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Hysteroscopy enables a physician to look through the vagina and neck of the
uterus (cervix) to inspect the cavity of the uterus with an instrument called a
hysteroscope. Hysteroscopy is used as both a diagnostic and a treatment tool.
Purpose Diagnostic hysteroscopy can be used to help determine the cause of
infertility, dysfunctional uterine bleeding, and repeated miscarriages. It can
also help locate polyps and fibroids, as well as intrauterine devices (IUDs).
The procedure is also used to investigate and treat gynecological conditions,
often done instead of or in addition to performing a dilation and curettage
(D&C).
A D&C is a surgical procedure that expands the cervical
canal (dilation) so that the lining of the uterus can be scraped (curettage). A
D&C can be used to take a sample of the lining of the uterus for analysis.
However, hysteroscopy has advantages over a D&C because the doctor can take
tissue samples of specific areas and view any fibroids, polyps, or structural
abnormalities. In addition, small fibroids and polyps may be removed via the
hysteroscope (in combination with other instruments that are inserted through
canals in the hysteroscope), thus avoiding more invasive and complicated open
surgery. This approach is also used to remove IUDs that have become embedded in
the wall of the uterus.
Demographics
There is no research available to indicate that hysteroscopy
is performed more or less frequently on any subset of the female population.
Description
The hysteroscope is an extremely thin telescope-like
instrument that looks like a lighted tube. The modern hysteroscope is so thin
that it can fit through the cervix with only minimal or no dilation. Before
inserting the hysteroscope, the doctor administers an anesthetic. Once it has
taken effect, the doctor dilates the cervix slightly, and then inserts the
hysteroscope through the cervix to reveal the inside of the uterus. Ordinarily,
the walls of the uterus are touching each other. In order to get a better view,
the uterus may be inflated with carbon dioxide gas or fluid. Hysteroscopy takes
approximately 30 minutes.
Treatment involving the use of hysteroscopy is usually performed as a
short-stay hospital procedure with regional or general anesthesia. Tiny surgical
instruments may be inserted through the hysteroscope to remove polyps or
fibroids. A small sample of tissue lining the uterus is often removed for
examination, especially if the patient has experienced any abnormal
bleeding.
Diagnosis/Preparation
If the procedure is performed under general
anesthesia, the patient should have nothing to eat or drink after midnight the
night before the procedure. Routine lab tests may be ordered if the procedure is
performed in a hospital. Occasionally, a mild sedative is administered to help
the patient relax. The patient is asked to empty her bladder. She is then placed
in position (usually in a special chair that tilts back) and the vagina is
cleansed. Usually, a local anesthetic is administered around the cervix,
although a regional anesthetic that blocks nerves connected to the pelvic region
or a general anesthetic may be required for some patients.
Aftercare
It is normal to experience light bleeding for one to two days
after surgical hysteroscopy. Mild cramping or pain is common after operative
hysteroscopy, but usually diminishes within eight hours. If carbon dioxide gas
was used, the resulting discomfort usually subsides within 24 hours.
Risks
Diagnostic hysteroscopy rarely causes complications. The primary
risk is infection. Prolonged bleeding may follow a surgical hysteroscopy to
remove a growth. Another complication is perforation of the uterus, bowel, or
bladder, caused by over-forceful advancement of the hysteroscope. An infrequent
but dangerous complication is increased fluid absorption from the uterus into
the bloodstream. Keeping track of the amount of fluid used during the procedure
can minimize this complication. Surgery under general anesthesia poses the
additional risks typically associated with this type of anesthesia.
The procedure is not performed on women with acute pelvic inflammatory
disease (PID) due to the potential of exacerbating the condition.
Hysteroscopyshould be scheduled after menstrual bleeding has ended and before
ovulation to avoid a potential interruption of a new pregnancy.
Patients should notify their health care provider if, after the hysteroscopy,
they develop any of the following symptoms:
• abnormal discharge
• heavy
bleeding
• fever over 101°F (38.3°C)
• severe lower abdominal pain
Normal results
Normal hysteroscopy reveals a healthy uterus with no
fibroids or other growths. Abnormal results include uterine fibroids, polyps, or
a septum (an extra fold of tissue down the center of the uterus). Sometimes,
precancerous or malignant growths are discovered.
Morbidity and mortality rates
The rate of complications during diagnostic
hysteroscopy is very low, about 0.01%. Surgical hysteroscopy is associated with
a higher number of complications. Perforation of the uterus occurs in 0.8% of
procedures and excess bleeding in 1.2 - 3.5% of cases. Death as a result of
hysteroscopy occurs at a rate of 2.4 per 100,000 procedures performed.
Alternatives
A laparoscope (an instrument with a video camera inserted
through the abdominal wall) may be used to visualize the outside of the uterus
or perform a surgical procedure on the pelvic organs. Laparoscopy and
hysteroscopy are sometimes performed simultaneously to maximize their diagnostic
capabilities.
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