Ambulatory hysteroscopy diagnosis center
Dr Jean-Philippe Estrade - Dr Brice Gurriet
6, Rue Rocca-13008 Marseille-France
This exam enables to explore the uterine cavity by going through the natural tracks, meaning the vagina and the cervix. The hysteroscope is an instrument made up of a mini camera, a source of light, an irrigation system and if needed, an operative canal to proceed with the medical acts.
I) Diagnostic hysteroscopy
You will usually do it as an outpatient, meaning without being hospitalized. The procedure does not require any anesthesia or fasting, and can be done outside of an operating room. The patient is installed on a gynecological table, a quick and thorough vaginal disinfection is done, then a speculum is inserted and a clamp fixed on the cervix. A 2.5 to 3mm diametric hysteroscope is inserted inside the cervix canal. This last procedure can be avoided by doing a vaginoscopy, meaning the uteroscope is directly introduced into the vagina without a speculum or clamp, then into the cervix. Stretching the tissue is ensured by using a physiological salt solution (the use of gas was abandoned many years ago).
The gynecologist visualizes the images on a screen and explores the cervical canal, the uterine cavity and the root of the fallopian tubes (tubular ostium). The exam only lasts for a couple of minutes and is generally well tolerated. The patient usually experiences slight uterine spasms similar to those felt during menstruation. It is possible to do superficial biopsies of the mucous during the exam, or to remove an IUD using a little clamp introduced in the hysteroscope. If a medical act is deemed necessary after the exam, an operative hysteroscopy will be scheduled. If a medical act is known as being unavoidable before the exam (ultrasound-revealed disorder, heavy bleeding), it is sometimes preferable to perform a diagnostic and operative hysteroscopy, at the same time, to spare the patient from repeated medical acts.
A hysteroscopy can be recommended for the following conditions:
Visible anomalies with a hysteroscopy
Different anomalies can be visualized, as follows:
II) Operative Hysteroscopy
It requires a general anesthesia or loco-regional anesthesia in an operating room: the patient must be fasting. An ambulatory hospitalization is usually sufficient. The hysteroscope used is generally bigger, 5 to 9 mm in diameter as it includes instruments, (however with today’s technology operative hysteroscopes are smaller). The patient is lying down on the gynecologist chair, and a vaginal antisepsis is done. A speculum is inserted and a clamp on the cervix. Usually, dilating the cervix is necessary.
The irrigation liquid can either be a physiological salt solution or glycocoll, depending on the materiel used.
Any condition requiring an intra-uterine act, such as :
They are extremely rare with a diagnostic hysteroscopy and seldomly occur with operative hysteroscopy. Nevertheless, hysteroscopies remain surgical acts and complications are possible and can include :
Delayed complications can also occur:
This exhaustive list can scare patients, but one must keep in mind that a hysteroscopy is a frequent medical act with rare complications. The procedure is simple is the vast majority of cases.
IV) Postoperative consequences
They usually are simple and short. Most of the time, the patient is released after one day in the hospital and can immediately resume eating. Light bleeding can occur during a few days, together with small uterine spasms but usually no medical treatment is neither prescribed nor necessary upon being discharged from the hospital.
If the patient underwent an endomectrectomy or thermo coagulation, some light liquid discharge can be experienced for an average of 15 days, depending on the oedema. The medical instructions are related to the dilatation of the cervix, therefore the patient must avoid bathing, sexual intercourse and tampons for a week.