from
the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,
MD.
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Laparoscopy -- The Kinder Cut (Page 2)
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What
is hysteroscopy ?
How
is hysteroscopy performed ?
What
is operative hysteroscopy ?
What
is hysteroscopic tubal cannulation ?
What
are the complications of hysteroscopy ?
What
is hysteroscopy ?
Hysteroscopy, as the name suggests (hystero
= uterus; scopy = to see), is a surgical procedure in
which a telescope is inserted inside the uterus to examine
the uterine lining. This procedure can assist in the
diagnosis of various uterine conditions which can cause
infertility, such as:
- submucous (internal) fibroids
- scarring (adhesions or synechiae)
- endometrial polyps
- uterine septa and other congenital
malformations
Before performing hysteroscopy, a hysterosalpingogram
(an x-ray of the uterus and fallopian tubes) may be
performed to provide additional information about the
cavity which can be useful during surgery. Many doctors
will also do a vaginal ultrasound as a diagnostic aid.
Diagnostic hysteroscopy is usually conducted on a day-care
basis with either general or local anesthesia and takes
about thirty minutes to perform.
How
is hysteroscopy performed ?
The first step of hysteroscopy involves
cervical dilatation - stretching and opening the canal
of the cervix with a series of dilators. Once the dilatation
of the cervix is complete, the hysteroscope, a narrow
lighted telescope, is passed through the cervix and
into the lower end of the uterus. A clear solution (Hyskon
or glycine) or carbon dioxide gas is then injected into
the uterus through the instrument. This solution or
gas expands the uterine cavity, clears blood and mucus
away, and enables the surgeon to directly view the internal
structure of the uterus.
The doctor systematically examines the
lining of the cervical canal; the lining of the uterine
cavity; and looks for the internal openings of the fallopian
tubes where they enter the uterine cavity - the tubal
ostia.
Some doctors may do a curettage (a surgical
scraping of the inside of the uterine cavity) after
the hysteroscopy and send the endometrial tissue for
pathologic examination.
What is operative hysteroscopy
?
The technique of hysteroscopy has also
been expanded to include operative hysteroscopy. Operative
hysteroscopy can treat many of the abnormalities found
during diagnostic hysteroscopy at the time of diagnosis.
The procedure is very similar to diagnostic
hysteroscopy except that operating instruments such
as scissors, biopsy forceps, electocautery instruments,
and graspers can be placed into the uterine cavity through
a channel in the operative hysteroscope. Fibroid tumors,
scar tissue (synechiae or adhesions), and polyps can
be removed from inside the uterus. Congenital abnormalities,
such as a uterine septum, may also be corrected through
the hysteroscope.
What is hysteroscopic
tubal cannulation ?
A relatively new method for treating
proximal tubal obstruction (cornual blocks, where the
tubes are blocked at the utero-tubal junction) is that
of hysteroscopic tubal cannulation. Many studies have
shown that this kind of block is often because of mucus
plugs or debris which plug the tubal lining at the uterotubal
junction which is as thin as a hair. It is now possible
to pass a fine guidewire through the hysteroscope into
the tubes, and thus remove the plug or debris and open
the tubes - thus restoring normal tubal patency with
"minimally invasive surgery"!
Another advance has been the development
of the method of falloposcopy - in which a very fine
flexible telescope is passed into the tube through the
hysteroscope, so as to visualize the interior of the
entire tube.
After a hysteroscopy, patients often
have cramping similar to that experienced during a menstrual
period; and some vaginal staining for several days.
Regular activities can be resumed within one or two
days after surgery. Sexual intercourse should be avoided
for a few days or for as long as bleeding occurs.
What are the complications
of hysteroscopy ?
Complications occur rarely during
hysteroscopy. In a few cases, infection of the uterus
or fallopian tubes can result. Occasionally, a hole
may be made through the back of the uterus - a perforation.
However, this is usually not a serious problem because
the perforation closes on its own. Frequently, when
extensive operative hysteroscopy is planned, diagnostic
laparoscopy is performed at the same time to allow the
surgeon to see the outside as well as the inside of
the uterus to try to reduce the risk of accidental uterine
perforation. Other possible complications include allergic
reactions and bleeding.
continued
. . .
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