Generality
Operative hysteroscopy is an endoscopic surgical procedure belonging to the gynecological sector, which is used to treat diseases of the uterus, uterine cervix or endometrium.
Operative hysteroscopy requires special preparation, which also includes a series of tests aimed at establishing the suitability of a woman for the procedure in question.
Duration of 30-60 minutes, the operative hysteroscopy involves the insertion into the uterine cavity, through the vaginal opening, of the hysteroscope, which acts as a surgical instrument.
Operative hysteroscopy is a safe and effective procedure, which, at its conclusion, requires a few days of rest waiting for a complete recovery.
A brief review of what is Isteroscopy
Hysteroscopy is an endoscopic gynecological procedure, which allows to evaluate from the inside the state of health of the uterus - in particular the uterine cavity, cervical canal and endometrium - and, in case of need, to intervene surgically, in order to cure some medical condition.
Hysteroscopy is based on the use of an instrument known as a hysteroscope ; the latter is a long tube, similar to a drinking straw, which, thanks to a camera and a connection system to a monitor, acts as an exploratory probe of the uterus and cervix, after its insertion into the uterine cavity, through the vaginal opening.
Hysteroscopy is a procedure generally performed in an outpatient or day surgery setting; therefore, except in special cases, it never provides for hospitalization of the patient.
Hysteroscopy is a matter for gynecological doctors, or doctors with a specialization in gynecology.
What is Operational Hysteroscopy?
Operative hysteroscopy, or therapeutic hysteroscopy, is hysteroscopy with the aim of treating some pathology that undermines the health of the uterus, cervical canal or endometrium.
Operative hysteroscopy is a surgical procedure belonging to the category of minimally invasive surgical procedures .
Operative hysteroscopy
When hysteroscopy, instead of having therapeutic purposes, has diagnostic intent, it is called diagnostic hysteroscopy .
Indications
Operative hysteroscopy is indicated at:
- Removal of uterine polyps ;
- Removal of uterine fibroids ( hysteroscopy myomectomy );
- Removal of benign tumors of the uterus other than polyps and uterine fibroids;
- The removal of intrauterine adhesions ;
- Removal from the uterus of post-abortion placental residues (ie post- abortion) or post-partum (ie following a birth);
- The extraction of the so-called intrauterine system (or IUS), a particular device that, inserted in the uterus, acts as a temporary contraceptive;
- The realization of the so-called tubal sterilization, a form of permanent contraception. Tubal sterilization is also called tubal closure.
Preparation
Operative hysteroscopy requires special preparation, which serves to discover a woman's suitability for such a procedure and to inform her of how she should behave, so that everything goes smoothly.
The preparation in question, therefore, includes health assessment exams and an illustration of how the patient should act on the day of the procedure and in the event that an anesthetic practice is required.
Health assessment exams
To establish suitability for operative hysteroscopy, the possible future patient must undergo:
- A careful gynecological examination ;
- An accurate medical history (or clinical history ). It includes a series of investigations, which serve to clarify important aspects such as: past illnesses of the papabile patient and his family; any drugs taken by the eligible patient at the time of the checks; the habits of the patient papabile (ex: cigarette smoke); etc.;
- A cervico-vaginal swab . It is used to determine if an infection is occurring in the cervical or vaginal area;
- A transvaginal ultrasound . Provides information on the anatomy and health status of the pelvic organs, such as the vaginal canal, uterus, ovaries and fallopian tubes;
- Blood analysis . They are used to verify the presence or absence of any coagulation disorders;
- A pregnancy test . As will be seen later, pregnancy is a contraindication to operative hysteroscopy.
Important note
The aforementioned exams are also provided in case of possible diagnostic hysteroscopy.
On the day of the procedure: how to behave?
Remember that: at this point in the preparation, there is suitability for the operative hysteroscopy procedure.
On the day of operative hysteroscopy, the patient must wear comfortable and practical clothes, because then she will have to remove them in favor of a hospital gown specially prepared for her by the medical staff.
How to behave if anesthesia is provided?
Under certain circumstances, operative hysteroscopy may require general anesthesia.
