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The technique of hysteroscopy has also been expanded to include operative hysteroscopy. Operative hysteroscopy can treat many of the abnormalities found during diagnostic hysteroscopy at the time of diagnosis.
The procedure is very similar to diagnostic hysteroscopy except that operating instruments such as scissors, biopsy forceps, electocautery instruments and graspers can be placed into the uterine cavity through a channel in the operative hysteroscope. Fibroid tumors, scar tissue (synechiae or adhesions) and polyps can be removed from inside the uterus. Congenital abnormalities, such as a uterine septum, may also be corrected through the hysteroscope.
An exciting method for treating proximal tubal obstruction (cornual blocks, where the tubes are blocked at the utero-tubal junction) is that of hysteroscopic tubal cannulation. Many studies have shown that this kind of block is often because of mucus plugs or debris that plug the tubal lining at the uterotubal junction that is as thin as a hair. It is now possible to pass a fine guidewire through the hysteroscope into the tubes, and thus remove the plug or debris and open the tubes - thus restoring normal tubal patency with "minimally invasive surgery"!
Another advance has been the development of the technique of falloposcopy - in which a very fine flexible telescope is passed into the fallopian tube through the hysteroscope, so as to visualize the interior of the entire tube.
After a hysteroscopy, patients often have cramping similar to that experienced during a menstrual period; and some vaginal staining for several days. Regular activities can be resumed within one or two days after surgery. Sexual intercourse should be avoided for a few days or for as long as bleeding occurs.
Complications rarely occur during hysteroscopy. In a few cases, infection of the uterus or fallopian tubes can result. Occasionally, a hole may be made through the wall of the uterus _ a perforation. However, this is usually not a serious problem because the perforation closes on its own. Frequently, when extensive operative hysteroscopy is planned, diagnostic laparoscopy is performed at the same time to allow the surgeon to see the outside as well as the inside of the uterus to try to reduce the risk of accidental uterine perforation. Other possible complications include allergic reactions and bleeding.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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