Hysteroscopy

What is a hysteroscopy?

Hysteroscopy is a procedure that is done to look and treat abnormalities inside the uterine cavity. A thin telescope, called a hysteroscope, is inserted into the uterus through the vagina and cervix. Fluid is inserted into the uterine cavity to open up the cavity to allow your doctor to see inside. There are no cuts in the vagina or on the abdomen.

Why is a hysteroscopy done?

There are many uses of hysteroscopy. You might have this procedure if you have:

Infertility
Abnormal uterine bleeding
Polyps
Fibroids

My doctor says I need a hysteroscopy. What should I expect?

A hysteroscopy is a common procedure. You will be able to go home the same day. You should arrange for someone to pick you up from the hospital. There are different options to control your pain during surgery. You should talk to the anesthetist (the pain doctor) to help decide which is best for you. You can have a general anesthetic where you would be asleep the entire surgery. Another option is a regional anesthetic, like a spinal anesthetic. This is where pain medication is inserted through a needle in your back. You will be awake but the medication will numb the region where you have your surgery.

Once you are comfortable, your legs will then be placed into leg holders. A speculum is then inserted into the vagina to let your doctor see your cervix. Your cervix is then dilated to 5 to10mm. The hysteroscope is then inserted through the cervix into your uterus. Fluid is then used to open up the uterine cavity to allow your doctor to see and perform the surgery. Sometimes there might be bleeding from the cervix and a small, dissolvable stitch may be placed to stop the bleeding.

Who will be involved in my surgery?

On the day of surgery, you will meet the surgical team. This will include:

Your doctor
Surgical assistants: these are usually trainees supervised by your doctor. They can include:
- Fellows (doctors who are licensed obstetricians and gynecologists and are doing extra training to perform minimally invasive surgery)
- Residents (doctors who are training to become obstetricians and gynecologists)
- Medical students (these are students learning to become doctors)
Nurses
Anesthesiologist (doctors who manages your pain during surgery)

What do I need to do to get ready for surgery?

Cervical Preparation

Your surgery might mean that your cervix has to be softened to let your doctor dilate your cervix more easily. If this is the case, your doctor will give you a prescription for a medication called Misoprostol. You will need to put these tablets in the vagina as high up as possible, the night before your surgery. If you do not have any cramping or vaginal bleeding over night, then you will need to repeat it the morning of your surgery. You might have some side effects from the misoprostol like cramping, vaginal bleeding, a slight fever, upset stomach and diarrhea. You can take acetaminophen or ibuprofen to help with the cramping.

How long will it take me to recover?

Right after surgery, you will be in the recovery room. If you have a general anesthetic, you will feel sleepy. Some women might feel sick and vomit. If you have a regional anesthetic, you might feel numb and have some difficulty with urinating and walking. In both cases, you will need someone to drive you home. Most of the time you will go home on the same day as the surgery.

For a few days after the surgery, you might feel tired and have some discomfort.

You should still move around at home.
You might feel some cramping that can be treated with pain medication.
You will also notice some vaginal bleeding and/or pink watery discharge that could last up to 4 to 6weeks. Most women are fully recovered after 1-2 days.

You can shower and lift. Your doctor will let you know when you can get back to regular activities. Usually, your doctor might recommend avoiding sex, hot tubs, swimming pools, and baths for up to 4 to 6 weeks. Avoid driving until you are no longer taking narcotic pain medication and you are mobile (although most women do not require narcotics for pain after hysteroscopy).

When should I be concerned?

While it is normal to have some pain, discharge and bleeding after surgery, you should see your doctor or go to the emergency room right away if you have any of these symptoms:

• Abdominal pain that is getting worse
• Heavy vaginal bleeding (changing 2 to 4 pads over 2 hours)

• Fever
• Chest pain or di culty breathing
• Severe pain, swelling and redness in on or both legs
• Unable to urinate
• Severe nausea (feeling sick to the stomach) and vomiting

What are the risks of hysteroscopy?

Hysteroscopy is a safe procedure, but there is a risk of:

Bleeding, rarely requiring transfusion
Infection
Injury to the cervix
Perforation of the uterus (making a hole in the uterus). If this happens, you might need a laparoscopy to ensure that there is no injury to the organs around the uterus, which may require you to stay in the hospital overnight
Scarring of the uterine cavity, which may affect future fertility
Injury to the nerves in the legs from the positioning during surgery
Electrolyte imbalance from the absorption of the fluid used to open the uterine cavity (this means that you can absorb too much water, through the uterus, which can create an imbalance in the amount of salt in your body). Your doctor will monitor the amount of fluid that you are absorbing during the procedure and might stop the procedure before it is completed to prevent your body from absorbing too much fluid.
A false passage in the cervix may be created, which means we cannot get into the cavity of the uterus (the womb). If this happens we may not be able to carry out the procedure we intended and you may need a second surgery
Problems from the anesthesia

Hysteroscopic Polypectomy

What is a hysteroscopic polypectomy?

Polyps are usually non-cancerous growths of the endometrium, the inner lining of the uterus. They can range in size from a few millimeters to several centimeters. They can be diagnosed by ultrasound.

A hysteroscopic polypectomy is a surgical technique where a hysteroscope is inserted into the uterine cavity and fluid is used to open up the uterine cavity. This allows your doctor to see the polyp. Using an electrical current, the polyp is removed where it is attached to the uterine cavity. The polyp is sent to the pathologist to have a look under the microscope to ensure that there is no cancer. It may take 4 to 6 weeks to get the results back.

Hysteroscopic Myomectomy

What is a hysteroscopic myomectomy?

This is the removal of fibroids using the surgical approach of hysteroscopy. Only fibroids that are submucosal or intracavitary (inside the uterus) can be removed this way.

In a hysteroscopic myomectomy, the hysteroscope is inserted into the uterine cavity and fluid is used to open up the uterine cavity. This allows your doctor to see the fibroid. Using an electrical current, the fibroid is removed.

What are the risks and recovery of hysteroscopic myomectomy?

The risks and recovery are the same for all hysteroscopic procedures.

Depending on the size of the fibroid, you might need multiple surgeries to remove the fibroid. Typically, fibroids bigger than 3.5 cm will need 2 surgeries. This is because bigger fibroids take longer to remove and this increases the amount of fluid your body absorbs during the procedure. If too much fluid is absorbed, there is a risk that your blood sodium becomes too low. While this is very rare, the effects can be serious (such as seizures, coma and even death). Your doctor will monitor how much fluid your body has absorbed. If he or she is concerned that you have absorbed too much, he or she might decide to stop the procedure before the fibroid is completely removed to reduce the amount of fluid you will absorb.

Who do I contact if I have questions?

If you have any questions or concerns, please call your gynecologist’s office.

Sunnybrook Health Sciences Centre

2075 Bayview Avenue Toronto, ON M4N 3M5

Telephone: 416.480.6100

www.sunnybrook.ca
PR 47187 (MAR 2016)