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    Hysteroscopy:

    A hysteroscopy is a procedure that allows a gynaecologist to look inside the uterus. The tiny hysteroscope passed through the vagina and cervix and into the uterus conveys an image to a video monitor to assist in diagnosis and/or treatment of gynaecological problems. A hysteroscopy may be done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause. It also may be done to see if a problem in the uterus is the cause of infertility. A hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps.

    Types of Hysteroscopy:

    Diagnostic Hysteroscopy:

    Diagnostic hysteroscopy is used to diagnose problems of the uterus. Diagnostic hysteroscopy is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes. Additionally, hysteroscopy can be used with other procedures, such as laparoscopy, or before procedures such as dilation and curettage (D&C). A diagnostic hysteroscopy may used to investigate any of the following conditions: Heavy or irregular periods, post menopausal bleeding, unexplained cramping or pain, infertility, recurrent miscarriage or irregular menstrual cycles. A hysteroscopy may also be recommended to assist in locating an intra-uterine device which has moved out of position.

    Operative hysteroscopy:

    Once a diagnosis has been made, a gynaecologist can use the hysteroscope to treat certain conditions. This is known as an operative hysteroscopy. Fine instruments can be inserted through channels in the hysteroscope and used to: Correct intra-uterine adhesions, remove fibroids or polyps, remove difficult intra-uterine devices or remove or burn the lining of the womb (endometrial ablation).

    Operative hysteroscopy is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy. If an abnormal condition was detected during the diagnostic hysteroscopy, an operative hysteroscopy can often be performed at the same time, avoiding the need for a second surgery. During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope.

    Procedure:

    A hysteroscopy needs to be done at a time when you are not menstruating. It is very rarely performed on a pregnant woman. You will normally be required to fast for 8 hours prior to the procedure but your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed. Cervical dilation: The diameter of the hysteroscope is generally too large to conveniently pass the cervix directly, thereby necessitating cervical dilation to be performed prior to insertion. Cervical dilation can be performed by temporarily stretching the cervix with a series of dilators of increasing diameter. Misoprostol prior to hysteroscopy for cervical dilation appears to facilitate an easier and uncomplicated procedure only in premenopausal women.

    Insertion and inspection: The hysteroscope with its sheath is inserted transvaginally guided into the uterine cavity, the cavity insufflated, and an inspection is performed.

    Insufflation media: During hysteroscopy either fluids or CO2 gas is introduced to expand the cavity. The choice is dependent on the procedure, the patient’s condition, and the physician's preference. Fluids can be used for both diagnostic and operative procedures. However, CO2 gas does not allow the clearing of blood and endometrial debris during the procedure, which could make the imaging visualization difficult. Gas embolism may also arise as a complication. Since the success of the procedure is totally depending on the quality of the high-resolution video images in front of surgeon's eyes, CO2 gas is not commonly used as the distention medium. Current recommendation is to use the electrolytic fluids in diagnostic cases, and in operative cases in which mechanical, laser, or bipolar energy is used.

    A light shone through the hysteroscope allows your doctor to see your uterus and the openings of the fallopian tubes into the uterine cavity. Your doctor may take a biopsy and the sample is looked at under a microscope for problems. Another surgery, called a laparoscopy, may also be done at the same time as a hysteroscopy if infertility is a problem. Finally, if surgery needs to be performed, small instruments are inserted into the uterus through the hysteroscope.

    Conditions:

    • Asherman's syndrome (intrauterine adhesions): Adhesions in the uterus can be removed using a technique called Hysteroscopic adhesiolysis with either microscissors or thermal energy modalities. Hysteroscopy may also be used in conjunction with laparascopy or other methods to reduce the risk of perforation during the procedure. Hysteroscopy has the benefit of allowing direct visualization of the uterus, thereby avoiding or reducing iatrogenic trauma to delicate reproductive tissue which may result in Asherman's syndrome.
    • Endometrial polyp. Polypectomy
    • Gynecologic bleeding.
    • Endometrial ablation: Some new technologies specifically developed for endometrial ablation do not require hysteroscopy.
    • Myomectomy for uterine fibroids.
    • Congenital uterine malformations or Mullerian malformations.
    • Evacuation of retained products of conception in selected cases.
    • Removal of embedded IUDs.
    • The use of hysteroscopy in endometrial cancer is not recommended as there is concern that cancer cells could be spread into the peritoneal cavity.
    • Hysteroscopy allows access to the utero-tubal junction for entry into the Fallopian tube; this is useful for tubal occlusion procedures for sterilization and for falloposcopy.
    • Polyps and fibroids —Hysteroscopy is used to remove these non-cancerous growths found in the uterus.
    Post surgery: The patient should be under observation if regional or general anesthesia is used during the procedure. Some cramping or slight vaginal bleeding for one to two days is common. If gas was used during hysteroscopy it can cause shoulder pain. It is recommended to consult a doctor if there is fever, severe abdominal pain or heavy vaginal bleeding or discharge.

    Complications: Hysteroscopy is a relatively safe procedure. However, as with any type of surgery, complications are possible. A hysteroscopy can cause injury to the uterus or cervix, an infection, or bleeding. In rare cases, the uterus, bladder, or bowel can be punctured during the test, requiring surgical repair. A possible problem is uterine perforation when either the hysteroscope itself or one of its operative instruments breaches the wall of the uterus. This may lead to bleeding and damage to other organs. Perforation of the bowel called peritonitis happens accidentally can be fatal. Furthermore, cervical laceration, intrauterine infection, electrical and laser injuries, and complications caused by the distention media can be encountered. The use of insufflation media can lead to serious and even fatal complications due to embolism or fluid overload with electrolyte imbalances. Risks associated with anesthesia may also observed in few cases.

    Advantages: Compared with other, more invasive procedures, hysteroscopy may provide the following advantages: Shorter hospital stay, shorter recovery time, less pain medication needed after surgery and possible avoidance of open abdominal surgery.
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