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Diagnostic Hysteroscopy
Operative Hysteroscopy
Risks of Hysteroscopy
Diagnostic Hysteroscopy
Hysteroscopy is an important tool on the study of infertility, recurrent miscarriage, or abnormal uterine bleeding. Diagnostic hysteroscopy is used to examine the inside of the uterus, also known as the uterine cavity, and is helpful in diagnosing abnormal uterine conditions such as internal fibroids, scarring, polyps, and congenital malformations. A hysterosalpingogram (an x-ray of the uterus and fallopian tubes) or an endometrial biopsy may be performed before or after diagnostic hysteroscopy.

The first step of diagnostic hysteroscopy involves slightly stretching the canal of the cervix with a series of dilatators. Once the cervix is dilated, the hysteroscope, a narrow lighted viewing instrument similar to but smaller than the laparoscope, is inserted through the cervix and into the lower end of the uterus. Carbon dioxide gas or special clear solutions are then injected into the uterus through the hysteroscope. This gas or solution expands the uterine cavity, clears blood and mucus away, and enables the physician to directly view the internal structure of the uterus.

Diagnostic hysteroscopy is usually conducted on an outpatient basis with either general or local anesthesia. Diagnostic hysteroscopy is usually performed soon after menstruation because the uterine cavity is more easily evaluated and there is no risk of interrupting pregnancy.

Operative Hysteroscopy
Operative hysteroscopy can treat many of the abnormalities found during diagnostic hysteroscopy. Treatment may be performed at the same time as diagnostic hysteroscopy or at a later date. Operative hysteroscopy is similar to diagnostic hysteroscopy except that a ideal hysteroscope is used to allow operating instruments such as scissors, biopsy forceps, electosurgical or laser instruments, and graspers to be placed into the uterine cavity through a channel in the operative hysteroscope. Fibroids, scar tissue, and polyps can be removed from inside the uterus. Congenital abnormalities, such as uterine septum, may also be corrected through the hysteroscope.

After surgical repair of the uterine cavity, a Foley catheter or intrauterine device (IUD) may be placed inside the uterus to prevent the uterine walls from fusing together and forming scar tissue. Antibiotic and/or hormonal medication may also be prescribed after uterine surgery to prevent infection and stimulate healing of the endometrium (uterine lining). Endometrial ablation, an operative hysteroscopy procedure in which the endometrium is destroyed, can be used to treat excessive uterine bleeding when a hysterectomy is not considered feasible.

Risks of Hysteroscopy
Complications of diagnostic hysteroscopy are rare and seldom life-threatening. Perforation of the uterus (a hole punctured in the uterus) is the most common complication, but the hole usually heals on its own, without requiring additional surgery. When operative hysteroscopy is planned, diagnostic hysteroscopy is frequently performed at the same time to allow the physician to see the outside as well as the inside of the uterus.

Complications occur in one or two out of every 100 operative hysteroscopy procedures, with uterine perforation being the most common. Some complications related to the liquids used to distend the uterus include pulmonary edema (fluid in the lungs), breathing difficulties, blood clotting problems, decreased body temperature, and severe allergic reactions. Complications related to the surgical procedure include damage to intra-abdominal organs and hemorrhage. Severe or life-threatening complications, however, are very uncommon.

Diagnosing and correcting gynecologic disorders once required major surgery and many days of hospitalization. Laparoscopy and hysteroscopy now allow physicians to diagnose and correct many of these disorders on an outpatient basis. Patient recovery time is normally only two to three days, which is significantly less than the recovery time from major abdominal surgery. The procedures also decrease patient discomfort. Before undergoing laparoscopy or hysteroscopy, patients should discuss with their physicians any concerns about the procedures and their risks.

Reprinted with permission from the
American Society for Reproductive Medicine

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