Diagnostic and operative hysteroscopy: preparation and importance of gynaecological examinations

By Cristiano Antonino On Nov 23, 2022

Hysteroscopy is a mini-invasive endoscopic technique that allows us to see inside the uterine cavity without having to use a scalpel, through a thin instrument called a hysteroscope, either directly or through a monitor connected to a special camera placed on the hysteroscope

Hysteroscopy, which also includes the study of the fallopian tubes, is called “hysterosalpingoscopy”

The hysteroscope is introduced into the uterus through the vagina. Although the method can be slightly uncomfortable, it eliminates as much anxiety, fear and above all pain for the patient as possible.

Diagnostic hysteroscopy and operative hysteroscopy

With a diagnostic hysteroscopy the doctor ‘limits’ himself to observing the uterine tissue, while with an operative hysteroscopy he can observe the tissue and perform minor surgical interventions, using miniaturised instruments, connected to the hysteroscope and controlled from the outside.

An operative hysteroscopy allows problems such as adhesions and small polyps to be resolved quickly, safely, with shorter recovery times than open surgery and without general anaesthesia.

Hysteroscopy: when can it be useful?

Diagnostic hysteroscopy becomes useful in the case of abnormal uterine bleeding, both in childbearing age and especially after menopause, and it is possible to detect uterine malformations such as septa, pathologies of the uterine cavity such as polyps, fibroids, hyperplasia, malignant tumours and pathologies of the fallopian tubes.

It is very useful in detecting pathologies and conditions that cause infertility.

It can take biopsies of the affected tissue: the sample is then sent to the pathologist who clarifies the nature of the lesion.

How do you prepare for a hysteroscopy?

The examination does not require special preparations, fasting or any kind of anaesthesia or drug preparation.

Antibiotics may only be used as prophylaxis in patients with valvular heart disease.

The patient may continue to take her medication regularly, taking care to advise when booking the examination if she uses anticoagulant medication.

Is it painful?

If hysteroscopy is performed as an outpatient procedure without anaesthesia, instruments with a thinner diameter (usually between 2 and 5 mm) are used, compared to those used in the operating theatre.

The cervical canal and the uterine cavity are dilated through the infusion of saline solution through the vagina: this dilation of the cervical canal is necessary to allow the passage of the hysteroscope and the vision of the uterine cavity.

The uterus responds to this dilation by contracting as during a menstruation and this often causes the patient a pain similar to menstrual cramps, which, however, disappears on its own within a few minutes.

Hysteroscopy with anaesthesia in the operating theatre

In 5% of patients, the examination performed in the operating room evokes more significant pain.

In these cases, as soon as the patient requests it, the doctor immediately suspends the procedure and schedules it under full sedation, but no longer in the outpatient clinic, but in the operating room with anaesthesia.

Is hysteroscopy dangerous?

It is an examination where complications are rare and are generally related to the possibility of injury to the examined structures by the hysteroscope, resulting in bleeding.

Hysteroscopic polypectomy

Uterine polyps (cervical, exocervical, endometrial…) are present in 24% of women, often asymptomatically, and are the main cause of atypical uterine bleeding (i.e. abnormal bleeding from the uterus).

They can become cancerous in 0.2-9 % of cases depending on whether the woman is in her childbearing years or menopausal.

Endocervical polyps are referred to as ‘sentinel polyps’ because in a quarter of cases they are a telltale sign of the presence of another cervical polyp behind them or of an endometrial polyp inside the uterus.

The treatment of choice for a cervical and endometrial polyp, even an asymptomatic one, is the resection (removal) of the polyp by operative hysteroscopy, a technique known as hysteroscopic polypectomy and which can be performed in an outpatient or operating room depending on many factors such as the number and size of the polyps.

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