Hysteroscopy is a procedure that allows direct visualization of the uterine cavity and is now recommended in place of D&C which is a blind procedure. Hysteroscopy is done using a hysteroscope, a thin, telescope that is inserted into the vagina to examine the cervix and inside of the uterus. This is similar to an endoscopic procedure to check ulcer in the stomach. It is usually done on operation theatre under smallanaesthesia, however can now be done as an office procedure without anaesthesia with the use of very this hysteroscopes.

Hysteroscopy is now an integral part of infertility & AUB evaluation, as it is used both for diagnosis of conditions that can be a cause of these issues as well as surgically correct these for improving outcomes. Hysteroscopy is useful in patients who have uterine malformation, uterine synechiae, tubal occlusions, intrauterine polyps or fibroids, presence of foreign body. It gives panoramic view of cervical canal, cavity and of the ostia. Hysteroscopy is always planned in follicular phase because this prevents encountering of an unsuspected pregnancy. This is the time when the endometrium is thinnest thus providing a clear view. A concomitant laparoscopy is indicated especially in surgeries like lysis of synechiae, excision of septum, removal of fibroid and removal of uterotubal occlusions.

When to suggest for hysteroscopy?

  1. Abnormal bleeding- irregular bleeding or heavy menstrual bleeding
  2. Abnormal report in USG like polyp or submucous fibroids
  3. Intrauterine filling defect on HSG
  4. Recurrent pregnancy failure
  5. Difficulty in subsequent conception after MTP or D&C or IUCD use or uterine manipulation
  6. Removal of intrauterine adhesions (scarring)
  7. Removal of a lost IUCD (intrauterine contraceptive device)
  8. Unexplained infertility

Recovery tends to be very quick as there are no incisions. Most patients will require some pain medication in the immediate post operative period and are allowed to go home the same evening. Sexual intercourse should be postponed as well as active sports for 1-2 weeks. Most women can return to work withinfew days.

What are the risks of hysteroscopy surgery? 
Bleeding and infection are the two main issues that can happen following hysteroscopic surgeries. At time the surgery may need to be stopped due to safely issues because of excessive bleeding, fluid absorption or size of the fibroid. Complications include perforation of the uterus and disproportionate fluid retention. Fluid is used to distend the uterine cavity during hysteroscopy. Occasionally this fluid may be absorbed into the general circulation (lungs and brain). If there is the excessive absorption of fluid, the procedure must be terminated. Emboli as well as death are RARE but potential complications of any surgery.

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