Hysteroscopy is the direct visualization of the uterine cavity and the cervical canal through a telescope-like instrument called the hysteroscope. Visualization of the uterine cavity will help detect the presence of any masses (polyps), bands (adhesions), uterine deformities (septum) and nature of the uterine lining or endometrium. The opening of the fallopian tubes into the uterine cavity can also be visualized. Hysteroscopy is a day care procedure performed between the seventh and the tenth day of the menstrual cycle.
Indications:
The main indications for a hysteroscopy are abnormal uterine bleeding and abnormal HSG finding (detection through the scan of the uterus).
Procedure:
Prior to the procedure, it is important to ensure that the patient is in good health by a clinical examination and certain laboratory investigations such as routine blood and urine tests. Hysteroscopy is performed in the operation theatre under general anaesthesia. The patient reports on the morning of the procedure with an empty stomach after an overnight fast. The patient is placed on the examination table in a specific yet comfortable position. Initially, a pelvic or vaginal examination is done to assess the position and size of the uterus. Then a hysteroscope is introduced into the uterus via the vagina and cervix after the cervix has been adequately opened or dilated by instruments called dilators. The uterine cavity and the opening of the fallopian tubes are visualized completely. The procedure is short and lasts about 5 to 10 minutes.
After the procedure:
The patient can usually leave after 1 to 2 hours after the procedure. Antibiotics are given to prevent infection and analgesics are prescribed to relieve pain. In some patients, there could be mild cramping pain in the abdomen for a few hours after the procedure. Uterine bleeding (mild to moderate) may occur for a few days after the procedure. The woman may resume work the next day.
Complications:
Complications of diagnostic hysteroscopy are rare and seldom life-threatening. They include perforation of the uterus (a hole punctured in the uterus), cervical trauma, infection, etc.
Operative hysteroscopy:
This is a procedure which involves introducing accessory instruments such as scissors, biopsy forceps, electrosurgical or laser instruments, through channels in the hysteroscope. These instruments are used to cut or burn tissues. Operative procedures are generally day care procedures performed under general anaesthesia. Treatment may be performed at the same sitting as a diagnostic hysteroscopy, or at a later date.