General anesthesia is an anesthetic practice that requires the observance of a fast of at least 8 hours and that includes the sleep and the unconsciousness of the patient until the end of the surgical procedure, in order to make him insensitive to any pain or discomfort.
In case of general anesthesia, then, it is necessary for a relative (or a trusted friend) of the patient to make himself available to take his loved one home, as the latter is not in physical condition to drive a vehicle and take care of himself of himself to 100% (when awakening from general anesthesia, in fact, appear, for a few hours, confusion, slowness in reflexes, malaise, headache, etc.).
Did you know that ...
With a view to general anesthesia, failure to comply with full fasting means the cancellation of the entire surgical procedure provided, even if all other circumstances exist to carry it out.
Procedure
FIRST PART
After the patient has stopped her clothes in favor of an ad hoc hospital gown, a nurse of the medical staff invites her to sit on a special bed (equipped with a support for the legs etc.) and has them assume the so-called gynecological position, with a favorable inclination to the introduction of the various tools necessary for the procedure.
As soon as the patient is in position and feels at ease, the gynecologist enters the scene, who, thanks to a speculum, opens the vagina and gently introduces the hysteroscope, in order to lead him into the uterine cavity.
In order to make the hysteroscope more easily inside the uterus, the gynecologist needs to stretch (in the sense of dilating) the walls of the uterine cervix, cervical canal and uterine cavity; during operative hysteroscopy procedures, this work of distension is achieved by an injection through a hysteroscope of a liquid substance, called " distension liquid ".
The hysteroscope is hollow on the inside just to allow the passage of gas, liquids or thin surgical instruments.
The distension (or dilation) of the uterus is essential not only to facilitate the hysteroscope conduction inside the uterus, but also to allow a better vision of the internal anatomy of the organ and to make the whole procedure less painful .
In this phase of the procedure, careful monitoring by the entire medical staff of intrauterine pressure is important, which must remain at a value between 60 and 70 mmHg. The maintenance of these pressure values, in fact, avoids the over-distension of the walls constituting the uterine cavity and prevents the diffusion fluid from spreading through the abdomen through the fallopian tubes.
SECOND PART
When the hysteroscope is finally inside the uterus and the latter is sufficiently dilated, the gynecologist can start the treatment foreseen on the affected uterine area. Thanks to the hysteroscope camera (which is also provided with a light source), the therapeutic action is very precise.
PART THREE
At the end of the therapeutic intervention, the gynecologist gently extracts the hysteroscope. With the extraction of the hysteroscope, the operative hysteroscopy can be considered concluded.
Where is Anesthesia placed, when scheduled?
In the aforementioned description of the various stages that characterize operative hysteroscopy, general anesthesia is placed after the patient is settled, but before the speculum and hysteroscope are inserted.
Once administered, the anesthetics go into action within minutes.
Please note that general anesthesia causes the recipient to fall asleep, a sleep that lasts until the end of the procedure.
The practice of general anesthesia is always an anesthesiologist, that is, a doctor who specializes in anesthesia and resuscitation procedures.
Instrumentation for Operational Hysteroscopy
The instrumentation for operative hysteroscopy includes: hysteroscope, speculum (vaginal valve), forceps, dilators, cannulae, insufflator, video camera system, sterile gauze, fiber optic cable, CO2 conductor cable, etc.
The preparation of this instrumentation - however obviously sterilized properly - takes place while the patient is wearing the gown provided for the procedure.
Did you know that ...
There are two types of hysteroscopes: the hysteroscope for diagnostic hysteroscopy procedures, whose diameter is between 4 and 5 millimeters, and the hysteroscope for operative hysteroscopy procedures, whose diameter is 7-8 millimeters.
How do patients feel during an operative hysteroscopy?
Without the practice of anesthesia, the patient subjected to operative hysteroscopy may experience a slight discomfort / pain during the introduction of the hysteroscope into the vagina and cervical canal. This feeling, however, is temporary, as, as readers will remember, the gynecologist follows, when the hysteroscope is introduced, dilation of the uterine cervix and uterus.
With general anesthesia, however, the patient sleeps and is insensitive to pain for the entire duration of the operative hysteroscopy.
