Name of the Procedure:

Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)

Summary:

Hysteroscopy with lysis of intrauterine adhesions is a minimally invasive surgical procedure that involves using a hysteroscope—a thin, lighted tube inserted through the vagina and cervix into the uterus— to locate and remove adhesions or scar tissue within the uterine cavity.

Purpose:

This procedure addresses intrauterine adhesions, also known as Asherman's syndrome, which can cause symptoms such as irregular menstrual cycles, pelvic pain, and infertility. The goal is to restore the normal uterine cavity, improve menstrual flow, and enhance fertility potential.

Indications:

• Irregular or absent menstrual periods
• Painful menstrual cycles or pelvic pain
• Infertility or recurrent miscarriages
• History of uterine surgery, infection, or trauma leading to adhesions

Preparation:

• Patients may be instructed to fast for a certain period before the procedure.
• Medication adjustments may be necessary, especially if blood thinners are being taken.
• Preoperative diagnostic tests such as ultrasound or hysterosalpingography (HSG) might be required to assess the adhesions.

Procedure Description:

1. The patient is typically placed under general or local anesthesia.
2. The hysteroscope is gently inserted through the vagina and cervix into the uterine cavity.
3. Saline solution or carbon dioxide gas may be used to distend the uterus for better visualization.
4. Special instruments are passed through the hysteroscope to cut and remove the adhesions.
5. Depending on the complexity, electrical or laser energy may be used to safely cut the scar tissue.
6. The hysteroscope is removed, and the patient is monitored during recovery.

Duration:

The procedure typically takes about 30 to 60 minutes.

Setting:

Hysteroscopy with lysis of intrauterine adhesions is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel:

• Gynecologist or gynecologic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurse or assistant

Risks and Complications:

• Infection
• Bleeding
• Perforation of the uterus
• Adhesion reformation
• Anesthesia-related complications

Benefits:

• Restoration of normal menstrual cycles
• Relief from pain and discomfort
• Improved fertility and reduced risk of future miscarriage
• Minimal recovery time due to the minimally invasive nature of the procedure

Recovery:

• Most patients can go home the same day.
• Some cramping or spotting is normal for a few days post-procedure.
• Avoiding strenuous activities and sexual intercourse for a short period is recommended.
• A follow-up appointment with the gynecologist is typically scheduled to monitor recovery and ensure the adhesions have been effectively removed.

Alternatives:

• Medical management with hormonal therapies
• In-vitro fertilization (IVF) in cases of infertility
• Repeat hysteroscopy if adhesions recur
• Uterine surgery, which is more invasive and has a longer recovery time

Patient Experience:

During the procedure, patients under local anesthesia may feel some pressure or mild discomfort, while those under general anesthesia will be asleep. Post-procedure, patients might experience mild cramping or spotting. Pain management typically includes over-the-counter pain relievers like ibuprofen. Comfort measures such as rest and applying a heating pad to the abdomen can also help alleviate discomfort.