Surgical hysteroscopy

Hysteroscopy is a minimally invasive gynecological procedure in which a fiber-optic endoscope is inserted through the cervix into the uterine cavity.

Surgical (operative) hysteroscopy is performed to correct various conditions identified during diagnostic hysteroscopy, and in most cases, both procedures are carried out during the same intervention. Surgical hysteroscopy allows the physician not only to visualize but also to treat different uterine pathologies. The procedure is used to remove polyps, fibroids, intrauterine adhesions, uterine septa, or to treat other structural abnormalities of the uterus. During the procedure, surgical instruments are introduced through the hysteroscope, thus avoiding open abdominal surgery. Hysteroscopy can be performed under local, regional, or general anesthesia. Surgical hysteroscopy is often preferred over other surgical methods due to faster recovery and a lower risk of postoperative complications.

Indications

• Endometrial polyps / submucosal fibroids – diagnosis and removal
• Intrauterine adhesions (Asherman syndrome) – scar tissue bands inside the uterus that may cause menstrual disorders and infertility
• Uterine septum – a uterine malformation that can be corrected hysteroscopically
• Abnormal uterine bleeding – hysteroscopy identifies the cause and provides therapeutic options (e.g., endometrial ablation, which is the hysteroscopic excision of the uterine lining to treat certain causes of abnormal bleeding)
• Removal of intrauterine devices that could not be extracted by other methods

Procedure

• Duration of the intervention: 30–60 minutes
• After the procedure, the patient is monitored for several hours to ensure that no immediate complications occur
• In most cases, the patient can go home the same day, provided her condition is stable and no continuous medical supervision is required
• General anesthesia requires monitoring for up to 24 hours
• Mild abdominal pain and minimal vaginal bleeding may persist for one to two days after hysteroscopy
• If postoperative fever, severe abdominal pain, heavy vaginal bleeding, or abnormal vaginal discharge occurs, the patient should contact the physician

Contraindications

• Pelvic inflammatory disease
• Herpes virus infection (prodromal or active phase)
• Active vaginal bleeding
• Intrauterine pregnancy
• Cervical cancer
• Severe cervical stenosis
• Hemodynamically unstable patient

Advantages

• Minimal hospitalization time
• Rapid recovery
• Minimal need for postoperative analgesic medication
• Avoidance of open surgery or hysterectomy
• Can be performed on an outpatient basis

Sources:

https://www.uclahealth.org/medical-services/obgyn/minimally-invasive-gyn-surgery/hysteroscopic-surgery
https://www.ncbi.nlm.nih.gov/books/NBK564345/
https://en.wikipedia.org/wiki/Hysteroscopy