Operative Hysteroscopy

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.