Name of the Procedure:

Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C (Dilation and Curettage)

Summary

Hysteroscopy is a minimally invasive procedure where a small camera (hysteroscope) is inserted into the uterus through the vagina and cervix. This allows the doctor to view the inside of the uterus, perform a biopsy of the endometrial lining, remove polyps, and sometimes perform a D&C to scrape the uterine lining if necessary.

Purpose

The procedure addresses abnormal uterine bleeding, uterine polyps, endometrial hyperplasia, or other uterine abnormalities. The goals are to diagnose the cause of symptoms and to treat any identified issues such as polyps or thickened endometrial tissue.

Indications

• Abnormal uterine bleeding
• Postmenopausal bleeding
• Infertility evaluations
• Suspected uterine polyps or fibroids
• Thickened endometrial lining on ultrasound

Preparation

• Fasting might be required if sedation or anesthesia is to be used.
• Adjustments to medications, especially blood thinners.
• Completion of any necessary diagnostic tests such as ultrasound or MRI.

Procedure Description

1. The patient is positioned, and possibly sedated or given anesthesia.
2. The hysteroscope is gently inserted through the vagina and cervix into the uterus.
3. Saline may be infused to expand the uterus for better visualization.
4. The doctor examines the uterine cavity and may take a biopsy of the endometrial tissue.
5. Polyps, if present, are removed using specialized instruments.
6. If required, a D&C may be performed by scraping the uterine lining.
7. The instruments are removed, and the patient is monitored as they wake from anesthesia or sedation.

Duration

Typically ranges from 30 minutes to 1 hour.

Setting

Usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Gynecologist or surgeon
• Nurses
• Anesthesiologist or nurse anesthetist, if sedation or anesthesia is used

Risks and Complications

• Infection
• Uterine perforation
• Bleeding
• Adverse reactions to anesthesia
• Scarring or adhesions in the uterus

Benefits

• Accurate diagnosis of uterine conditions
• Treatment of problematic polyps or thickened endometrial tissue
• Potential relief from symptoms such as abnormal bleeding

Recovery

• Patients may experience mild cramping and spotting.
• Usually, recovery takes a few days to a week.
• Avoid heavy lifting, sexual intercourse, and tampons for a specified time.
• Follow-up appointments may be needed to discuss biopsy results or further treatment.

Alternatives

• Medications to manage symptoms
• Endometrial ablation
• Myomectomy for fibroids
• Hysterectomy (in severe or unresponsive cases)

Patient Experience

Patients may feel mild discomfort or cramping during the procedure. Post-procedure, cramping and spotting are common, but pain management can be achieved with over-the-counter pain relievers. Comfort measures include rest and avoiding strenuous activities.