Hysteroscopy

Hysteroscopy is a gynecologic procedure that involves placing a small tube with a camera on one end and a light on the other into the uterus to tell if there are problems within the uterine cavity. This procedure has developed over the years to become one of the more common and useful gynecologic tools. The tube, called a hysteroscope (say “hyst-er-oh-scope”), is about as big around as one’s little finger, and is slipped into the uterus after slowly dilating the cervix. Once inside the uterus a gynecologist can diagnose a number of problems and can often treat them during the same procedure.

Hysteroscopy can be done in the office or as an outpatient surgical procedure. Whether or not it is done in the office depends on such things as the size of the uterus, the amount of time your doctor feels he or she will need to do the procedure, the potential diagnosis, and whether or not electrical current will be used within the uterus to cut or cauterize tissue. Most cases are done in the operating room, but a number are safely performed within the office under local anesthesia.

Problems a gynecologist might try to diagnose with hysteroscopy include the cause of abnormal bleeding, fibroid tumors that arise within the uterine cavity, intrauterine polyps (small and non-cancerous growths that can cause bleeding), lost IUDs, uterine abnormalities (such as a septum, or a “heart shaped” uterus), and in some cases, cancer of the uterine cavity (endometrial cancer).

During the procedure a gynecologist may diagnose a problem then proceed directly to treatment. She or he may pass tiny scissors, a small electrical wire loop used to cut tissue, or a grasping device to remove polyps. These instruments are indeed small. For example, the cutting part of the scissors may be no larger than the tip of an ink pen! While watching with the camera your doctor will use the different devices to remove or correct the abnormality. Afterwards, barring any unusual complications, you will be discharged to home.

Although this is a safe procedure there are potential complications to any surgical procedure. A specific complication that may arise with hysteroscopy is perforation of the uterus while dilating the cervix. This is actually not usually a problem, since the uterus will heal rapidly, but it may lead your doctor to postpone the procedure until the uterus is fully healed. Another rare, but dangerous, complication is increased fluid absorption from the uterus into the blood stream. We use various fluids to distend the uterus so we can see better, and the pressure may cause some of this fluid to leak into the blood vessels of the uterus. Too much fluid in one’s blood vessels can cause fluid on the lungs (pulmonary edema) or even seizures. Thankfully, this is rare, and can usually (but not always) be prevented by keeping track of the amount of fluid used during the procedure. Finally, bleeding and damage to the uterus are always potential, although unusual, complications of hysteroscopy. In rare cases your doctor may ask you to spend the night for observation, or may leave a catheter inside the uterus for a few hours to prevent bleeding. Overall, this is a very useful and very safe procedure that gynecologists use to diagnose and treat intrauterine problems.