Frequently asked questions about Hysteroscopy

 

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Prof. Dr. R. K. Mishra

What is Hysteroscopy?

Hysteroscopy is the visual inspection of the interior of the uterine cavity through a small circular tube containing fibre optics. The hysteroscope is inserted into the uterus through the opening of cervix allowing a surgeon or gynecologist to view interior of uterus. Sometimes the procedure is simply for diagnostic purposes, and other times the procedure is used for treatment purposes, such as the removal of a tissue sample or removal of a polyp, or tumour. These days out-patient hysteroscopy is becoming increasingly popular with saline distension of the uterine cavity.

What is an Hysteroscope?

The hysteroscope is a medical instrument that allows the surgeon to view the internal anatomy of uterus. The scope has a small diameter rigid insertion tube that enters the body through cervix and contains optical components that send an image from the inside of the body to a video monitor for the mi8nimal access surgeon to view. The hysteroscope is generally 2.5 to 5.5 mm in diameter.

what are the Indications of different types of hysteroscopy?

The indication of different types of hysteroscopy depends on the type of problem patient have. It depends on the symptom of the patient and the assumption of gynecologist what he or she wants to see and what is his provisional diagnosis. Some frequent indication of hysteroscopy is as follows:

  • women of child bearing age with endometrial pathology on ultrasound examination
  • Women of child bearing age with menorrhagia unresponsive to medical treatment
  • Women of child bearing age with break through bleeding on Hormone Replacement Therapy (HRT)
  • Women of child bearing age with Infertility or habitual abortion
  • Women of childbearing age with misplaced intrauterine contraceptive device
  • Elderly women with polyps, menorrhagia or hyperplasia
  • Elderly women with postmenopausal bleeding
  • Suspected endometrial carcinoma and patient who are receiving Tamoxifen and who develops uterine bleeding

How hysteroscopy is performed

Parient lies down in lithotomy position head is down 15 degree. patient is positioned well down on the operation table to ensure the buttock overhang the end of the table. The gynecologist or minimal access surgeon sits between the patient's legs. The patent is draped, thoroughly cleaned. Sims speculum is inserted to locate the cervix. Gynecologist will then gently dilate the cervix with the help of hegar's dilator. After adequate dilatation hysteroscope is inserted slowly through cervix. For good vision a balanced flow of saline is started to clean and wash out blood and tissue debris. Once hysteroscope enters into the uterine cavity either saline or CO2 is used to distend the uterus. Once hysteroscope started getting good view of interior of the uterus the gross pathology can be detected. After complete examination the hysteroscope is gently withdrawn.

What are the complication of hysteroscopy

Possible complications of hysteroscopy include bleeding and puncture of the uterus (uterine perforation). Bowel damage through the hole of uterine perforation. However, such complications are rare. Most people will probably have nothing more than a mild lower abdominal pain after the procedure.

What should be done after a complication of uterine perforation?

The chance of uterine perforation during hysteroscopy is very rare in experienced hand. If it happens, the diagnostic laparoscopy should be performed to examine any possible bowel injury. If there is not any bowel injury and uterine perforation small (usually the case) then patient can be discharged next day with some antibiotic coverage. In case of large perforation and extensive bowel injury some times laparotomy may be necessary.

R.K.Mishra

Minimal access surgeon