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OPERATIVE
HYSTEROSCOPY |
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What is Operative Hysteroscopy?
Hysteroscopy is a procedure used to look inside a woman's
uterus. If an abnormal condition is detected during the
diagnostic procedure, operative hysteroscopy can often be
performed to correct it at the same time, avoiding the need
for second surgery.
A wider hysteroscope allows operating instruments such as
scissors, biopsy forceps, graspers, electrosurgical or laser
instruments to be introduced into the uterine cavity through
a channel in the operative hysteroscope.
What is the purpose of this Operative
Hysteroscopy?
Many of the problems that affect fertility can be treated
through the hysteroscope. Some of the procedures that can
be performed through an operative hysteroscopy include fibroid
removal, polypectomy, septum resection, adhesiolysis, IUD
removal, and lateral metroplasty. One of the most common
is scar tissue formation (adhesions) inside the cavity of
the uterus, which can interfere with the woman's ability
to become pregnant. This is known an Asherman’s Syndrome.
The scar tissue may be the consequence of previous infection,
or over zealous curettage. The scar tissue is cut and removed
through the hysteroscope, clearing the uterine cavity.
After surgical repair, a Foley catheter or intrauterine
device may be placed inside the uterus to prevent the uterine
walls from fusing together. Antibiotics and/or hormonal
medication may also be prescribed after uterine surgery
to prevent infection and stimulate healing of the endometrium
(uterine lining).
With operative hysteroscopy, there are no incisions, and
the abdomen is not opened. Because of this, the patient
can frequently go home the same day after surgery. This
greatly reduces the cost of the surgery, and allows you
to return to work and to your normal activities sooner.
The amount of pain involved is also much less.
Many infertile women have problems with their tubes. They
may have blocked tubes as seen on a hysterosalpingogram
(HSG). In this case, one can attempt to reopen the tubes
by hysteroscopic cannulation. A number of other procedures
can also be accomplished through the hysteroscope.
As an operative procedure, hysteroscopy can also be used
for female sterilization using tubal occlusive devices.
It also is a useful technique for taking a biopsy from a
suspicious area within the uterus, or locating and removing
an intrauterine device (IUD) whose threads cannot be seen.
The Advantages of Operative Hysteroscopy
- No incisions
- Reduced post-operative pain
- Shortened hospital stay
- Shortened Convalescence
- Reduced risk of infection
To the patient the most significant advantage is the early
mobilization, a shorter hospital stay and more importantly
an early return to work, due to less pain and early healing.
The cosmetic value is also important to many patients who
do not wish to have long, obvious scars. Of greater importance
are the benefits of reduced risk of infection and adhesion
formation. Hysteroscopic surgery is by nature a closed operation
and hence reduces the risk of contamination.
The preparation required, the type of anesthesia and the basic
procedure are the same as for a diagnostic hysteroscopy.
Duration of Operative Hysteroscopy
Operative Hysteroscopy can last from 30 minutes to 1 hour,
depending on the complexity of the procedures that are required.
What are the risks associated with Operative Hysteroscopy?
Complications of hysteroscopy are rare and seldom
serious.
- Perforation of the uterus(hole in the uterus) is the
most common complication, but the hole usually heals on
its own.
- Some complications related to the liquids used to distend
the uterus include fluid overload, pulmonary edema (fluid
in the lungs), blood clotting problems, and severe allergic
reactions.
- Complications related to the surgical procedure include
damage to intra-abdominal organs and hemorrhage.
- Allergic reactions to medications can also arise, and
this is unpredictable.
- Severe or life-threatening complications, however, are
very uncommon.
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