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Hysteroscopy

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hysteroscopyHysteroscopy is visualization of the inside of the uterine cavity (womb) with a thin telescope called as hysteroscope, that is inserted through the vagina, the cervix and into the uterus. A liquid or gas is instilled to expand the uterine cavity for better visibility. The telescope is connected with a camera and light source and the uterine cavity can then be viewed on a video monitor. This is usually done in operating room but can be done as an office procedure . Either general or local anesthesia is used. A hysteroscopy can be done as a diagnostic procedure or additional small instruments can also be inserted through the operative hysteroscope to perform different procedures such a biopsy, treating a fibroid or polyp, septum, adhesions, etc.

Diagnostic hysteroscopy- is an endoscopic visualization of the inside of uterine cavity or womb .it is utilized to diagnose problems of abnormal bleeding like heavy periods ,irregular bleeding and spotting, infertility ,recurrent abortions , secondary amenorrhea(stopping of regular monthly periods),severe dysmenorrhoea , uterine cancers , developmental anomalies of uterus like double uterus ,septate uterus ,adhesions inside uterus due to infections . blind D&C as a diagnostic procedure has no role in modern gynaecological practice with advancements in equipments and technology has made hysteroscopy so simple that it can even be done in a doctors clinic as OPD or day case under local or short general anesthesia when patient can be discharged within few hours and can resume normal routine the very next day.blind D&C has also shown to miss focal lesions like polyps, myomas and even localized cancer of uterus in upto 50% of cases.it has anyway got no role as treatment of these conditions or even heavy bleeding .

Operative hysteroscopy- latest advancements in equipments and technology has allowed us to perform surgical treatment of many benign gynaecological problems hysteroscopically by using very thin operative hysteroscopes Treatment of polyps ,myomas, intrauterine adhesions ,septums, lost IUCD , infertility ,menorrhagia ,DUB are all possible now as day case with the use of bipolar operative hysteroascopy .patient can be easily sent home few hours after hysteroscopic surgery and can resume normal routine the very next day .

It is also possible to follow a “see and treat” management approach where diagnostic and operative hysteroscopy can be done in same sitting .thus it avoids need for giving general anaesthesia twice for diagnostic and operative procedure .

It is ideal for those women who are young (in their 30’s and 40’s)who do not want their uterus removed for bleeding problems and also useful in cases of infertility and recurrent abortions.

In older women it allows us to accurately diagnose and also treat the cause of irregular or heavy periods and other bleeding problems due to local pathology.many a times if only D&C is done ,focal lesions are missed and women end up getting their uteruses removed for trivial problems like polyp or small myoma or even DUB when it can be solved by minimally invasive hysteroscopic surgery.with much less morbidity and faster return to normal life.

When is it useful?
» To find cause of abnormal bleeding like irregular bleeding and heavy periods .some causes like polyps ,fibroids etc can also be treated at the same time.
» To find cause of bleeding after menopause. in this case a biopsy of the lining of uterus may be taken.
» To see whether any problem with in the uterine cavity is the cause for infertility. In this case it may be combined with the laparoscopy
» In case of infertility hysteroscopy is also done to look at the uterine openings of the fallopian tubes and if blocked tubal canulation can be done to open them.
» To find a possible cause of repeated miscarriages like ,septum, adhesions, abnormal shape of uterus etc.
» Locate a misplaced Cu T/ multload.
» Locate and remove small fibroids or polyps
» It may be used to diagnose endometrial /uterine cancer
Read 271535 times Last modified on Thursday, 31 May 2012 13:12

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