Operative Hysteroscopy: Its Overview, Indications, Process & Complications

Overview

Operative hysteroscopy is used to correct the abnormality found in diagnostic hysteroscopy.

If an abnormality is detected in diagnostic hysteroscopy,  an operative hysteroscopy is performed at the same time. There is no need of second surgery.

To perform the operative hysteroscopy, small surgical instruments are inserted via hysteroscope to correct the present abnormality. It takes more time in operative hysteroscopy than diagnostic hysteroscopy.

This is performed by an obstetrician or gynecologist using a hysteroscope, which is a thin tube having a light source and a camera at the end.

This instrument is inserted into the vagina to view cervix and inside of the uterus.

Image recorded by the camera are sent to a monitor in which the doctor view the images and examine it.

Operative hysteroscopy is sometimes assisted with laparoscopy to provide better guidance to perform the surgery. It helps to prevent perforation of uterine walls.

Indications

Operative hysteroscopy is performed to correct following conditions:

Asherman’s Syndrome: It is a condition in which scar tissue is formed inside the uterus or cervix. This changes the menstrual flow and can cause infertility. Doctors can locate remove adhesions using operative hysteroscopy.

Polyps And Fibroid: These are non cancerous abnormal tissue growth in uterine cavity. These can be removed by operative hysteroscopy.

Septums: A uterine septum is a congenital malformation which parts the uterine cavity. This abnormality can be treated by operative hysteroscopy.

Heavy Menstrual Bleeding: Endometrial ablation is a procedure to destroy the endometrium using operative hysteroscopy to treat the cause of heavy bleeding.

Process

The best time to perform hysteroscopy is the proliferative phase i.e. 4th to 14th day of menstrual cycle.

Pain during the procedure varies from person to person. Some may feel mild or no pain while some may feel severe pain.

Minor surgeries are performed under local anesthesia and mild sedation while major hysteroscopies require local, regional anesthesia or general anesthesia.

Before starting the procedure, vagina is prepared by applying Povidone iodine to kill any bacteria, fungs, protozoa, fungus etc present on the skin.

Dilator tools or medications are used to dilate or open the cervix. This is done to get access to the cervix. A speculum is used to keep the vagina open.

After this hysteroscope is gently inserted into the uterus through the cervix.

A operative sheath is required to transfer the distention media into the uterine cavity. The telescope fits into this sheath. The diameter of operative sheath range from 7 to 10 mm. Operative sheath provide space for insertion of operative devices.

Uterine walls are very close to each other hence, to get a panoramic view these walls must be separated. To do this uterus is expanded using distention media. It is filled into the uterus to get clear and visible images in hysteroscopy.

Distention media is classified as gas or liquid distention media.  For e.g. carbon dioxide (CO2)

After inserting the hysteroscope, gas or liquid saline is injected through the hysteroscope into the uterus. This is done to expand the uterus to have a clear view of linnings and openings of fallopian tubes.

The images of inside the uterus, are sent by the camera in hysteroscope to the monitor through which the doctor view and analyse the images. If the view is not clear, fluid is aspirated from uterine cavity until a clear view is obtained.

Examination of all uterine linings and the tubal openings is carried out by axial movement of the telescope.

Any abnormality, scar tissue, fibroid etc. are recognizable by the gynecologist and are removed by operative hysteroscopy using surgical instruments.

Generally laparoscopy is used along with operative hysteroscopy during excision of large myomas, lysis of uterine adhesions, tubal cannulation and septal resection etc.

Complications

Hysteroscopy is a safe procedure and has low complication rate but still some complications are possible. Complications and risks associated with hysteroscopy are:

  • Heavy Bleeding: Excess bleeding may be seen during or after the procedure. It can be treated by medications or in rare case might require another process.

  • Infection: Vaginal or uterine infection is possible after hysteroscopy. One should know the symptoms of infection so that she can get it treated on time. Symptoms of infection are smelly vaginal discharge, fever and heavy bleeding. Infection can be treated or prevented by use of antibiotics.

  • Damage to cervix and uterus: As the instruments are inserted via cervix, there is possibility of accidental damage to the parts of reproductive tract. If any injury or damage is caused it can be easily treated with antibiotics or in rare cases may require another operation.

  • OverDistension Of Uterus: This is the most frequent complication seen in hysteroscopy. This happens due to use of inappropriate instrument or technique or insertion of excess distention media.

  • Uterine Perforation: It might occur during dilation, when the dilator passes to more depth than the length of the uterine cavity.

  • Gas Embolism: Gas embolism is rare but fatal complication of hysteroscopy. It could be air (atmospheric air) or carbon dioxide (CO2) embolism. It is mostly seen in cases where gas distention media is used. This is the reason why gas distention was replaced by saline distention media.

  • Vaginal Bleeding: After hysteroscopy vaginal bleeding with abdominal pain and cramping like menstrual period occur. This usually lasts for about two weeks.

 

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