Hysteroscopic Procedures
Hysteroscopy, D&C
This procedure is usually performed in order to identify the cause of the abnormal bleeding. It is typically required in women with new onset abnormal uterine bleeding near or after menopause. Hysteroscopy, refers to the insertion of a thin camera through the cervical canal into the uterine cavity. The cavity is examined for presence of polyps or fibroids and uterine sampling (D&C) is accomplished to rule out cancerous or pre-cancerous lesions of the uterine lining.
Hysteroscopic Myomectomy
This approach can only be used to remove small fibroids that are growing within the cavity of the uterus.
Hysteroscopic Myomectomy is the removal of fibroids using a specialized instrument called a hysteroscope, which is a thin telescope-like instrument. It is inserted through the cervix and into the cavity of the uterus without the need for any incisions. The uterus is then distended with fluid, allowing us to see inside. A small wire loop fitted to the end of the hysteroscope is then placed over the base of the fibroid and an electrical current is passed through the loop, allowing us to cut the fibroid away in small pieces.
Hysteroscopic Resection of Adhesions
Scar tissue (adhesions) inside the uterus may develop as a result of previous surgery to the uterus (D&C or myomectomy), which can lead to difficulty or inability to get pregnant (infertility). The treatment involves hysteroscopy with cutting or resection of the adhesions. Laparoscopy at the same time of the hysteroscopy is often required to avoid uterine perforation. Sometimes, this procedure has to be repeated several times in order to successfully remove all of the scar tissue and maximize the chances of pregnancy. At the end of the procedure, a balloon is inserted inside the uterine cavity to decrease bleeding and avoid “rescarring” of the uterine cavity. To build up a healthy uterine lining, high dose hormone therapy is recommended followed by a repeat hysteroscopy to ensure that the cavity is normal and is ready for pregnancy.
Hysteroscopic Resection of Uterine Septum
Uterine septum refers to a thick muscular wall that divides the uterine cavity. The presence of the septum is a result of congenital malformation (incorrect formation during fetal development). Patients with this condition may experience inability to get pregnant or repeat miscarriages.
Hysteroscopy is used to resect the septum using similar technique to the hysteroscopic resection of fibroids. As with hysteroscopic resection of adhesions, laparoscopy is required to avoid uterine perforation. Intrauterine balloon and high dose hormones are also used post resection.