What is Hysteroscopy?
Hysteroscopy is the process of evaluating the cervical canal, the inside of the uterus and the exit points of the tubes from the uterus with the help of a camera by entering through the cervix with an optic. Hysteroscopy is performed in two different ways: office and Operative Hysteroscopy. The image taken with the hysteroscope is transferred to the monitor via the optical-camera system. Modern hysteroscopy was first performed in Turkey by Prof. Dr. Applied by Recai PABUÇCU Hysteroscopy indications can be listed as follows;
- Abnormal Bleeding
- Treatment of submucous fibroids or endometrial polyps
- Removal of lost intrauterine devices or other foreign bodies
- Evaluation of cases in which problems were detected in the uterine film
- Diagnosis and treatment of intrauterine adhesions
- Diagnosis and treatment of intrauterine curtains
- Stopping bleeding with laser or electrosurgery in patients with bleeding that does not respond to treatment
- Unclogging the tubes with tubal cannulation process
- Examination of the endocervical canal and uterine cavity in cases of recurrent miscarriage
- Hysteroscopic tube obstruction-sterilization
- Evaluation of the uterus before treatment in cases with infertility
In Which Situations Is Hysteroscopy Performed?
- In the presence of myoma or polyp occupying space in the uterus,
- In the presence of intrauterine septum, which is one of the types of congenital uterine anomalies,
- In order to open intrauterine adhesions,
- In case of residual tissue remaining in the uterus after miscarriage or curettage,
- They can be used to remove intrauterine devices that cannot be removed vaginally.
How is Hysteroscopy Done? What are the Types of Hysteroscopy?
- Office (Diagnostic) Hysteroscopy
- Operative Hysteroscopy.
It is the observation of the uterine cavity for diagnostic purposes. It is usually performed under local anesthesia. It is performed for definitive diagnosis in cases where the diagnosis cannot be made otherwise or is uncertain. Whether there is a disorder in the uterus, if so, its actual size and location can be determined and the treatment can be easily programmed. If necessary, operative hysteroscopy can be performed in the same session. It is performed by entering the uterus with a device containing a camera, which is advanced through the natural opening of the cervix. Office Hysteroscopy helps diagnose the following conditions.
- Polyps or fibroids that cause excessive bleeding
- Congenital uterine anomalies (septum, bicornis, arcuate, hypoplasia)
Early stage cancers of the uterine tissue (endometrium) can be diagnosed. A biopsy can be taken from the suspicious area under direct observation.
- Removal of the spiral whose rope cannot be seen or has escaped into the uterus
- Investigation of recurrent miscarriages
- Investigation of recurrent in vitro fertilization failure
- It may be performed to confirm an abnormal hysterosalpingography (HSG) or ultrasound finding.
What is operative hysteroscopic?
Disorders in the uterus are treated with operative hysteroscopy, which is generally performed under general anesthesia. It is a more advanced form of diagnostic hysteroscopy. After all structures within 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.
- Intrauterine adhesions (intra-uterine synechiae)
- Excessive menstrual bleeding: The lining of the uterus (endometrium) is removed to stop excessive menstrual bleeding that continues despite drug treatments (there should be no desire for a child later).
- Proximal tubal stenosis or obstruction (tubal cannulation)
What are the advantages of operative hysteroscopy?
The patient can be treated without open surgery or removal of the uterus. Especially in women who are undergoing infertility treatment or who are considering having children in the future, an operation performed in the form of an abortion or an open abdominal surgery may make it difficult to get pregnant in the future or lead to new causes of infertility (such as adhesions in the abdomen). Hysteroscopic surgery is the most successful treatment method, especially in this group of women.
Other Applications with Hysteroscopy
A spiral stuck inside the uterus can be removed under hysteroscopic observation. If parts remain in the uterus after an unwanted pregnancy termination or miscarriage, the remaining parts can be removed by hysteroscopy under direct observation. These cases typically describe a persistent bloody discharge after the abortion; The remaining part is easily visualized in vaginal ultrasonography. In these cases, blinding and a second curettage should be avoided and the remaining parts should be removed under direct hysteroscopic observation.