Q1. What is Hysteroscopy?
Examination of a woman’s internal organs can be very useful for diagnosis and treatment of various problems. Directly seeing the outer aspect of the internal organs is done via laparoscopy which inserts a small telescope through a small one centimetre incision in the abdomen and few half centimetre incisions for the operating instruments. However, if we want to see the inside of the uterus, we need to insert a long, lighted telescope, the size of a straw, from below, the vagina, into your uterus. This is a natural passage through which the telescope enters the uterus. A camera is screwed over the outer end of the telescope and a beautiful, magnified view of the inside of the uterus is projected on a monitor. The telescope is covered by a sheath through the side of which can be passed thin operating scissors, forceps and cautery instruments. This procedure is called Hysteroscopy (hystero means uterus and scopy refers to telescopy). No cut is made on the body, either the abdomen or the vagina for Hysteroscopy.
Q2. What is hysteroscopy done for?
Hysteroscopy is very useful in cases of infertility to find whether anything inside the uterus is preventing a woman from getting pregnant. It is recommended to combine Laparoscopy for a view of the outside of the uterus, the pelvis with tubes, ovaries, and Hysteroscopy for the inside of the uterus in patients of infertility. Hysteroscopy is also very useful for analysis of frequent miscarriages, causes of thick lining of uterus as seen on ultrasound and for diagnosis of tumours inside the uterus like fibroids, polyps, precancers and cancers. Another very important reason to do hysteroscopy is for diagnosis of abnormal bleeding from the uterus – either heavy or scanty; delayed or frequent in adult or postmenopausal women. Scarring inside the uterus from previous infection or surgery can cause scanty or absent periods and infertility, and can be diagnosed by hysteroscopy.
Q3. How is Hysteroscopy better than ultrasound which can also diagnose problems inside the uterus?
Ultrasound is an indirect way of looking inside the abdomen and inside the uterus. Often it cannot differentiate between the reasons why the lining of the uterus is thick. Hysteroscopy is the only direct way to actually see inside the uterus and make a definitive diagnosis of the presence of fibroids, polyps, their size, location, base and blood vessel patterns, and exact location of abnormal lining to take a ‘directed’ biopsy so that cancers are not missed. No other method can do that.
Further, the beauty of Hysteroscopy is that it can ‘see and treat’ in the same sitting. For small growths Hysteroscopy can be Diagnostic and Operative Hysteroscopy, in the same sitting, saving considerable costs to the patient. A person can thus be ‘cured’ with removal of small polyps, foreign bodies like broken tubing, lost Copper-T inside the uterus and opening of blocks in the near-end of the tubes by a simple hysteroscopic procedure without having to cut open the abdomen, at the same time as the diagnosis is made. Bigger surgeries may require Operative Hysteroscopy at next sitting.
Q4. How long does the procedure take and when can i go home?
All Diagnostic procedures and minor Operative Hysteroscopy for removal of small lesions may take between 20 to 30 minutes and are done as Day Care procedures. The patient can go home soon after the procedure, if done under local anaesthesia, or a few hours later if done under general anaesthesia. Major operative Hysteroscopic surgeries for removal of large fibroids, scars/adhesions or septum inside the uterus may take longer, about 1-2 hours. These are generally done under general anaesthesia and patient can be discharged that evening or next morning.
Q5. Will I have any discomfort after the procedure?
You are expected to have a very rapid recovery after the procedure even when major surgery for fibroids or adhesions has been performed. You can be fit to rejoin work next day after short procedures and latest by a week after major hysteroscopic surgery. You may, however, have mild cramping in low abdomen or a little discharge/spotting for few days after the procedure. If you were given general anaesthesia, you may feel a little light headed or nausea for few hours after the procedure. It may be better to have someone drive you home if you are leaving same day and not take any important decisions that day.
Q6. What about risks and complications of Hysteroscopy?
Hysteroscopy is a very safe procedure, considering that every surgical procedure carries some risks due to surgery or the anaesthesia used. The risks with hysteroscopy are mostly minor in nature because any surgery done is under vision. These occur in not more than 2% of procedures and often resolve by simple measures. There can be puncture of the uterus or cervix by the hysteroscope or the tiny operating instruments used; there may be fluid retention in body, bleeding or infections. Serious complications are rare and are further decreased by use of better systems of electro-cautery. The complication rates are also dependant on the training and expertise of the operator.
Q7. Why is Hysteroscopic surgery better than any other surgery?
Hysteroscopic surgery is for problems inside the cavity of the uterus. For this there can be no other better way than the hysteroscope to see and operate under direct view. It is more accurate, faster and safer, lesser anaesthesia requirement, lesser infections and complication rates and with very rapid recovery and return to normal activity since no cut or incision is made on the abdomen. The natural passage from the vagina is used to enter the uterus. Bleeding is much less and can be easily controlled by touching the cautery instrument to the bleeding point which is clearly visible. Hysteroscopy, however, cannot be used to remove tumours from inside the walls of the uterus or from outside the uterus. That is its limitation.