Hysteroscopy

Prior to Procedure –

Your doctor will likely do the following:

• Explain the procedure
• Ask about medical history, medications, and allergies
• Conduct a physical exam and take blood work
• Allow you to ask questions (You may wish to ask how often he or she has performed hysteroscopies, as experience decreases risk of complications.)

In the days leading up to your procedure:

• Arrange to have someone drive you home, and help with daily tasks.
• Follow instructions given by your doctor.
• Stop/start medications as directed.

The day before your procedure:

• Have a light dinner.
• Do not eat or drink anything after midnight, or the morning of the procedure (including coffee, tea, water, and juice) unless directed otherwise.

The day of the procedure:

• Wear comfortable clothes.
• Bring a sanitary napkin to catch any postprocedure fluids.
• The staff will ask you to use the bathroom.
• Anesthesia will be administered after you have been made comfortable.

Anesthesia –

Anesthesia numbs the body temporarily so pain and discomfort are not felt. There are three anesthesia options for hysteroscopy. Your doctor will help you to decide which is best for your procedure and needs. In certain instances you may opt not to have an anesthetic.

Local Anesthesia:

• Used for diagnostic hysteroscopy
• Can be applied like a lotion or injected
• Loss of feeling only to the area where the anesthetic is applied
• Consciousness is not lost

Regional Anesthesia:

• Used for either diagnostic or operative/therapeutic procedure
• Anesthetic is injected
• Regional loss of feeling (similar to the injection given to numb the pelvic region during childbirth)
• Consciousness is not lost

General Anesthesia:

• Used for operative/therapeutic hysteroscopy
• Medication is given intravenously (IV)
• Entire body is numbed
• Consciousness is lost

Description of the Procedure –

The doctor will clean the vaginal area and may dilate (gradually open) the cervix. This is done so the doctor can see better and has more room to work. The hysteroscope is then fed into the uterus, and the uterus is filled with carbon dioxide gas or a liquid. Filling the uterus causes it to inflate like a balloon, allowing the doctor to get a closer look at its walls. Also, the pressure put on the walls reduces bleeding. The remainder of the procedure depends on the purpose of having the hysteroscopy.

Diagnostic Hysteroscopy:

The doctor will examine the uterus for abnormal looking tissue. A biopsy (tissue sample) may be taken, or the uterine walls may be swabbed to gather cell samples. The gathered samples will then be sent to a lab for testing.

Operative/Therapeutic Hysteroscopy:

Miniature tools are inserted through the hysteroscope. The doctor uses the tools to remove diseased tissue and make repairs. Depending on the procedure, a laparoscope (another type of viewing tube) may be needed to help the doctor see. This tube is inserted through a small cut in the abdomen. Using a laparoscope with the hysteroscope allows the doctor to view the outside and inside of the uterus at the same time.

After Procedure –

The doctor may prescribe pain relievers and limit some activities. Also, the following may be experienced:

• Sleepiness (from the anesthetic)
• Difficulty using the bathroom for a few hours following the procedure
• Cramping
• Watery or bloody vaginal discharge for 3-4 weeks

Note: Do not take medications without your doctor’s approval. Some medicines may make bleeding worse. Notify you doctor if you experience a great deal of bleeding or abdominal pain.

How Long Will It Take –

The length of the operation depends on the degree of difficulty. It could take anywhere from 15-45 minutes or more.

Will It Hurt –

Hysteroscopy should not hurt since the anesthesia numbs and relaxes the body. Let your doctor know if you do experience pain during the procedure. After the procedure, pain relievers can be prescribed for mild cramping and soreness.

Possible Complications –

Complications are more likely to occur during an operative/therapeutic hysteroscopy than diagnostic hysteroscopy.

Edema – organ swelling that is caused by the excessive absorption of the uterine inflation fluid. Finding a doctor that is experienced with hysteroscopy can reduce risk of edema. The shorter the procedure, the less time organs have to absorb the liquid and swell. If there has been excessive over-absorption of fluid, this can be dangerous, but it is completely reversible.

Allergic Reaction – substance used to inflate the uterus, materials used during surgery, and anesthetic can cause an allergic reaction. To reduce your risk, tell your doctor about your allergies.

Infection – Bacterial infection may result from irritating or injuring the uterus. It may also be a result of an existing condition that makes a person more susceptible (eg, pelvic inflammatory disease). Antibiotics may be prescribed for individuals at risk for infection prior to the surgery, or for infections as they arise.

Organ Injury – The bladder and bowel may be injured as a result of the procedure. The uterus may also be punctured and require additional surgery to repair. This injury is very rare. Risk is reduced by the skill of the doctor; however, some injuries may be difficult to avoid depending on the condition.

Average Hospital Stay –

Most hospital stays are 1-2 hours. Certain operative/therapeutic hysteroscopies require an overnight hospital stay.

Postoperative Care –

Recovery time is minimal. Daily routines can usually be resumed the day after the procedure. Some individuals may need extra rest and help to perform tasks. Your doctor will give you instructions, and let you know if a follow-up appointment is needed.