Hysteroscopy is an operating procedure that is performed for the purposes of diagnosis and therapy. The purpose of the procedure is an inspection of the inside of the uterus with the help of an instrument called hysteroscope, which is inserted in the uterus through the cervix. It is best to perform the procedure during the period when the endometrium (internal lining of the uterus) is at its thinnest, i.e. immediately after the completion of the menstrual cycle. It is performed under local or general anesthesia.
How is the procedure performed?
The intervention begins with dilation (expansion) of the cervical canal, with the use of dilators. Next comes the placement of the hysteroscope, which has a built-in camera in order to follow the procedure on the screen. The inside of the uterus is a virtual cavity and its walls lie against one another. In order for the inside of the uterus to become visible, it is filled with a liquid or a gas. Liquids are most commonly used, since they purify the uterus from blood and remains from the endometrium, besides the distension (expansion). This leads to a clear picture of the inside of the uterus, which is crucial for the success of the procedure. During the procedure, the control of the inserted and exported liquid is very important, in order to prevent excessive intake and intoxication of the patient.
If any type of change that deviates from the normal results is encountered, the diagnostic hysteroscope is replaced with a surgical hysteroscope after additional dilation of the cervical canal. The whole procedure is monitored on the screen until the end of the procedure.
When is a hysteroscopy performed?
- On a septate uterus. It is removed during one or more procedures, depending on the size
- Polyp on the uterus or the cervix
- Submucosal myoma (myoma which is prominent inside the uterus)
- Endometrial ablation – removal of the endometrium to a certain depth to the lining of the uterus
- Removal of a Intrauterine Device (IUD) (ingrown in the lining of the uterus)
- Adhesiolysis – the breaking of the intrauterine adhesions, most commonly the consequence of Asherman syndom
- Abnormal bleeding of the uterus
- Visualisation of the uterotubal junction