Hysteroscopies

Hysteroscopy is a minimally invasive procedure that allows direct visualization of the uterine cavity using a hysteroscope, a narrow endoscope inserted through the cervix. A distention medium, typically saline for diagnostic work and certain operative settings, expands the cavity to improve visibility and working space.

Indications include evaluation of abnormal uterine bleeding, infertility assessment, and recurrent pregnancy loss, as well as investigation of suspected uterine anomalies or issues with intrauterine devices. It can also guide targeted endometrial biopsy and inform the planning of therapeutic procedures within the uterus.

There are diagnostic and operative forms. Diagnostic hysteroscopy uses the scope to inspect the cavity and may permit targeted biopsy. Operative hysteroscopy employs additional instruments through the hysteroscope to remove polyps or submucosal fibroids, perform adhesiolysis in intrauterine scar (Asherman) syndrome, remove placental remnants, perform endometrial ablation, or facilitate tubal cannulation. Equipment typically includes a rigid or flexible hysteroscope with one or more operative channels, a camera and light source, and distention media; instruments such as graspers, scissors, electrosurgical devices, and laser or mechanical tools may be used.

Techniques and settings vary, but procedures are often performed in an outpatient setting with local, regional, or general anesthesia as indicated. The cervix may be dilated, the scope advanced under direct vision, and the cavity continuously distended to maintain visualization while any planned interventions are carried out.

Risks are uncommon but include uterine perforation, infection, significant bleeding, fluid overload, and vasovagal reactions. Recovery is typically rapid, with mild cramping and light vaginal discharge for a short period. When performed by trained clinicians, hysteroscopy provides high diagnostic accuracy and enables targeted intrauterine treatment with generally favorable outcomes.