Operative Hysteroscopy

Procedure Description

Operative hysteroscopy is a surgical procedure to treat diseases of the uterine cavity. The surgery is usually performed in a hospital operating room under general anesthesia (patient is asleep). The cervical canal is dilated and a surgical instrument called a hysteroscope is inserted into the uterine cavity. A camera is attached to the hysteroscope and the picture is projected onto a television monitor in the operating room. The uterus is then distended with fluid so the surgeon can see inside the uterus. Various instruments can be passed through the hysteroscope to treat diseases of the uterine cavity. Depending upon the nature and extent of the disease being treated, the procedure can take from 30 minutes to several hours to complete. Patients are usually discharged home the same day of the surgery. Operative hysteroscopy is usually performed in the first half of your cycle, i.e. before ovulation. Your physician may place you on hormones to suppress ovulation before this procedure.

Indications

Endometrial polyps and uterine fibroids can be removed using the hysteroscope. These are common causes of abnormal uterine bleeding and sometimes can be associated with infertility. Intra-uterine adhesions (scar tissue) can form after a previous dilation and curettage (D&C). These adhesions can be associated with infertility and recurrent miscarriages. The hysteroscope is used to remove these adhesions. Congenital malformations of the uterine cavity, such as a uterine septum, can be treated with the hysteroscope. Fallopian tubes that are blocked at their insertion into the uterine cavity (proximal occlusion) can sometimes be opened by placing small wires through the hysteroscope and into the tube (see fallopian tube catheterization). Tubal sterilization can also be performed through the hysteroscope by placing small metal coils into the opening of the fallopian tubes (see Essure procedure).

Risks

There is a small risk of perforating (making a hole) the uterus either during the cervical dilatation or during the hysteroscopy procedure. If this happens, your doctor may need to place a laparoscope into your pelvis to check for injury to adjacent organs. The risk of uterine perforation is low. The fluid used to distend your uterus can also cause complications if you absorb too much of it. Your physician will discuss these risks with you in detail before you have the surgery.

Post Procedure

You can expect to have some cramping and light bleeding for several days after the surgery. You will be given pain medicine to take for this. You should call your physician if you have a temperature greater than or equal to 101 degrees Fahrenheit or if you experience bleeding equal to or greater than a normal menstrual period. A follow up appointment will be made in your doctor’s office two weeks after the surgery.