Hysteroscopy
What is a Hysteroscopy?
Hysteroscopy is a surgical technique allowing detailed examination of the inside lining of the uterus (womb). The instrument used (hysteroscope) is a narrow fibre-optic telescope which can be passed through the cervix (neck of the womb) allowing the gynaecologist to see the cervical canal and endometrial cavity (internal lining of the chamber). A small video camera is often attached to the eyepiece of the telescope to allow a magnified picture on a video screen to be viewed by the gynaecologist and assistants. In some procedures the patient may be awake and also able to view these areas.
What are the Indications for Hysteroscopy?
Diagnostic Hysteroscopy
The hysteroscope is used to help determine the cause of gynaecological symptoms, for example to investigate:
- Heavy or irregular menstrual periods
- Post-menopausal bleeding
- Infertility
- Recurrent miscarriage
- Unexplained pain
- Fibroids
- To check the results of prior uterine surgery
- To check or remove an intrauterine contraceptive device
Operative Hysteroscopy
Several new or modified operative procedures use the hysteroscope to see the inside of the uterus, included are:
How is hysteroscopy performed?
Hysteroscopy may only take a few minutes and is performed either under a light general anaesthetic or under a local anaesthetic injected into the cervix. Your gynaecologist will advise which type of anaesthetic is preferable for your case.
The examination is performed with the patient lying on her back with legs apart (perhaps supported in special stirrups). The vulva and vagina are cleansed with antiseptic solution and a sterile speculum is inserted to allow the cervix to be visualized. (The speculum is similar to the instrument used for taking a cervical smear). If local anaesthesia is used the cervix will be grasped with a pair of forceps and slowly injected with local anaesthetic until patient comfort is ensured.
The cervical opening and canal is gently stretched and the telescope passed into the uterine (endometrial) cavity. Carbon dioxide gas or a fluid medium is used to slightly distend the endometrial cavity to improve visualisation. The shape of the uterine cavity and any irregularities can be recognised. The openings of the fallopian tubes and uterine lining layer (endometrium) can be inspected. Where necessary tissue samples may be removed for microscopic examination, this is known as an endometrial biopsy.
Because operative hysteroscopic examinations take longer it is more likely that general anaesthesia will be used and often the telescope is a little bit larger, which allows instruments such as scissors, diathermy forceps, etc., to be passed through operating channels into the uterine cavity. In operative hysteroscopy a special distending fluid is used to expand the cavity and help wash away any bleeding.
 Post Operative Care
When a general anaesthetic has been administered the patient is transferred from the operating theatre to a recovery room for a short period of observation, but the procedure is a day case operation and discharge home is usually possible within a few hours. Where local anaesthetic only is required for a diagnostic procedure patients often go home immediately after the procedure. Patients are advised not to drive or indulge in high risk activity or occupational work within 24 hours of a general anaesthetic day case operation. Simple pain relief, e.g. Panadol, is often needed and some vaginal bleeding may occur for a few days. Sexual intercourse can resume once bleeding has ceased.
Risks and Contraindications
Diagnostic outpatient hysteroscopy is a very minor and safe procedure and the chance of serious complication is extremely remote. The operation is contraindicated in the presence of pregnancy or uterine infection. Where operative techniques are involved there are attendant risks, but these are minimised by proper preparation and the advanced surgical skills of your specialist gynaecologist and anaesthetist.
The main complications are:
- Anaesthetic problems
- Fluid imbalance due to overload from the fluid used to distend the uterine cavity
- Damage to the uterus, bladder, bowel or blood vessels
- Bleeding
Because of the fluid distension required special risks may arise with women who have serious heart or renal disease and your surgeon may decide in some circumstances that the procedure is contraindicated.
Alternative Procedures
Before the development of fibre-optic hysteroscopes, patients needing investigation and operation for the indications, as described above, were submitted to cervical dilatation and uterine curettage (D&C). This technique simply used special forceps to scrape and peel the lining of the uterus and obtain samples of tissue. The hysteroscope allows accurate visualisation and appropriate sampling and reduces the necessity for more major surgery such as hysterectomy or abdominal operations.
Conclusion
The hysteroscope is a valuable surgical telescope which allows accurate viewing and sampling of the uterine cavity and, where appropriate, facilitates tissue removal in an attempt to avoid more major surgery.
The gynaecologists at Oxford Clinic welcome your inquiries about the techniques. They are fully trained and experienced in this surgical skill and are eager to ensure that you feel fully informed about your operation, its expected benefits and are reassured about the risks. They would also encourage you to discuss your surgery with your family physician.
Relevant Links
Endometrial Ablation/Resection
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