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)
uterine septa and other congenital malformations
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.