Hysteroscopy is an effective and advanced medical procedure that allows you to view the uterus (Hyster = uterus, scope = to see) by inserting a thin optical fiber through the vagina and cervix.
Doctors use fiber optics, unique lighting, and a physiological saline solution to expand the space to perform the procedure. Utilizing all of these in combination allows them to see a clear picture of the organs that are being examined.
The hysteroscopy procedure has 3 possible purposes:
- Diagnosis – In diagnostic hysteroscopy, an optical fiber is inserted with a tiny lens that reflects the inside of the uterine cavity, the cervical canal, the uterine lining, and the fallopian tubes. The resulting image is projected on a screen in the treatment room, allowing the doctors and the patient to observe a clear internal view of the said organs to locate various problems that can not be diagnosed through other imaging tests.
- Surgery and treatment – Surgical hysteroscopy is performed after a specific diagnosis has already been made, and it has been decided that a minor surgical treatment is needed. During surgical hysteroscopy, the hysteroscopic device (the same optical fiber that allows inner vision of the organs) is inserted, along with a small canal through which needles or an electric loop can be inserted into the uterine cavity. Then, doctors will perform a minor operation on the uterine cavity or cervix using the needles or the electric loop.
According to the findings, combined operation – diagnostic and therapeutic (“See and Treat”) – performing hysteroscopy for diagnosis and providing immediate surgical treatment.
In which cases is diagnostic hysteroscopy performed?
A patient will be referred for a diagnostic hysteroscopy in the following cases and more:
- Recurrent miscarriages
- Irregular uterine bleeding (suspected cancer, polyp, atrophy, etc.)
- Suspicion of pregnancy remnants after abortion or miscarriage (when uterus did not return to her normal state)
- Infertility problems
- Suspected intrauterine infections
- Suspicion of uterine malformations (eg uterine septum)
- Suspicion of uterine polyp or fibroid in the uterine cavity
The diagnostic test is performed in a gynecology clinic without anesthesia and doesn’t require any special actions to take before the test. It’s done directly at the end of your period. It is intended for observation and diagnosis only, and in case a problematic finding is discovered, doctors can decide on the type of treatment to continue the procedure: perform a small surgical operation without anesthesia, or refer the patient for surgical hysteroscopy under anesthesia and day hospitalization.
Diagnostic hysteroscopy is a very short operation, and is considered the most reliable and accurate test for diagnosing problems in the uterine cavity and cervix. When there might be a infection or uterine inflammation, suspicion of pregnancy or suspicion of malignant cancer, the test should not be performed.
In which cases is surgical hysteroscopy performed?
During diagnostic hysteroscopy, it may be decided to perform surgical hysteroscopy (as will be explained below). In addition, there are cases where the doctor will choose to have a surgical hysteroscopy scheduled under anesthesia in the hospital due to the size of the findings.
In these cases, the patient will be hospitalized. After anesthesia, the cervix will be enlarged, and a hysteroscopic device with a thicker diameter will be inserted to perform a quick and effective operation.
The operation will be performed in the following cases:
- Muscle or polyp resection
- Removal of a uterus
- Uterine septum
- Removal of pregnancy remnants or placenta
- Ablation (burning) of uterine mucosal findings
What is combined hysteroscopy – diagnostic and therapeutic (using the SEE AND TREAT method)?
A combined hysteroscopy will be performed at the Women’s Health Center without anesthesia and not as part of the operating room, and only a mild discomfort will be felt. The operation begins as a diagnostic hysteroscopy, and in the following cases, surgical treatment will be performed immediately on the spot (depending on the size of the findings):
- Findings indicating uterine polyps
- Results indicate remnants of pregnancy or placenta after abortion or childbirth.
- Removal of an intrauterine device that cannot be removed in any other way.
- Uterine abnormalities (mainly septum).
- Infections of the uterine cavity
Possible complications and costs
Possible complications of hysteroscopy:
These complications are extremely rare, and the test is considered to have a high safety profile. Possible complications include:
- Injury to internal organs during treatment (in very rare cases)
- Feeling of discomfort and pressure in the lower abdomen
These diagnostic procedures are covered by the HMO, but some treatments are not. A patient who chooses to perform the test in a private setting will be entitled to reimbursements through their insurance, with the deductible varying between the different hospitals and doctors.