About the Procedure
Depending on the patient's medical history and the nature of the patient's disorder, she may be given either local, major block, or general anesthesia for hysteroscopy. The gynecologist and/or the anesthesiologist advises the patient on which type of anesthesia will be best for her particular condition.
There are no surgical incisions made in performing hysteroscopy. After gradual dilation of the cervix, the hysteroscope—a long, very thin rod with a video camera and light attached to it—is placed through the opening of the cervix and guided through the endocervical canal into the uterus. A diagnostic hysteroscope is approximately three to four millimeters in diameter; an operative hysteroscope is wider, approximately eight to 10 millimeters in diameter, to accommodate the appropriate surgical instruments, such as a small scissors, wire loop, or laser. At the same time, carbon dioxide gas or a fluid such as sorbitol, saline, or glycine, may be pumped into the uterus to slightly distend (enlarge) it. This process enables the gynecologist to see inside the uterus.
Depending upon the type of procedure being performed, hysteroscopy can take from two to five minutes to more than one hour. However, diagnostic hysteroscopy generally takes less time than operative hysteroscopy.
In certain instances, a surgeon may decide to use the hysteroscope with another surgical instrument called a laparoscope (lap'ah-roskop'). A surgical procedure that involves the use of the laparoscope is called laparoscopy (lap'ah-ros'ko-pe). Like the hysteroscope, the laparoscope is a long, rigid tube that is attached to a tiny video camera and a light. Unlike a hysteroscope, which is inserted vaginally through the cervix, the laparoscope is inserted through a tiny incision in the patient's navel. By using the laparoscope, the surgeon is able to get a view of more than just the uterus because a laparoscope provides a view of the uterus, ovaries, and fallopian tubes on a video monitor in the operating room. Performing a laparoscopy in conjunction with a hysteroscopy enables the surgeon to treat a variety of medical conditions that affect a woman's reproductive health, such as endometriosis, adhesions, or fibroid tumors. These conditions can be treated by inserting special surgical instruments through the laparoscope or other small incisions in the abdomen. Although laparoscopy does require the surgeon to make incisions, they are very small. Therefore, scars left from the procedure are barely noticeable upon healing.
Since the surgeon cannot see the uterus in detail until the hysteroscope is inserted, the decision to perform a laparoscopy in conjunction with a hysteroscopy cannot always be made until a hysteroscopy is in progress.