Name of the Procedure:

Hysteroscopy, surgical; with division or resection of intrauterine septum (any method)

Summary

A hysteroscopy is a procedure where a thin, lighted tube (hysteroscope) is inserted into the uterus through the vagina and cervix to examine the inside of the uterus. When combined with the division or resection of an intrauterine septum, the procedure involves the removal of a tissue wall (septum) that divides the uterine cavity.

Purpose

This procedure aims to correct a uterine septum—a congenital abnormality that can cause infertility, recurrent miscarriages, or menstrual irregularities. By removing the septum, the uterine cavity is restored to a more normal shape, potentially improving fertility and pregnancy outcomes.

Indications

• Recurrent miscarriages
• Infertility
• Abnormal uterine bleeding
• Pain during menstruation (dysmenorrhea)
• Prior imaging showing the presence of an intrauterine septum

Preparation

• Fasting for a few hours before the procedure
• Adjusting certain medications as per doctor's instructions
• Pre-procedure ultrasound or MRI to assess the uterine septum
• Preoperative blood tests as needed

Procedure Description

1. The patient is given anesthesia (typically general or local with sedation).
2. The hysteroscope is gently inserted through the vagina and cervix into the uterus.
3. Saline solution is infused to expand the uterine cavity for better visualization.
4. Specialized instruments are used to divide or remove the septum.
5. The hysteroscope is removed and the procedure is completed.

Tools used may include a hysteroscope, saline solution, and surgical instruments for cutting and removal of tissue.

Duration

The procedure usually takes about 30-60 minutes.

Setting

It is typically performed in a hospital or an outpatient surgical center.

Personnel

• Gynecologic surgeon (hysteroscopist)
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Perforation of the uterus
• Scarring (Asherman's syndrome)
• Reaction to anesthesia

Benefits

• Improved fertility potential
• Decreased risk of miscarriage
• Relief from abnormal uterine bleeding
• Reduction in menstrual pain

Recovery

• A few hours of observation post-procedure
• Light spotting or cramping for a few days
• Avoiding heavy lifting and sexual intercourse for 1-2 weeks
• Follow-up visit after 1-2 weeks to ensure proper recovery

Alternatives

• Expectant management (watchful waiting)
• Medical management using hormonal treatments
• Surgical correction via abdominal approach (laparotomy)
• Each alternative has its own risk and success profile compared to hysteroscopic septum resection.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, they may experience mild cramping and spotting. Pain management will be provided, and comfort measures include rest and over-the-counter pain medications.