Diagnostic and Therapeutic Hysteroscopy

Hysteroscopy is not performed in:

• Ongoing intrauterine pregnancy
• Active pelvic infections (e.g., genital herpes)
• Known cervical or endometrial cancers
• Severe cardiovascular disease

 

Advantages of Hysteroscopy Over Other Diagnostic Methods:

Compared to pelvic ultrasound, sonohysterography, or hysterosalpingography, hysteroscopy provides direct visualization of the uterine cavity. In addition, many pathologies can be treated during the same procedure.

However, hysteroscopy cannot evaluate conditions within the myometrium (e.g., adenomyosis) or fallopian tube pathology. In such cases, combining hysteroscopy with laparoscopy is recommended.

 

Preoperative Assessment:

• Complete medical history
• Full pelvic examination with special attention to uterine size, mobility, and tubal status
• Pregnancy test
• Cervical culture and treatment in case of cervicitis

The patient must be informed of possible risks and sign an informed consent. These include:

• Early termination of the procedure due to excess fluid absorption
• Risk of uterine perforation
• Potential conversion to laparoscopy or laparotomy if vascular or visceral injury is suspected

 

Patient Preparation:

• Scheduling the procedure:

• Premenopausal women: best performed shortly after menstruation (within the first week). For therapeutic hysteroscopy, medications may be prescribed to thin the endometrium beforehand.
• Postmenopausal women: procedure can be performed at any time.

• Cervical preparation:

• Cervical dilation is often required, especially in postmenopausal women or those with a history of cervical stenosis or surgery.
• Misoprostol may be prescribed orally or vaginally the night before or the morning of surgery, depending on the physician’s instructions.

Other preoperative considerations:

• Use of hormonal medication if prescribed
• Use of cervical dilators as directed
• Treating any vaginal or cervical infections prior to surgery
• Avoiding vaginal douches, tampons, or creams 24 hours before surgery
• Showering and shaving the genital and abdominal area
• Discontinuing Aspirin and Warfarin 72 hours prior, and Heparin 24 hours prior (if applicable)
• Fasting for at least 8 hours before surgery
• Removing jewelry, watches, makeup, nail polish, glasses, dentures, hearing aids, lenses, or prosthetic nails before entering the operating room
• Emptying the bladder immediately before surgery

 

 

How Hysteroscopy is Performed?

• The patient is positioned in the lithotomy position (legs in stirrups).
• The external genitalia, vagina, and cervix are disinfected.
• Anesthesia is administered (diagnostic hysteroscopies are often performed under sedation, while therapeutic ones usually require general anesthesia).
• A speculum is inserted, and the cervix is dilated with special instruments to allow the passage of the hysteroscope.
• To improve visualization, the uterine cavity is distended with saline solution or, if electrocautery is needed, with a different distension medium.
• The surgeon can either look directly through the hysteroscope or use video monitoring on a large screen.
• If necessary, miniature surgical instruments are introduced through the hysteroscope to remove polyps, fibroids, or adhesions.
• Since 1–3% of uterine lesions may be missed during hysteroscopy, an endometrial biopsy is usually performed, especially in women with unexplained persistent bleeding.
• After the procedure, the patient is monitored in recovery before returning to the ward.

 

Discharge After Hysteroscopy

• Most patients are discharged the same day.