In which cases is hysteroscopy performed, what are its types?
- In the presence of myoma or polyp occupying space in the uterus,
- In the presence of intrauterine curtain (uterine septum), which is one of the types of congenital uterine anomaly,
- In order to open intrauterine adhesions,
- In case of residual tissue remaining in the uterus after miscarriage or curettage,
- They can be used for the removal of intrauterine devices that cannot be removed vaginally.
How is hysteroscopy performed, What are the types of hysteroscopy?
Hysteroscopy consists of two different practices. One of them is Office (Diagnostic) hysteroscopy and the other is Operative Hysteroscopy.
Office (Diagnostic) hysteroscopy:
For diagnostic purposes is the observation of the uterine cavity. It is usually performed under local anesthesia. In cases where the diagnosis cannot be made in another way or it is not certain, it is performed for definitive diagnosis. Whether there is a disorder in the uterus, if there is a disorder, the actual size and location of the disorder can be determined and the treatment method can be easily programmed. If necessary, operative hysteroscopy can be performed in the same session. It is performed by entering the uterus with the device that is advanced through the natural opening of the cervix and has a camera in it.
Office Hysteroscopy can help diagnose the following conditions:
- Polyps or myomas that cause excessive bleeding
- Congenital uterine anomalies (septum, bicornis, arcuate, hypoplasia)
- Intrauterine adhesions
- Early stage cancers of the intrauterine tissue (endometrium) can be diagnosed. A biopsy can be taken from the suspicious area under direct observation.
- Removal of the spiral whose thread cannot be seen or which went into the uterus
- Investigation of recurrent miscarriages
- Investigation of recurrent IVF failure
- Abnormal hysterosalpingography (HSG) or ultrasound may be done to confirm the finding.
Intrauterine disorders are treated with the operative hysteroscopy method, which is usually performed under general anesthesia. It is a more advanced form of diagnostic hysteroscopy. After all kinds of structures in the uterus are visualized in detail, any pathology can be corrected or removed with the electrosurgical system called resectoscope.
The following conditions are treated with operative hysteroscopy:
- Removal of polyps
- Intrauterine adhesions (intrauterine synechiae)
- Excessive menstrual bleeding: The intrauterine layer (endometrium) is removed to stop excessive menstrual bleeding that continues despite medications (there should be no desire to have children later)
- Proximal tubal stenosis or obstruction (tubal cannulation)
What are the advantages of operative hysteroscopy?
Without open surgery, the treatment of the patient can be carried out without removing the uterus. Especially in women who are treated for infertility or who plan to have children in the future, the operation performed in the form of abortion or open surgery from the abdomen may make it difficult to get pregnant in the future or lead to new causes of infertility (such as adhesion in the abdomen). Especially in this group of women, hysteroscopic surgery is the most successful treatment method.
Other Applications with Hysteroscopy
The spiral that has gone into the uterus can be removed under hysteroscopic observation. In case of unwanted pregnancy termination or miscarriage, the remaining parts can be removed under direct observation by hysteroscopy. These cases typically describe a continuous bloody discharge after an abortion; In vaginal ultrasonography, the remaining part is easily visualized. In these cases, blinding, a second abortion procedure should be avoided and the part(s) under direct hysteroscopic observation should be removed.