HYSTEROSCOPY

What is hysteroscopy?

Hysteroscopy, as the name suggests (hystero = uterus; scopy = to see), is a surgical procedure in which a telescope is inserted inside the uterus to examine the uterine lining. This procedure can assist in the diagnosis of various uterine conditions which can cause infertility, such as:

submucous (internal) fibroids
scarring (adhesions or synechiae)
endometrial polyps
uterine septa and other congenital malformations

Before performing hysteroscopy, a hysterosalpingogram (an x-ray of the uterus and fallopian tubes) may be performed to provide additional information about the cavity which can be useful during surgery. Many doctors will also do a vaginal ultrasound as a diagnostic aid. Diagnostic hysteroscopy is usually conducted on a day-care basis with either general or local anesthesia and takes about thirty minutes to perform.

How is hysteroscopy performed?

The first step of hysteroscopy involves cervical dilatation – stretching and opening the canal of the cervix with a series of dilators. Once the dilatation of the cervix is complete, the hysteroscope, a narrow lighted telescope, is passed through the cervix and into the lower end of the uterus. A clear solution (Hyskon or glycine) or carbon dioxide gas is then injected into the uterus through the instrument. This solution or gas expands the uterine cavity, clears blood and mucus away, and enables the surgeon to directly view the internal structure of the uterus.

The doctor systematically examines the lining of the cervical canal; the lining of the uterine cavity; and looks for the internal openings of the fallopian tubes where they enter the uterine cavity – the tubal ostia.

Some doctors may do a curettage (a surgical scraping of the inside of the uterine cavity) after the hysteroscopy and send the endometrial tissue for pathologic examination.

What is operative hysteroscopy?

The technique of hysteroscopy has also been expanded to include operative hysteroscopy. Operative hysteroscopy can treat many of the abnormalities found during diagnostic hysteroscopy at the time of diagnosis.

The procedure is very similar to diagnostic hysteroscopy except that operating instruments such as scissors, biopsy forceps, electocautery instruments, and graspers can be placed into the uterine cavity through a channel in the operative hysteroscope. Fibroid tumors, scar tissue (synechiae or adhesions), and polyps can be removed from inside the uterus. Congenital abnormalities, such as a uterine septum, may also be corrected through the hysteroscope.

What are the complications of hysteroscopy?

Complications occur rarely during hysteroscopy. In a few cases, infection of the uterus or fallopian tubes can result. Occasionally, a hole may be made through the back of the uterus – a perforation. However, this is usually not a serious problem because the perforation closes on its own. Frequently, when extensive operative hysteroscopy is planned, diagnostic laparoscopy is performed at the same time to allow the surgeon to see the outside as well as the inside of the uterus to try to reduce the risk of accidental uterine perforation. Other possible complications include allergic reactions and bleeding.