The optical lens or hysteroscope is used to view the inside of the uterus.
The optical lens or hysteroscope is used to view the inside of the uterus.

Operative hysteroscopy is a procedure that involves the insertion of an optical lens through the cervix into the uterus to treat disorders of the uterus. The optical lens or hysteroscope is used to view the inside of the uterus. Small instruments are passed through the hysteroscope to treat the medical conditions involving the uterus.

When is operative hysteroscopy indicated?

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

When should be operative hysteroscopy avoided?

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

What to expect during an operative hysteroscopy?

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

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Medically Reviewed on 11/11/2020
References
https://emedicine.medscape.com/article/1848467-overview#a7

https://my.clevelandclinic.org/health/treatments/10142-hysteroscopy/risks--benefits