women`s health

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Afonso JS. E-book hysteroscopy. In: http://www.histeroscopia.med.br/. Access in:

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INFORMATIVE WOMEN`S HEALTH

José Sebastião Afonso

Hysteroscopy could be used for diagnostic and/or therapeutic purposes.

Diagnostic

It is usually indicated in cases where pathologic alterations need to be clarified, whether they are or not discovered through other diagnostic methods, such as ultrasound. The most common pathologic alterations that need this clarification are irregular bleeding, endometrial thickening, tumours and problems of infertility. By means of this technique it is possible to proceed with the direct visualisation of the cervical canal (uterine wall) and uterine cavity (endometrium) thus allowing for a more accurate diagnosis. This technique will also point the spot where biopsy should be carried out in doubtful cases. Most of the times, the procedure is carried out on an outpatient basis, dispensing with the need for previous preparation or anaesthesia. Slight discomfort may be felt by the patient during the examination while the device is introduced into the cervical canal and the CO2 produced distends the uterine cavity. Where difficulties arise, the examination is carried out at the operating theatre with the help of anaesthetics. Complications seldom arise, however, like any invasive procedure they should not be ruled out.
 

 


Surgical (therapeutic)

This technique will allow the surgery to be carried out within the uterine cavity through the vagina. Polyps and myomas can be removed, endometrial ablation, resection of adherence and uterine septum, cateterism of the fallopian tube and removal of intrauterine device. In particular, in the treatment of myoma presenting an intramural component, a second intervention is foreseen for the removal of a residual portion, when necessary. Endometrial ablation is indicated in certain cases of abnormal bleeding and a failure of the method is foreseen (abnormal uterine bleeding recurs) in about 15% of the cases.

The steps of the surgery, after anaesthetics and asepsis, can be briefly described as follows: 

01. Insertion of hysteroscope, a surgical instrument similar to a telescope, through the previously dilated uterine cavity.

02. Uterine cavity is distended by a liquid solution.

03. Via hysteroscope, a small surgical instrument that will allow the intervention to be carried out will be introduced into the uterine cavity.

The hysterocopic surgery without complications is of fast recovery. We generally recommend resting on the second day of the surgical procedure, light work after the second day, full activity after the seventh day and immediate return to the doctor if any alteration is noticed. 

No matter how careful the intervention is carried out, like any other surgical procedure, complications may result from hysteroscopy, some of which being very serious, such as:

01. Perforation of the uterus, likely to affect other organs (bladder, intestines and arteries).

02. Infection.  

03. Excessive leakage into the circulatory system and extra-vascular spaces of the solution used to distend uterine cavity. 

04. Air embolism. 

These complications, however, do not occur very often.  

The chances are that during the treatment or after it a situation might occur in which a more complicated treatment, and different from the treatment proposed will be required. It is possible that a laparotomy (opening in the abdomen) will be needed and even the complete removal of the uterus.  

Note 

This passage is intended only for educational purposes. It does not claim to define diagnostic or therapeutic procedures. Your doctor is the person to look for if you want technical details or indications. All we do is approach the subject in an impersonal manner. We do not offer medical advice through Internet. Medical consultation is a complex issue and demands the physical presence of the patient. There are rules in medicine and exceptions that can lead to different procedures in similar situations.

Reference

Serv. Riproduzione Umana - Prof. Dr. Antonio Perino (Universita' Degli Studi di Palermo)