WHAT IS HYSTEROSCOPY?
Hysteroscopy is the process of evaluating the cervical canal, the inside of the uterus and the exit points of the tubes from the uterus with the help of a camera, by entering through the cervix with an optic. Hysteroscopy is performed in two different ways as diagnostic and operative hysteroscopy. The image taken with the hysteroscope is transferred to the monitor via the optical-camera system. Modern hysteroscopy in Turkey is performed for the first time by Prof. Dr. Recai PABUÇCU. Hysteroscopy indications can be listed as follows:
- Abnormal bleeding
- Treatment of submucous fibroid or endometrial polyps
- Removal of lost intrauterine devices or other foreign bodies
- Evaluation of cases with problems in the uterine film
- Diagnosis and treatment of intrauterine adhesions
- Diagnosis and treatment of intrauterine septum
- Cessation of bleeding with laser or electrosurgery in patients with bleeding unresponsive to treatment
- Opening the tubes with tubal cannulation
- Examination of the endocervical canal and uterine cavity in cases of recurrent miscarriage
- Occlusion of tubes – sterilization by hysteroscopic methods
- Evaluation of the inside of the uterus before treatment in cases with infertility
In Which Situations Hysteroscopy Is Performed?
• In the presence of fibroids or polyps occupying space in the uterus,
- In the presence of uterine septum, which is one of the congenital anomaly types in the uterus,
- To open the intrauterine adhesions,
- In case of residual tissue in the uterus after miscarriage or curettage,
- For the removal of intrauterine devices that cannot be removed vaginally.
How is Hysteroscopy Performed? What are the Types of Hysteroscopies?
1. Office (Diagnostic) hysteroscopy
- Operative Hysteroscopy
1.1 Observation of the uterine cavity for diagnostic purposes. It is usually performed under local anaesthesia. It is made for definitive diagnosis in cases where the diagnosis cannot be made in any other way or when the diagnosis is not definite. It can be determined whether there is a disorder in the uterus or if there is a disorder, the actual size and location can be determined, and the treatment method can be easily programmed. If necessary, operative hysteroscopy can be performed in the same session. It is performed by entering the uterus with a device containing a camera that is advanced from the natural opening of the cervix. Diagnostic Hysteroscopy helps to diagnose the following conditions:
- Polyps or fibroids that cause excessive bleeding
- Congenital uterine anomalies (septum, bicornis, arcuate, hypoplasia)
Early-stage cancers of the lining of the uterus (endometrium) can be diagnosed. A biopsy can be taken from the suspicious area under direct observation. It can be performed in the following cases:
Removal of the spiral with invisible thread or spiral which escape into the uterus
Investigation of recurrent miscarriages
Investigation of recurrent IVF failure
Confirming abnormal hysterosalpingography (HSG) or ultrasound finding
What is operative Hysteroscopy?
1.2. Intrauterine disorders are treated with the operative hysteroscopy method, which is usually performed under general anaesthesia. It is a more advanced form of diagnostic hysteroscopy. After all kinds of structures inside the uterus are viewed in detail, any pathology can be corrected or removed with an electrosurgical system called a resectoscope. The following conditions are treated with operative hysteroscopy:
Intrauterine adhesions (intra-uterine synechia)
Excessive menstrual bleeding (The endometrium is removed to stop excessive menstrual bleeding that continues despite drug treatments (there should not be a child request later))
Proximal tubal stenosis or obstruction (tubal cannulation)
What are the advantages of operative hysteroscopy?
Without open surgery, the patient can be treated without removing the uterus. Especially in women who are undergoing infertility treatment or are considering having a child in the future, the operation performed as abortion or open surgery on the abdomen may make it difficult to become pregnant in the future or lead to new causes of infertility (such as adhesions in the abdomen). Especially in this group of women, hysteroscopic surgery is the most successful treatment method.
Other Applications with Hysteroscopy
An intrauterine device can be removed under hysteroscopic observation. In cases of undesired pregnancy termination or miscarriage, the remaining fragments can be removed by hysteroscopy, under direct observation. These cases typically describe a persistent bloody discharge after abortion; The remaining part is easily visualized in vaginal ultrasonography. In these cases, an uncontrolled second abortion should be avoided, and the pieces should be removed under direct hysteroscopic observation.