A hysteroscopy is a procedure that allows a doctor to examine the inside of the uterus and to diagnose and treat the causes of abnormal bleeding. The doctor uses a hysteroscope, a thin, flexible tube that is inserted into the vagina in order to examine the cervix and uterus. Hysteroscopy is sometimes performed as an alternative to hysterectomy, which fully removes the uterus.
Hysteroscopy may be diagnostic or operative, depending on the patient’s specific requirements. Operative hysteroscopy can also be used to remove polyps, fibroids (non-cancerous growths) and adhesions (scar tissue in the uterus which may affect the menstrual flow and fertility).
Hysteroscopy may be performed alongside other tests to confirm results. Diagnostic hysteroscopy can often be performed in a non-surgical, office setting. The procedure does not take long if only diagnostic hysteroscopy is being performed.
It is sometimes used alongside laparoscopy. An endoscope, a flexible tube with a camera and light source at its end, is used for the examination. Endoscopy allows the doctor to examine the uterus, ovaries and fallopian tubes. It is performed in a surgical setting and requires an incision made through or below the navel.
Operative hysteroscopy is usually used to treat issues that have been identified through hysteroscopy. The two procedures are sometimes performed in the same session. Small instruments that are used to treat the issue are inserted through the hysteroscope.
Operative hysteroscopy can be performed under local or general anaesthesia. The doctor will dilate the cervix and insert the hysteroscope through the vagina and into the cervix. Carbon dioxide gas or a liquid solution is inserted into the uterus through the hysteroscope to expand it and remove any blood. The hysteroscope is equipped with a light, which makes the uterus and fallopian tubes visible to the doctor. Operative hysteroscopy can take an hour or longer.
Advantages of Operative Hysteroscopy
For patients who are suitable candidates for operative hysteroscopy, it may be a preferable option to hysterectomy. It avoids the full removal of the cervix. It also requires a shorter hospital stay and recovery time. It will generally lead to less post-operative pain and less medication. It may also allow the patient to avoid open abdominal surgery.
Operative hysteroscopy is a very safe procedure, although it does carry some very minor risks (affecting fewer than 1% of patients). These include the standard surgical risks of infection, reaction to anaesthesia and heavy bleeding. In some cases, there may be an injury to the cervix or other organs and there may be some scarring. These results are extremely rare.
After the Procedure
It is usually possible for the patient to return home on the day of an operative hysterectomy. There may be some cramping or minor vaginal bleeding for one or two days after the procedure, but this should ease gradually. You may also feel slightly faint or nauseous at certain points, but this is not a cause for concern unless it is very severe or persistent. Call your doctor if you experience severe pain or illness, if there is heavy bleeding, or if you experience symptoms that may indicate infection.
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