Dr Sarthak Sidapara

Operative Hysteroscopy

What is Operative Hysteroscopy?

When an abnormal condition is detected in the uterus during the process of diagnosis hysteroscopy doctors perform the operative hysteroscopy. It can also be performed to avoid the need for a second surgery. The surgical procedure may also be done to treat infertility or remove growths from the uterine cavity. An operative hysteroscopy is performed to treat the following abnormal conditions of the uterus, abnormal bleeding, Polyps and fibroids, Septum, Adhesions. Operative hysteroscopy performed along with laparoscopy can help to prevent perforation of the walls of the uterus.

What is hysteroscopy?

Hysteroscopy is a procedure that allows your doctor to look into the uterine cavity to treat and diagnose the reasons for uterine bleeding. It is done with the help of a hysteroscopy. Hysteroscopy is a thin and lighted tube that is put inside the vagina to examine the inside of the uterus and the cervix. It can also be an operative or diagnosis process.

When is operative hysteroscopy performed?

An operative hysteroscopy is performed to treat the following abnormal conditions of the uterus:-

  • Abnormal bleeding: Abnormal bleeding may be the cause of heavy menstrual flow or bleeding after menopause or between the periods. To treat such types of heavy or lengthy bleeding, doctors use the procedure of endometrial ablation. During this procedure, a hysteroscope along with other instruments are used. They help to destroy the uterine lining.
  • Polyps and fibroids: Polyps and fibroids are the non-cancerous growths in the uterus. Hysteroscopy can be used to treat them.
  • Septum: Doctors use the procedure of hysteroscopy to find out the defect of the uterus or if you have a uterine septum.
  • Adhesions: Sometimes scar tissues form a band in the uterus, which causes changes in the menstrual flow and infertility. Doctors use the procedure of hysteroscopy to locate and remove the adhesions.

Who is a candidate for hysteroscopy?

A person suffering from the following conditions is an ideal candidate for a hysterectomy.

  • Irregular bleeding followed by cramping: If you are suffering from cramping and irregular periods, you must consult a gynecologist first. They will recommend you for a hysteroscopy to have a closer look at your uterus. This help helps them to know about the various problems like fibroids and polyps. The heating tool may be used by your gynecologist to stop excessive bleeding.
  • Assisting with permanent birth control: A small device is inserted in the fallopian tube using the technique of hysterectomy.
  • Infertility issues: If you and your partner have problems regarding conceiving, you must consult a gynecologist. They will perform a hysterectomy to examine various problems of your uterine wall that are creating problems for your parenthood.

How is hysteroscopy performed?

Before hysterectomy your doctors will perform the following steps:

  • Use of sedative – Before the procedure, your doctor will prescribe some sedatives to you. It will help you to be relaxed before the procedure.
  • Scheduling – Gynecologists set up the time of one week after your periods as the perfect time for a hysterectomy. It will help them get the best view of the uterine line.
  • Anesthesia – Your genealogist will depend on whether you will have general anesthesia or local anesthesia. It will depend on your treatment which anesthesia to be given.

The gynecologist will maintain this order during the time of hysterectomy:
The gynecologist will insert the hysteroscope after widening the cervix.
Through the vagina and cervix, the hysteroscope is inserted into the uterus.
With the help of the hysteroscope, carbon dioxide gas or liquid solution is inserted into the uterus. It expands the uterus and clears away any mucus or blood.
Furthermore, the doctors can see the uterus and the openings of the fallopian tube inside the uterine cavity with the help of the light attached at the end of the hysteroscope.
Small instruments are inserted depending upon whether the surgery will be performed or not.
The length of the procedure depends upon the type of procedure, i.e. operative or diagnostic hysteroscopy. Usually, it ranges from five minutes to more than an hour. In case a laparoscopy is performed along with hysteroscopy more time will be needed.

What are the benefits of hysteroscopy?

Hysteroscopy provides the following benefits if compared to other procedures:

  • Recovery time is much less.
  • Hospital stay is shorter.
  • Medication needed after surgery is less painful.
  • Open abdominal surgery is possibly avoided.

Types of hysteroscopy

The main motive to undergo a hysteroscopy is to find out the problems in the uterus. There are two types of hysteroscopy depending upon the circumstances. The two types of hysteroscopy are operative and diagnostic. An operative hysteroscopy might be needed by a woman who is undergoing diagnostic hysteroscopy.

Diagnostic Hysteroscopy

Diagnostic hysteroscopy is needed for the following reasons:

  • Find out the reason for repeated miscarriages
  • Diagnose the non-cancerous growths in the womb such as polyps and fibroids
  • Examine fertility issues if a couple is having problems to conceive
  • To study the reason for pelvic pain

Operative hysteroscopy

  • To exclude adhesions which are the scars in the uterine wall caused due to surgery or infections
  • To remove non-cancerous growths in the uterus
  • Perform a process of sterilization
  • For further investigation take a biopsy of tissue

Risks associated with hysteroscopy

Hysteroscopy is much safe than compared to any other procedures but there are some small risks too. Women who undergo treatment along with hysteroscopy are at a higher risk. Some of the risks are:-

  • A woman may faint in case hysteroscopy is performed without anesthesia or just local anesthesia.
  • Cervix is accidentally damaged.
  • The womb is accidentally damaged and in that case, it must be treated with antibiotics, or in some cases another operation might be needed.
  • The womb might be infected causing a smelly discharge from the vagina along with fever and heavy bleeding. A short course of antibiotics from the gynecologist might treat this infection.
  • A woman might experience excessive bleeding after the surgery. It is a result of undergoing treatment under general anesthesia.

Techniques used in operative hysteroscopy

  • The electrode is only activated once it starts moving towards the cervix.
  • The operator can coagulate, cut, and vaporize by adjusting the setting of the generator. It depends upon the kind of electrode chosen.
  • The myometrium is cut deeply, especially at the corner and in the cervix.
  • Depending upon the energy used, the uterine distension medium used in the case of operative hysteroscopy differs. The distension medium used nowadays is N/saline, in the case of bipolar energy. In the case of monopolar energy, the distension medium used is an electrolyte-free medium.
  • The balance of fluid is monitored thoroughly.

What to expect after the hysteroscopy procedure?

Whatever is expected after the hysteroscopy procedure is based on the kind of anesthesia given. Your blood pressure, breathing, and pulse will be checked constantly if you are given general anesthesia or sedative. When you are in a stable condition you will be discharged. No special care is needed after hysteroscopy.

You might receive some cramping or bleeding from the vagina for the next couple of days after the procedure. The gas or fluid solution is given in the uterus for a better view of the uterus might result in gas in the digestive tract and pain for about 24 hours. You may sometimes feel pain in your shoulder and upper belly.

Operative hysteroscopy recovery

The kind of recovery depends upon the type of anesthesia being used. You must rest for sufficient time after the procedure.

Operative hysteroscopy cost

The average cost of operative hysteroscopy in India ranges from Rs. 15,000 to Rs.51,000.