What Is Operative Hysteroscopy?

Operative hysteroscopy is indicated to correct the following uterine conditions:

• Polyps and fibroids
• Asherman syndrome (a condition where bands of scar tissue form in the uterus that may lead to infertility and menstrual changes)
• Septums (a malformation of the uterus that is present from birth)
• Abnormal bleeding (characterized by heavy or lengthy menstrual flow, as well as bleeding between periods or after menopause)
• Blockage of the fallopian tube
• Removal of residual fetal tissue after the termination of pregnancy
• Sterilization

Operative hysteroscopy should be avoided in:

• Pregnancy
• Cervicitis (inflammation of the cervix)
• Active infection of the pelvis
• Cancer of the cervix or endometrium
• Underlying conditions that may be exacerbated due to volume overload
• Allergy to nickel or radioactive contrast dye

Before the procedure:

• The physician will take details of your medical and medication history.
• Inform the physician about any medical conditions, pregnancy, or active infection of the reproductive system.
• The physician will enquire about your menstrual cycle and the last menstrual date.
• You may get medications to induce the thinning of the endometrial lining (inner lining of the uterus).
• The physician will obtain your consent before the procedure.
• Before the procedure, the doctor may prescribe a sedative to help you relax.

During the procedure:

• You will be positioned on an operating table.
• A urinary catheter may be placed before entering the operating room.
• An IV line will be established in the arm or hand.
• The hair around the surgical site may be shaved. The cervix will be cleaned with an antiseptic solution.
• You may get local anesthesia, either an epidural or spinal block to numb you from the waist down.
• The doctor uses a speculum to view the cervix.
• Next, the doctor uses a type of forceps, called a tenaculum, to hold the cervix throughout the procedure.
• The doctor may dilate the cervix for the hysteroscope to enter.
• Once the hysteroscope reaches the uterus through the vagina and cervix, it pumps out carbon dioxide gas or a liquid solution to expand it and to clear away the blood and mucus.
• The light from the hysteroscope helps the physician to view the uterus and detect any abnormalities.
• Next, small instruments are inserted into the uterus through the hysteroscope to perform surgery.

After the procedure:

• You may be able to go home the same day if the procedure is performed in an outpatient setting.
• You can resume your regular diet.
• For extensive surgery, you may experience cramping or mild spotting following the procedure.
• After the removal of the polyps, women can attempt pregnancy in the next menstrual cycle.
• In other surgeries, pregnancy should be delayed by 3 months or as directed by the doctor.
• You may have to follow up for 2-4 weeks after the procedure.
• You may develop some rare complications after the surgery, which include:
  • Infection
  • Bleeding
  • Heavy bleeding
  • Scarring of the uterus
  • Injury to the cervix, uterus, bowel, or bladder