patient should arrange for someone else to drive her home afterwards.
Risks
Cramping and bleeding are common in the days following the hysteroscopy. A patient should notify her doctor if she has intense pain, heavy bleeding or discharge, or fever over 100° F. According to the American College of Obstetrics and Gynecology, 1% of patients of patients suffer complications from the hysteroscopy. These include
- Accidental puncture of the cervix or uterus
- Infection
- Complications of anesthesia
- Complications from gas injected into the uterus
Additional Uses
The doctor may use hysteroscopy to test for endometrial cancer or to perform an endometrial ablation, in which the lining of the uterus is permanently destroyed. The procedure may also be used by the doctor to locate or remove an IUD (pregnancy prevention device).
Combination Procedures
The doctor may perform the hysteroscopy in combination with the hysterosalpinogram (HSG) or sonohysterogram (SHG). The hysteroscopy can be used to confirm diagnoses and treat the conditions found in these procedures. Additionally, the hysteroscope may be used in combination with a dilation and curettage (D&C) procedure. In some cases, hysteroscopy may be performed in conjunction with the laparoscopy. The latter would be a more intensive procedure and would require more recovery time.
