The operative hysteroscopy is a surgical procedure that allows us to operate directly inside the uterus using a hysteroscope (Figure 1) which is introduced by natural means, ie the vagina through the cervix.
The cervix is dilated before the introduction of candles, increasing diameter, successively. Once expanded the hysteroscope is inserted into the uterine cavity. It is equipped with a camera attached to a video screen for visualizing the uterine cavity and to look for lesions. An irrigation system by saline is connected to the hysteroscope, this allows a better visualization. The hysteroscope has a snare that allows the resection of any lesions At the beginning of the operation , the surgeon makes a thorough exploration to verify that no other abnormalities than that for which the operation was indicated. Anesthesia is necessary. Depending on the type of intervention, characteristics and the desire of the patient, anesthesia is generally locoregional (spinal anesthesia) or local.As may be agreed with your surgeon (and by type of intervention provided), you can or not go out that night from the surgery.In all cases, the exit permit is issued after review of the surgeon and the anesthesiologist. How the surgery went can change the leaving conditions (eg if the operation lasted longer than expected).
Indications :
This medical procedure is usually indicated when uterine injury requiring surgical treatment was identified during diagnostic hysteroscopy.-Removal of a uterine polyp.-Removal of uterine fibroids.-Treatment of uterine synechiae.-Ablation of the uterine lining (endometrial): In some situations, this technique represents an alternative to hysterectomy.-Section of uterine wall (uterine septum).
-Enlargement of the uterine cavity(metro tummy expansion, Distilbene uterus).-Removal of an intrauterine device (when its removal is not standard).-Tubal sterilization.
At what point can we do a hysteroscopy procedure?:
As for diagnostic hysteroscopy, it is between J8 and J13 of the menstrual cycle in premenopausal women. It can be done AT ANY TIME for postmenopausal women.
What happens during the operation?:
In general the operation is done as an outpatient, the patient arrives in the morning and leaves in general the same evening, or in some cases 24 or 48 hours.later You will be in the lithotomy position and a speculum will be put in place. The first step is to introduce the hysteroscope into the uterus through the birth canal: vagina and cervix. The hysteroscope is a thin metal tube containing optical fibers and connected to a camera, so the entire procedure is monitored on a screen (like a TV). The hysteroscope is a small diameter optical instrument when it comes to diagnostic hysteroscopy (2.5 to 3.5 mm) and in diameter a slightly bit higher (8-10 mm) when it comes to the operative hysteroscopy. To introduce the hysteroscope into the cervix, the surgeon needs to dilate the cervical canal using candles increasing diameters. We introduce a liquid into the uterine cavity on one hand to stretch it so as to be able to have good visibility, and secondly in order to use the energy needed to carry out the surgery. This liquid can be either saline (if using a bipolar energy) or glycine (in case of operative hysteroscopy using a monopolar conventional energy). If removal of a lesion at surgery, it is sent to the laboratory for analysis. The results are communicated to the patient within 10 days.
Possible complications:
They are rare and unpredictable occurrences:-The persistence of a small amount of bleeding for several days is common.-Risk of bleeding, occurring immediately after surgery or remotely (in the days following the operation.) It may be related to a cervical laceration or uterine perforation. The occurrence of bleeding may require reoperation.-Risk of infection, manifested by malodorous vaginal discharge, pelvic pain and fever, urinary tract infection.-Failure of the intervention following a wrong path of the hysteroscope contraindicating the continuation of the intervention.-Very rarely, a hysteroscopy can cause infertility by obstructing the cervix (stenosis) or the occurrence of postoperative synechiae.
-Absence of periods by stenosis (obstruction) of the cervix or the appearance of a synechia, which may require dilation or reoperation.-Incompetent cervix associated with cervical dilation.-Risks related to anesthesia: allergy, infection ...-Exceptionally, an intestinal wound or urinary tract, associated with uterine perforation.-Neurological impairment related to a passage of intravascular large irrigation fluid (glycine): headache, visual disturbances, respiratory disorders, and cardiovascular and blood sodium hypo hemodilution.The postoperative course is usually simple and painless.
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Victor Hugo