What Is Hysteroscopy?
The procedure of inspecting the uterus with the help of an endoscope inserted through the cervix is known as hysteroscopy. It is basically an endoscopic procedure done for the visualization of the uterine wall, cervix and the vagina. The instrument used is also known as a hysteroscope. There are various methods of hysteroscopy and many different hysteroscopes that can be put to use for this medical procedure. This procedure can be both a diagnostic one as well as a surgical intervention for the detection and correction of any pathology respectively.
Why Is Hysteroscopy Needed?
It becomes essential to opt for a hysteroscopy in the following conditions:
- Cases where the fallopian tubes are ligated, falloscopy needs to be done, hysteroscopy is used to assess the areas of occlusion
- Removal of intrauterine devices such as copper T
- Evacuation of the remains after conception, in case it is required
- Small uterine fibroids
- Polyps of the endometrium
- Uterine bleeding, where blood needs to be evacuated and prevented from forming clots and obstruction
- In cases of uterine adhesions where the walls of uterus get adhered and block the normal functions
- In early stages of endometrial cancers
Signs and Symptoms A Hysteroscopy Is Needed:
- You have been diagnosed with stage I endometrial cancer
- Your USG reports say you have small uterine fibroids which need a non invasive removal, the surgical hysterectomy will be indicated
- Irregular bleeding from the uterus, hysteroscopy will prevent the blood clots
- Endometrial polyps
- Adherence of the endometrial walls
- Retention of tissue debris in the endometrium after parturition
How Does A Hysteroscope Work?
- A conventional or a standard hysteroscope is a long and narrow telescopic tube that is connected to a source of light for the purpose of illumination.
- There are two ends to it, proximal part is the one where a camera is attached so as to view the uterine wall images on a screen.
- The distal end is inserted into the cervical canal and advanced into the uterine cavity either for the purpose of inspection or surgical intervention.
Preparation for A Hysteroscopy:
- The procedure is advised just after the menstrual cycle is over, because during this time the endometrial lining is relatively thin
- The diagnostic procedure can be done in the clinical setting with or without the local anesthesia and the patient sent home immediacy after it has been done
- The type of hysterectomy required to surgically remove polyps or fibroids can be done with administration of local anesthesia via the paracervical blocks or by using general anesthesia, depending upon the severity of the case
- The patient is explained the procedure and assured that mid pain and discomfort may be caused while the procedure will be performed, advised not to panic and co operate till the procedure gets completed
There is particular sequence in which the procedure needs to be performed. The steps are as follows:
- Cervical dilation: The diameter of the hysteroscope is usually small enough to enter the vagina and the cervix without any hindrance or resistance. However in certain females the openings are small and the hysteroscope insertion may cause tremendous pain and discomfort owing to which the patient does not comply. In such cases dilators are administered either orally or injected half hour prior to the onset of the procedure.
- Insertion and inspection: A sheath is used to cover the hysteroscope and then it is inserted transvaginally inserted into the uterus, insufflated and the inspection is performed.
Insufflation is performed to distend the uterine cavity so as to enable a good unobstructed inspection of the uterus. For this purpose, fluids and carbon dioxide gas are used, both having their own pros and cons.
- Fluids: They include electrolytic solution such as normal saline and Ringer’s lactate solution. they have a potential to conduct electricity and hence cannot be used in electrosurgical type of hysteroscopy. The non electrolytic solutions include glucose, glycine, dextran, mannitol and sorbitol. When these solutions are used, it becomes essential to make sure that the fluids are extracted well from the uterine cavity after the procedure is completed so as to prevent further complications
- Surgical/interventional hysteroscopy: In this procedure, after the cervical dilation has been achieved, the surgical instruments are inserted into the uterine cavity. These are the micro instruments in the form of forceps or scissors used for the removal of fibroids, polyps or debris from the uterus. Endometrial ablation, endometrial polypectomy and submucosal fibroid resection are the procedures done by this method.
Complications and Risk Factors Associated With Hysteroscopy:
- A breach in the uterine/endometrial wall by the hysteroscope can lead to perforation
- Perforation of the bowel can also occur owing to use of immense pressure, this leads to bleeding and peritonitis
- Cervical lacerations
- Intrauterine bleeding and infections
- Electrical and thermal injuries
- Embolism due to excess fluid
- Emphysema due to air, air embolism
- Hyponetremic encephalopathy
Am I Good Candidate For Hysteroscopy?
If you happen to be suffering from any of the below mentioned pathological conditions involving your uterus, you surely are an ideal candidate for the hysteroscopy procedure:
- Tubal adhesions, ligations and obstructions
- Uterine fibroids, smaller in number and diameter
- Uterine polyps which require a non invasive approach
- Uterine bleeding
- Stage I endometrial cancer
- General screening for well being of the uterus
- If the hysteroscopy is done for your diagnosis, you would recover on the same day, maybe cramps for an hour or so or general discomfort may bother you which eventually would subside
- If a polyp or a fibroid is removed with the help of the surgical intervention, you may take two three days to recover from the bleeding, if it occurs. Antibiotic coverage may be started if need be
Success Rate of Hysteroscopy:
Be it a diagnostic or a surgical procedure, there is hardly any chance of a hysterectomy being unsuccessful. 2 percent of cases may see a failure owing to any underlying systemic disease the patient may be suffering from for example hypertension, peritoneal infections or raised diabetes.
Benefits of Hysteroscopy:
- It is a minimally invasive procedure
- Does not require extensive hospital stay
- No chances of scars, keloids, post operative infections
- Recovery time is relatively shorter
- Patient can be discharged on the same day
- No need for administration of general anesthesia
Cost Comparisons for Hysteroscopy:
A diagnostic hysteroscopy will cost you around 15,000 to 20,000 INR, the operative hysterectomy will charge you around 40,000 to 45,000 INR. These charges are approximately 60 percent less than what you will be required to pay in the United States/Australia.
Why choose India?
One of the most genuine places of medical tourism and health care providers, the basic motto of team MedcureIndia which eventually represents India, is to help its clients in getting a good diagnosis of the ailment and an even better treatment planning for the same. We not only take into consideration the cost at which the diagnostic or operative hysteroscopy will be offered, but also make sure that the entire protocol is finished efficiently.