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 treat various conditions identified during diagnostic hysteroscopy—often during the same session. Unlike diagnostic hysteroscopy, which only allows visualization, operative hysteroscopy enables the treatment of intrauterine pathologies. This technique is used to remove polyps, fibroids, intrauterine adhesions, uterine septa, or to treat other structural abnormalities. Instruments are inserted through the hysteroscope, avoiding the need for an "open" abdominal surgery. The procedure may be performed under local, regional, or general anesthesia.
Operative hysteroscopy is often preferred over traditional surgical methods due to its quick recovery time and lower risk of complications.
Indications for Surgical Hysteroscopy:
- Endometrial polyps/submucosal fibroids – for diagnosis and removal.
- Uterine adhesions (Asherman’s syndrome) – scar tissue bands inside the uterus that may cause menstrual issues or infertility.
- Uterine septum – a congenital malformation that can be corrected hysteroscopically.
- Abnormal uterine bleeding – hysteroscopy helps identify the cause and can be therapeutic (e.g., endometrial ablation to remove the uterine lining).
- Removal of intrauterine devices (IUDs) that cannot be extracted otherwise.
Advantages of Hysteroscopy:
- Minimal hospital stay
- Fast recovery
- Reduced need for post-op pain medication
- Avoids "open" surgery or hysterectomy
- Can be performed on an outpatient basis
Contraindications:
- Pelvic inflammatory disease (PID)
- Herpes virus infection (active or prodromal stage)
- Vaginal bleeding
- Intrauterine pregnancy
- Cervical cancer
- Severe cervical stenosis
- Hemodynamic instability
Preparation for Surgical Hysteroscopy:
The optimal timing is within the first week after menstruation, when the endometrial lining is thinnest.
Pre-op blood tests: CBC, coagulation panel, and others depending on associated conditions.
Avoid sexual intercourse 1–2 days prior, and do not use vaginal douches or intimate hygiene products for one week before the procedure. Hygiene should be done using only warm water.
Inform the physician about all medications being taken, especially anticoagulants, as they may increase bleeding risk.
Fasting may be required for a few hours prior—especially if general anesthesia is used. With local anesthesia, restrictions may be less strict, but all medical instructions must be followed carefully.
Duration of Surgical Hysteroscopy:
Typically lasts 30 minutes to over an hour, depending on complexity.
More complex cases, such as large fibroid removal or correction of uterine malformations, may take longer.
After the procedure, patients are monitored for a few hours.
Most can return home the same day, if stable.
General anesthesia may require monitoring for up to 24 hours.
Recovery:
Mild abdominal pain and light vaginal bleeding may persist for 1–2 days.
Seek medical attention if you experience:
- Fever
- Severe abdominal pain
- Heavy bleeding
- Foul-smelling or unusual vaginal discharge
Surgical hysteroscopy is an effective and safe procedure that avoids invasive surgery, allows for direct treatment of intrauterine abnormalities, and promotes fast recovery.