How long is the operative hysteroscopy?
Normally, an operative hysteroscopy procedure lasts 30-60 minutes .
The duration of an operative hysteroscopy depends on the present medical condition and how easy it is to cure.
Did you know that ...
Diagnostic hysteroscopy lasts far less than operative hysteroscopy; in fact, its duration does not generally exceed 15 minutes.
When is the return home expected after an operational hysteroscopy?
The patient subjected to operative hysteroscopy can return home only after a series of medical examinations, aimed at assessing the good outcome of the procedure and the body's response to a possible general anesthesia (eg: monitoring of vital functions, etc.) .
As a rule, these medical examinations require from 2 to 4 hours, the period in which the patient receives all the necessary attention from the nursing staff.
Recovery
Recovery from operative hysteroscopy requires a few days of complete rest ; after which, it is possible to return to normal daily activities, provided that there is a certain gradation.
What can a woman do after an operative hysteroscopy?
At the end of an operative hysteroscopy, the patient can safely eat and drink as usual, and take a shower.
If you have received general anesthesia and feel a slight sense of confusion, it is better that you consume small and light meals for at least 24 hours.
What can't a woman do after an operative hysteroscopy?
Women undergoing operative hysteroscopy should refrain from sexual activity for about 7 days or, in the presence of vaginal bleeding, until the end of the latter. Abstention from sexual activity is a precautionary measure aimed at preventing infections .
Risks and Complications
Operative hysteroscopy is a safe procedure . In fact, it is very rare that it can lead to adverse effects or, worse still, complications.
Did you know that ...
On the occasion of a hysteroscopy, the risk of complications is less than 1%, therefore a real rarity.
Because it is a surgical procedure, operative hysteroscopy tends to be less safe than diagnostic hysteroscopy.
Adverse effects
For adverse effects of a diagnostic or operative procedure, the doctors intend to deal with minor and temporary problems.
The list of possible adverse effects of operative hysteroscopy includes:
- Mild vaginal bleeding . Result of injuries caused by the passage of the hysteroscope, along the cervix and cervical canal, this adverse effect can last from a few days to even a little over a week;
- Abdominal pain and cramps . Often, the painful sensation is controllable with an analgesic, such as paracetamol or ibuprofen (an NSAID);
- Feeling tired and / or unwell .
Complications
For complications of a diagnostic or operative procedure, the doctors intend problems of a certain clinical relevance, which can take place during or after the aforementioned procedure.
The potential complications of operative hysteroscopy procedures include:
- Uterine perforation ;
- Bladder perforation ;
- Development of an infection at the pelvic level ( metritis );
- Laceration of the blood vessels of the uterus resulting in massive vaginal bleeding;
- Endometritis, or inflammation of the endometrium;
- Peritonitis, ie inflammation of the peritoneum;
- Severe allergic reaction (anaphylactic shock) to anesthetics;
- Edema in the uterine area ;
- Embolism gas (is connected to the practice of general anesthesia);
- Trauma to the cervix caused by the hysteroscope.
How to recognize any complications?
The most classic symptoms of complications associated with operative hysteroscopy are:
- Intense and protracted abdominal pain that does not fade with the most common analgesics;
- Fever above 38 ° C;
- Large and recurrent vaginal bleeding;
- Loss of dark and smelly liquid from the vagina.
Contraindications
Operative hysteroscopy has some contraindications; more specifically, these contraindications are:
- Cervical cancer ;
- Endometrial carcinoma ;
- Pregnancy
- Pelvic inflammatory states, such as endometritis, metritis, pelvic peritonitis, acute vaginitis and acute cervicitis .
Doctors also consider the performance of diagnostic hysteroscopy in case of: nulliparity, intact hymen and cervical stenosis unsuitable.
Did you know that ...
The contraindications to operative hysteroscopy above also apply in the case of diagnostic hysteroscopy.
Results
Operative hysteroscopy is a procedure that, without being particularly invasive, allows a wide range of uterine pathologies to be treated with good results .
Thanks to this and to the fact that it does not require hospitalization, operative hysteroscopy is an increasingly popular therapeutic solution.
