Hysteroscopy

A hysteroscopy is a diagnostic or surgical procedure done using a hysteroscope. The hysteroscope is an instrument that consists of a long and thin optical lens attached to a camera. It is used to provide vision inside the uterine cavity. In a similar manner a gastroscopy looks inside the stomach, an arthroscopy looks inside joints and a laparoscopy looks inside the abdomen.

It is used for diagnosis when the hysteroscope is used to look for any problems inside the uterus, and for treatment, when the hysteroscope is used to remove fibroids or polyps, correct a uterine septum, divide intra-uterine scarring, etc.

Why do I need a hysteroscopy?

A hysteroscopy gives the surgeon the ability to diagnose any problems inside the uterine cavity by direct visualization as well as perform small surgical procedures when treatment is required.

 Some situations that require a diagnostic hysteroscopy are post-menopausal bleeding, endometrial polyps and fibroids. A surgical hysteroscope can be used to take biopsies in the case of post-menopausal bleeding and to remove polyps or small fibroids.

 How is a hysteroscopy performed?

The hysteroscope is inserted through the vagina into the natural opening of the cervix and therefore does not require incisions or cuts. The hysteroscope is attached to a light source that illuminates the uterine cavity so that the doctor can see inside and to a camera that shows the image on a screen. If any surgical procedures are necessary, there are long thin instruments that can be inserted through the hysteroscope.

 What anaesthesia is used for a hysteroscopy?

Hysteroscopies can be done under local or general anaesthesia. Which one is used usually depends on doctor and patient preference. As a general rule, simple, shorter procedures such as diagnostic hysteroscopies can be under local anaesthesia. More complex and prolonged procedures such as resection of fibroids are usually done under general anaesthesia. New technological advances have made the instruments smaller and more precise. With the correct surgical technique more and more hysteroscopies can be done without the need for  general anaesthesia.

 What are possible complications of a hysteroscopy?

By and large, there are no major complications associated with the procedure. The main one is a uterine perforation. That means that an instrument is inserted too deep into the uterine cavity and can cause a small puncture to the uterine wall. The hysteroscope can then reach inside the abdominal cavity and, worst case scenario, can damage intra-abdominal organs such as the bowel. Uterine perforations are fairly rare (1/200 procedures) and serious complications are extremely rare (< 1/1000).