Operative hysteroscopy involves «operating» inside the uterus while guiding the surgeon’s movements through direct visualization of the uterine cavity using an endoscopic camera connected to the hysteroscope.
Operative hysteroscopy is performed on an outpatient basis: that is, you are hospitalized for only a few hours and go home the same evening (except in cases related to: your overall health (chronic or disabling conditions), a significant distance from your home, or the absence of someone to accompany you…).
The procedure is performed in the operating room at a healthcare facility, most often under light general anesthesia (without intubation or assisted ventilation) or under local anesthesia alone (cervical infiltration with xylocaine), more rarely, a locoregional anesthetic (epidural or spinal anesthesia),
The postoperative course is generally very straightforward: some bleeding and little or no pain.
This procedure is therefore indicated whenever it is necessary and possible to correct certain abnormalities internally (that is, through natural pathways without «opening» the body), such as:
- Polyps: It is a small growth on the lining of the uterus, known as the endometrium; its size can range from a few millimeters to several centimeters.
In general, these lesions cause bleeding that occurs outside of the menstrual period (metrorrhagia), They can also contribute to potential infertility when they are large or when they are located in an area of the uterus where embryo implantation occurs (at the back of the uterine cavity).
They can very rarely become malignant (cancerous), except during perimenopause or postmenopause, when they should be examined more closely through a histological analysis.
- Myoma, also known as «fibromyoma» or «leiomyoma,», also known as a «fibroid,» is a benign tumor formed by the proliferation of muscle cells from the uterine wall, It has—somewhat—the consistency of a golf ball but varies greatly in size, ranging from that of a pea to that of a tennis ball, or, more rarely, even larger (the size of a grapefruit or larger).
Fibroids, or myomas, are always benign, but it is important to rule out any associated lesions that could be malignant, especially after menopause.
A fibroid is a benign muscle tumor of the uterus that can cause pain, bleeding, or difficulty getting pregnant
If the fibroid or myoma grows inside the uterine cavity, it is said to be submucosal; in that case, it is accessible via hysteroscopy and can therefore also be removed through the natural birth canal.
- Synechiae: This involves the two walls of the uterus sticking together; normally, the uterus is like a hollow cavity lined with a mucous membrane (a sort of “carpet” that lines it), which prevents one wall from sticking to the other. If the mucous membrane becomes damaged and disappears, the two sides of the cavity can stick together, thereby reducing the size of the cavity, which can compromise implantation and the progression of a pregnancy. In very severe cases, this condition can even affect menstrual flow, leading to the absence of menstruation.
This condition can therefore occur either after damage to the mucous membrane resulting from a miscarriage, a surgical procedure on the uterus, or an infection such as genital tuberculosis.
Synechiae are best treated by hysteroscopy, in which the adherent fibrous bridges are precisely severed under direct visualization.
- Endometrectomy: This procedure involves removing the endometrium—that is, the lining (like a carpet) that covers the inside of the uterus—to reduce bleeding during menstruation (in cases of heavy or very long periods (also known as menorrhagia).
An endometrial ablation may be considered whenever menstrual flow is excessive and medical treatment has been insufficient; it is, in a sense, an attractive alternative to a hysterectomy because the procedure is performed on an outpatient basis, requiring only a few hours of hospitalization, and allows patients to return to work the very next day, provided, of course, that there is no longer any desire to become pregnant, as this procedure—which removes the endometrium—reduces fertility.
The procedure is performed, like all operative hysteroscopies, under general anesthesia. The recovery is not painful, but is generally accompanied by some minor bleeding.
- Removal of an IUD: Sometimes, after an IUD is inserted, the strings can no longer be found on the cervix.
In fact, the strings are usually left outside the cervix so that they can be grasped and the IUD removed if necessary—particularly to replace it after a few years.
But sometimes, over time, the IUD shifts or moves higher up into the uterine cavity, and the strings are no longer visible or are coiled higher up; therefore, it is not possible to remove it easily because the strings are no longer accessible.
With hysteroscopy, it is possible to navigate through the cervix and into the uterine cavity to visualize the IUD and its string, and then to grasp it, lower it, and remove the intrauterine device (IUD) without any anesthesia, as the endoscopy is painless.
- Tubal ligation or tubal sterilization:When a couple no longer wishes to have children, but traditional methods of contraception—such as the birth control pill or intrauterine devices—are not well tolerated or are contraindicated, tubal sterilization—that is, the «ligation» of the fallopian tubes—is an option.
This procedure involves «blocking» the fallopian tubes to prevent sperm from reaching the eggs and thus preventing pregnancy.
Traditionally, fallopian tube «ligation» was performed surgically (via open abdominal surgery) or by laparoscopy. Recently, it has become possible to visualize the opening of the fallopian tubes via hysteroscopy and to insert an Intra-Tubal Device (ITD) into the tube (without any incision or scar).
This IUD will gradually block the fallopian tubes and prevent sperm from reaching the eggs, thereby providing permanent but also irreversible contraception.
- Uterine septum: The diagnosis is made using ultrasound, which allows for the assessment of the septum’s height, thickness, and blood supply. Most importantly, it helps distinguish between septate uteri and double uteri, the latter of which is a contraindication for hysteroscopic treatment.
