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Hysteroscopy uses a hysteroscope, which is a thin telescope that is inserted through the cervix into the uterus. Modern hysteroscopes are so thin that they can fit through the cervix with minimal or no dilation. Although hysteroscopy dates back to 1869, gynecologists were slow to adopt hysteroscopy. Because the inside of the uterus is a potential cavity, like a collapsed airdome, it is necessary to fill (distend) it with either a liquid or a gas (carbon dioxide) in order to see. Diagnostic hysteroscopy and simple operative hysteroscopy can usually be done in an office setting. More complex operative hysteroscopy procedures are done in an operating room setting.
Unless a women has major medical problems, we numb the cervix (this is easily done and rarely uncomfortable.) and attach a video camera to the hysteroscope, so that the patient can also see, and then insert the hysteroscope into the uterus under direct vision while using either saline or carbon dioxide to fill the uterus. Usually this causes mild cramping. We then can look for fibroids, polyps, and other problems that may be causing bleeding. This often takes about a minute or two. The hysteroscope is removed. A small plastic tube may be used to take a sample of the lining of the uterus.
By being very gentle, and using local anesthesia, there is usually minimal discomfort during hysteroscopy. Most women are able to get up and return to their normal activities immediately. If someone is very anxious, it is possible to give a short acting narcotic intravenously. This makes it very unlikely that the procedure will be uncomfortable.
During diagnostic hysteroscopy the hysteroscope is used just to observe the endometrial cavity (inside of the uterus.) During operative hysteroscopy a type of hysteroscope is used that has channels in which it is possible to insert very thin instruments. These instruments can be used to remove polyps, to cut adhesions, and do other procedures. With the development of better and smaller instruments, I find that I am able to remove some polyps in addition to doing other procedures that used to require a full operating room. In many situations, operative hysteroscopy may offer an alternative to hysterectomy.
The resectoscope has been used for male prostate surgery for over 50 years. It has been modified so it can be used inside the uterus. The resectoscope is a hysteroscope with a built in wire loop (or other shape device) that uses high- frequency electrical current to cut or coagulate tissue. The resectoscope has revolutionized surgery inside the uterus.
The hysteroscopy cannot be performed during your menstrual cycle or if you may be pregnant. The best time to perform this procedure is within 7 days after your period ends. ... There are no restrictions on activity or diet before the hysteroscopy unless otherwise instructed by your doctor.