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Details the hysteroscopy procedure. Both diagnostic hysteroscopy and operative hysteroscopy are discussed.


There are two main types of hysteroscopy that a patient may encounter: diagnostic hysteroscopy and operative hysteroscopy. Both use a hysteroscope (a fibre optic mini telescope) for observing the interior of the uterus.

Diagnostic hysteroscopy

Diagnostic hysteroscopy is a simple procedure used to inspect the inside of the uterus and detect abnormalities that may contribute to infertility, recurrent failure of embryo implantation and recurrent miscarriage such as: polyp, adhesions, fibroids and uterine septum (a piece of tissue dividing the cavity of the uterus). The diagnostic hysteroscopy procedure can be performed as an outpatient procedure. No anesthetic is usually required but some times a local anesthetic is injected into the neck of the womb.

A speculum is inserted into the vagina to visualize the cervix, which is then cleaned from any discharge. . A fine fibre-optic telescope about the same thickness as a pencil is then inserted through the cervix into the uterus. Either carbon dioxide gas or fluid is used to distend the cavity of the womb in order to get a clear view of the cavity. Vaginoscopy (avoiding the use of vaginal speculum or cervical instrumentation) should be the standard method for outpatient hysteroscopy.

Hysteroscopy showing normal uterine cavity
Inside of the womb as seen by  hysteroscopy

Hysteroscopy showing normal ostia (opening) of the Fallopian tube
Inside of the womb as seen by  hysteroscopy

Operative hysteroscopy

If an abnormality is confirmed at the time of diagnostic hysteroscopy e.g. septum or adhesions, and it has been discussed and agreed before with the patient; it can be surgically treated by operative hysteroscopy at the same time.

Operative hysteroscopy is usually performed in theatre under a general anesthestic as a day case but the patient may stay overnight. Recently more and more operative hysteroscopic procedures are done in the outpatient department using local anaesthetic .

The operative hysteroscopy procedure is very similar to diagnostic hysteroscopy except that operating instruments such as a pair of fine scissors or biopsy forceps can be placed into the uterine cavity through a special channel in the operative hysteroscope.

Operative hysteroscopy procedures include removal of polyp or polyps within the uterus, removal of fibroid, division of scar tissues and tubal cannulation.

Tubal catheterisation is procedure used to treat proximal blockage of the Fallopian tubes diagnosed following Hysterosalpinogram (HSG). Hysteroscopic tubal cannulation is performed under laparoscopic guidance and a dye test is performed to assess tubal patency. The procedue involve inserting a fine canula (catheter) through the hysteroscpe into the tubal ostium. If this fail to unblock the obstruction, then a guided wire is inserted through the canula and advanced toward the obstruction.

Many women can have laparoscopy and/or hysteroscopy with no complications. However, possible complications include: infection, making a hole through the uterus, injury to internal organs and bleeding. After hysteroscopy the patient may experience some discomfort, with period like cramps and vaginal staining for few days.

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