HYSTEROSCOPY

A diagnostic hysteroscopy is procedure in which a narrow tube with a camera attached is used to look into your uterus. This is a simple Day Stay procedure performed under General Anaesthesia. An Endometrial Biopsy (biopsy of the lining of the uterus) is also performed. This tissue sample is sent off to the pathologist.

A Hysteroscopy will assess the shape of the uterus and whether there is any other pathology including polyps, fibroids and intra-uterine adhesions. The procedure takes 15 minutes. You may experience light bleeding or mild cramps for 24 hours. Most women will take the next day off work. You are advised to avoid swimming and intercourse for 48 hours post procedure.

Complications are very rare and minor. Complications can include infection or light bleeding. Uterine perforation is rarely seen. If this occurs, the small area will heal spontaneously. Antibiotics are given.

Hysteroscopic Polypectomy (refer to Gallery)

Endometrial Polyps are removed under direct vision using a device called Myosure. The procedure is performed as a Day Stay procedure under General Anaesthesia. A narrow instrument is inserted into your uterus. The Endometrial Polyp is visualised. The Polyp is then removed and the specimen collected in a bag. The specimen is sent to the pathologist.

The recovery after this procedure is very fast. You may experience minor cramps or light bleeding for 24 hours. You are advised to avoid swimming and intercourse for 48 hours post procedure. Complications are very rare and minor. Complications can include infection or light bleeding.

There are many advantages of this technique of Endometrial Polyp removal. It is performed under direct vision – a picture of the uterus is viewed on a large screen. The Polyp is removed in its entirety to minimise the risk of re-growth of the Polyp.

Hysteroscopic Myomectomy

This is performed to remove a fibroid which is growing into the cavity of the uterus. The procedure is a Day Stay procedure performed under General Anaesthesia. A Hysteroscopy is performed and a detailed image of the uterine cavity and fibroid obtained. The Myosure device is used to progressively remove the fibroid. The specimen is collected in a bag and sent to the pathologist. The procedure lasts about 10 minutes to 50 minutes. A second procedure may be required for a larger fibroid (greater than 5.5cm in diameter).

The recovery after this procedure is very fast. You may experience minor cramps or light bleeding for 24 hours. You are advised to avoid swimming and intercourse for one week post procedure. Complications can include fluid overload. Fluid is used to distend the cavity of the uterus and this can be absorbed. If this occurs, it will be necessary to stay overnight.

There are several advantages of the Myosure device over the traditional Resectoscope procedure. Firstly, the Myosure device gives an excellent view obtained and allows very rapid removal of the fibroid. A faster procedure will mean less risk of fluid overload. Diathermy (electricity) is not required inside the cavity of the uterus and this has major advantages in terms of fertility. There is almost no risk of scarring inside the uterus with the Myosure device as compared to the traditional Resectoscope procedure. The Myosure device is narrower and thus less cervical dilatation is required.

Hysteroscopy – division of Uterine Septum

A uterine Septum is a relatively uncommon abnormality of the uterine cavity. There is a wall of tissue dividing the uterus into two parts. This can be associated with recurrent pregnancy loss – including first trimester and second trimester. A Uterine Septum can be associated with pre-term onset of labour, malpresentation of the fetus (including breech presentation) and increased risk of Caesarean delivery.

Diagnosis of a Uterine Septum is by Pelvic Ultrasound or Sonohysterogram. Note is made of the size of the Septum and the distance between the septum and associated uterine muscle. Note is also made of the Uterine Shape.

Division of the Uterine Septum involves a Hysteroscopy to visualise the area of abnormality. The procedure is performed as a Day Stay procedure under General Anaesthesia. A needle point diathermy is used to divide the septum. The pressure of the fluid in the uterus also works to divide the Septum. A Myosure device can occasionally be used to divide a Septum. The procedure takes about 20-30 minutes.

Hysteroscopy – division of Adhesions

Adhesions can form in the uterus following infection or repeated curettes (eg) for miscarriages or TOPs. These can vary from minor adhesions (called synechiae) to complete occlusion of the cavity of the uterus (Ashermann’s Syndrome). Symptoms can vary from lighter periods, to difficulty conceiving to complete absence of periods.

Intra-uterine adhesions can be diagnosed with Sonohysterogram.

Division of intra-uterine adhesions involves a Hysteroscopy to visualise the area of abnormality. The procedure can be performed using ultrasound to assist with entering the cavity of the uterus if there are significant adhesions. The adhesions can be divided under direct vision with Hysteroscopic Scissors. High dose oestrogen is given post-operatively to facilitate the laying down of new Endometrial lining. Various devices can be used to ensure the cavity remains open including a small balloon or a non hormonal IUCD. You may be given antibiotics for one week following the procedure to minimise the risk of infection.

The recovery after this procedure is very fast. You may experience minor cramps or light bleeding for 24 hours. You are advised to avoid swimming and intercourse for 5 days post procedure. Complications can include fluid overload. Fluid is used to distend the cavity of the uterus and this can be absorbed. If this occurs, it will be necessary to stay overnight.

Hysteroscopy – Novasure Endometrial Ablation

This procedure is performed for Heavy Menstrual Bleeding in a woman who has no plans for a further pregnancy. A Hysteroscopy is performed and a detailed image of the uterine cavity obtained. An Endometrial Biopsy is taken. If an Endometrial Polyp or Fibroid is present, this is removed.

An Endometrial Ablation is then performed. This is a Day Stay procedure performed under General Anaesthesia. An instrument with netting is inserted into the uterus. The netting expands to take up the cavity of the uterus. The netting is then heated for about one minute and the Endometrial lining of the uterus is destroyed. This prevents the lining growing and shedding each month with the monthly menstrual cycle. A Hysteroscopy is performed following the ablation to confirm that the cavity has been evenly treated. The total operating time is about 30 minutes.

The recovery after this procedure is very fast. You may experience minor cramps for 24 hours. You are advised to avoid intercourse and swimming for one week post procedure. You may notice brown vaginal loss or light bleeding for several days. 50% of women in the long term do not have any further periods. Overall, 95% of women find their bleeding is lighter.