Hysteroscopy Operation
visualisation of your womb (uterus)
performed by distending the abdomen
  It allows the doctor to see the inside of the womb.
    Hysteroscopy Operation and Laparoscopy  
  Hysteroscopy is the visualisation of the inside of your womb (uterus) to establish that it is structurally normal and that there are no abnormal findings within the cavity of the uterus, such as fibroids, polyps or adhesions. The investigation will usually allow the surgeon to see the openings to the Fallopian tubes at the top of the uterine cavity on each side (i.e. the tubal ostia). A solution of saline is used to distend the cavity to give a clear picture. The findings are normally recorded on videotape, which can be viewed afterwards at your follow-up consultation.

Laparoscopy is performed by distending the abdomen with gas to help obtain a good view and by inserting a fibre-optic telescope through the navel (umbilicus). The incisions that are made are very small indeed and have been described as 'key-hole'. Inspection allows the operating surgeon to view the abdominal cavity in general, and the pelvis in particular. The structures that we need to see include the uterus, the Fallopian tubes and the ovaries, and the spaces between the uterus and the bladder in the front, and the uterus and lower bowel (recto-sigmoid colon) behind. The surgeon is able to check whether the Fallopian tubes are open and functioning normally by noting whether Methylene blue dye passes through the tubes into the pelvic cavity following injection of a blue solution through the cervix. In addition, deviations from normal (such as adhesions or blockages of the Fallopian tubes) will become apparent as, indeed, will fibroids, ovarian cysts or endometriosis.

Hysteroscopy and laparoscopy are commonly performed together thereby giving maximum information about the state of the pelvis.

As a general anaesthetic is administered, you are advised to go home with an escort and not to drive yourself. It is wise to take things easy the day following your operation prior to resuming your normal activities.

When you wake up after the operation, you may have slight discomfort but the doctor will normally have put local anaesthetic into the small incisions made during the laparoscopy. In addition, the sutures used to close the incisions are usually hidden under the skin and do not need removal. There may be slight bruising and discolouration of the abdominal wall on the day following the procedure but this should normally disappear and should not concern you.

Discomfort may be felt in your shoulders (particularly on the right-hand side) after the operation and this is due to gas being located under the diaphragm, but our surgeons make every effort to express all the gas at the conclusion of the operation and it is rarely a significant problem.

You may have a slight blood loss which may last for one day or, in some cases, up to a week, but the latter is much more likely to be the case when surgical procedures are performed on the inside the uterus, such as removing fibroids. If the bleeding is not excessive, it should not cause you undue concern.

You are able to take a shower/bath the very next day. The small dressings need not necessarily be removed prior to this, although they can be removed a few days later since the small incisions tend to heal rapidly.

You are usually seen by the surgeon prior to your discharge from hospital in order to be given a brief outline of what was found. However, once you are home, you should telephone the Secretaries of the London Fertility Centre to make a follow-up appointment (if this has not been arranged prior to your operation) so that a member of our team can discuss the findings of your operation with you, view the video and discuss further management.

Like all surgical procedures there are risks associated with a laparoscopy, but these are thankfully very rare. They include internal haemorrhage, damage to vital organs such as blood vessels, bowel and the urinary tract as well as more minor problems such as bruising and wound infections.

This operation is performed for two reasons. The first is to try to make a diagnosis, usually to explain why the womb is bleeding in an abnormal way. The second is to treat something that is wrong. A hysteroscopy is usually done at the same time as a D&C. It allows the doctor to see the inside of the womb. A hysteroscopy can be done in the clinic or in the operating theatre under an anaesthetic. DIAGNOSIS When a woman has a normal period, she loses blood and the tissue cells lining the womb (endometrium). In the first half of the monthly cycle the ovaries make a hormone called oestrogen. This makes the endometrium grow thicker. After ovulation, the ovaries make a second hormone, progesterone. If the egg which is released from the ovary each month is not fertilized, the endometrium is shed, together with blood. The whole cycle then starts all over again. If a woman bleeds too often, too much or too little, she may have a hormone problem or an abnormality inside the womb itself.
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