An Overview of Diagnostic and Operative Hysteroscopy

A hysteroscope is an endoscope that carries optical and light channels or fibers. It is introduced in a sheath that provides an inflow and outflow channel for insufflation of the uterine cavity. In addition, an operative channel may be present to introduce scissors, graspers or biopsy instruments. A hysteroscopic resectoscope is similar to a transurethral resectoscope and allows entry of an electric loop to shave off tissue, for instance to eliminate a fibroid. A contact hysteroscope is a hysteroscope that does not use distention media. Hysteroscopy has been done in the hospital, surgical centers and the office.

It is best done when the endometrium is relatively thin, that is after a menstruation. Diagnostic can easily be done in an office or clinic setting. Local anesthesia can be used. Simple operative hysteroscopy can also be done in an office or clinic setting. Hysteroscopic intervention can also be done under general endotracheal anesthesia, but a short diagnostic procedure can be performed with just a paracervical block using the Lidocaine injection in the upper part of the cervix. The patient is in a lithotomy position.

A hysteroscopy may be done to:

Find the cause of severe cramping or abnormal bleeding.

Your doctor can pass heated tools through the hysteroscope to stop the bleeding.

See whether a problem in the shape or size of the uterus or if scar tissue in the uterus is the cause of infertility.

Look at the uterine openings to the fallopian tubes.

If the tubes are blocked, your doctor may be able to open the tubes with special tools passed through the hysteroscope.

Find the possible cause of repeated miscarriages. Other tests may also be done.

Find and remove a misplaced intrauterine device (IUD).

Find and remove small fibroids or polyps.

May be used to check for endometrial cancer.

Use heated tools to remove problem areas in the lining of the uterus (endometrial ablation).

Place a contraceptive implant (such as Essure) into the opening of the fallopian tubes as a method of permanent sterilization.