We are a regional referral center for hysteroscopy.  Hysteroscopy is an endoscopic procedure used to visualize the uterine cavity and treat conditions such as intrauterine adhesions (scarring), uterine fibroids (when inside or deforming the uterine cavity), endometrial polyps, or uterine and vaginal developmental abnormalities (congenital defects).  Hysteroscopy is performed under regional or general anesthesia.  Doctors Williams and Smith have received special training and certification to perform the most difficult hysteroscopic procedures.

The hysteroscope is introduced through the vagina and cervical opening into the uterine cavity which is distended with sterile saline solution thus allowing the fertility specialist to see the contents of the uterine cavity.  We use the most advanced and safest techniques and instruments available for hysteroscopy.

The hysteroscopy can also be used to perform several surgical procedures. Operative tools, such as small scissors or biopsy forceps may be introduced along with the hysteroscope.  If a myomectomy (removal of uterine fibroids/myomas) is planned, a special endoscope called a resectoscope will be used.  One type of resectoscope has a small wire loop and electric current may be passed through the loop to cut intrauterine fibroids and allow for their removal.  Another type of resectoscope has a blade in the top which morcellates (cuts into small pieces) a fibroid to remove.

With complicated hysteroscopic surgery, involving the resectoscope, or extensive cutting using scissors, simultaneous laparoscopy may be performed to insure the safety of the hysteroscopy.

Hysteroscopy’s major risk is injury to the uterus in the form of a perforation, which is a small hole in the uterine wall.  Small perforations are usually not consequential, will heal without treatment, and usually do not bleed.  Injury to the uterine wall during the hysteroscopy, in the vicinity of uterine blood vessels, may cause bleeding that will require further treatment, such as insertion of an intrauterine pressure balloon or further surgery.  Bowel injury or infections after surgery are other possible complications of hysteroscopic surgery.  The collective risk of a significant complication is less than 1%.  Hysteroscopic myomectomies require the use of saline to fill the uterine cavity.  There is a slight risk related to absorption of saline through the uterine wall, which can lead to fluid imbalance.  However, patients undergoing hysteroscopy have a monitoring device assessing for fluid imbalance so the surgery can be discontinued before any excessive absorption of saline can occur.

Patients report only minor, or no, pain from the hysteroscopy without simultaneous laparoscopy. If laparoscopy is employed, patients may experience a day or two of light vaginal bleeding and some pelvic pain.  If general anesthesia is used, nausea and dizziness may result for 12-24 hours after hysteroscopic surgery.  Some people have generalized muscle aches and fatigue and uterine cramping as a consequence of the hysteroscopy. Most patients are back to normal activities within two days.

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