Hysteroscopy

Article

23. 04. 2018 Gynecology

Hysteroscopy is a surgical procedure whereby a doctor examines the state of the uterine cavity. To achieve this, a narrow tubular device which includes a light source as well as a camera is inserted through the endocervix and the cervical canal. The image is then transmitted to a display where the doctor can assess any changes that may be occurring in the uterine cavity.

Hysteroscopy can be a diagnostic procedure where the primary goal is to determine the source of any complications (such as irregular menstruation, infertility, uterine septum etc.) as well as a method of treatment where surgery is required (removal of polyps, septum or growth removals). The ideal timing for the procedures is immediately following the end of menstruation. 

 

Prior to the procedure

You should receive all important information concerning the planned procedure from your doctor. 

You should however inform your doctor with the following information:

  • You suffer from allergies
  • Any long-term medication you are using
  • Any coagulation disorders you may have (bleeding disorders)
  • Any surgeries you have undergone
  • Any other disease that you are suffering from
  • Whether you are pregnant,  i.e. you must have a negative pregnancy test

Prior to the procedure itself, you can eat dinner. However, from midnight onwards, you should not drink or eat anymore. If you are using long-term medication, ask your doctor if you should take them on the day of the procedure. 

 

During the procedure

The surgical procedure is most commonly carried out under short general anesthesia. During the anesthesia, your veins will be supplied with medication to ensure that you are asleep and relaxed throughout it being carried out. Less frequently, especially with women suffering from chronic disease where general anesthesia is risky, the procedure is carried out using local anesthesia where the anesthetic is applied directly to the cervix.

The procedure is carried out in the so-called gynecology position where you lay down your back with your feet angled and supported.

After the insertion of the speculum into the vagina and then a thin (usually metallic) tubular part of the hysteroscope is inserted through the endocervix and the cervical canal. The device has its light source and a camera. The image from the camera is then transmitted to a display. With today's technological capabilities (high-resolution cameras and displays), the doctor can identify even the smallest of changes which can occur in the uterine cavity. For better visibility and access, a clear physiological solution or gas can be pumped into the cavity. In case any signs of disease are detected, a biopsy can be carried out immediately. If deemed possible, the diagnostic phase can be followed up with operative hysteroscopy or curettage. 

The procedure lasts anywhere between 15-30 minutes. In case of operative hysteroscopy, it can last up to 1 hour.

 

After the procedure

After you wake up from the procure, you will find yourself in the resting room where you will remain for 4 more hours. Only once you are fully conscious and stable, you will be released from the clinic. For the journey home, please make sure you have someone to take you. You should most definitely not drive yourself. Overnight hospitalization, considering all went smoothly is unlikely. In the first hours following surgery, you can feel nauseous or like vomiting. In such cases, you will be given medication to make you feel better. In case you were intubated during the procedure (you had a flexible plastic tube applied to allow you to breathe), you can experience pain and scratching in your throat. This uncomfortable feeling can be alleviated with any menthol lozenges. Following the surgery, you can also experience lower abdominal pain and bleeding. Generally, this only lasts for a couple days and should disappear entirely within 2 weeks. 


What to ensure following the procedure

  • You should not drive a car for 24 hours after the procedure.
  • For the first 4 days following the procedure, measure your body temperature 2x per day and note down the measurements in case you would need to urgently visit a doctor.
  • Avoid any heavy physical strain for a period of 1week following the procedure. For the same amount of time, avoid lifting heavy objects (5 Kg and more).
  • For a period of 2 weeks, only use the shower instead of baths, or accordingly based on the recommendation by the doctor responsible for treating you. For the same time (at minimum), do not swim, use tampons or flush the vagina. 
  • You can have sexual intercourse 14 days after the procure (at minimum)

 

Complications

Hysteroscopy is considered s safe surgical procedure. The risk of complications remains below 1%. In addition to this, it is only accompanied by a short stay at the clinic, quick recovery and generally a lower need for any pain killers following surgery. For this reason, it is one of the most commonly carried out gynecological procedures. In case any complication does occur, it is generally one related to the applied anesthetic or with the actual procedure itself.  These can include inflammation following surgery, strong vaginal bleeding, intrauterine adhesions or other damage caused by the hysteroscope to the cervix or the uterine wall. Alternatively it can include damage to the surrounding organs such as the bladder or intestines. However, it is important to stress that any such complications occur in exceptional cases. 

 

When should you call an emergency?

  • When you suffer from pain that is not getting better even after using painkillers or you experience sudden and escalating pains.
  • When you identify a smelly discharge from the wound or the vagina.
  • When you experience a rash.
  • When you start bleeding more than you do during menstruation or you are bleeding with blood clots.
  • When you experience a fever.
  • When you are experiencing chest pains or have difficulty breathing. 
  • When your head is spinning and you are fainting. 
  • When you experience intense pain shooting up to the shoulders.

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