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Hysteroscopy

Hysteroscopy to Remove a Polyp or Fibroid

A hysteroscopy is a minimally invasive (no outside incisions) surgery done to examine the inside of the cervix and the uterus using a special light called a hysteroscope. This procedure is typically performed in order to take biopsies, remove polyps or fibroids, or preventing bleeding with cautery. It is done in the hospital and the most common type of anesthesia used during a hysteroscopy is a general anesthesia, which will result in you going all the way to sleep. The surgery could be done “awake” with spinal or epidural anesthesia.

hysteroscopyWhen to Have a Hysteroscopy

You may be scheduled for a hysteroscopy if previous testing has shown a “filling defect” inside the uterus. This is usually a polyp or a fibroid. In addition, we will have found a medical necessity to remove the polyp or fibroid. The reason for surgery to remove this tissue is specific to the individual finding and the individual patient.

The Benefits for having this procedure done are based on our the reason for surgery. The benefit is to achieve the goal because medicines can not fix, or have not fixed things. Sometimes surgery is a better fix than long term use of medication.

Alternatives to Surgery

In situations like this, the alternative is to do nothing or use medicine to manage the problem if that is an option. This type of surgery is minimally invasive, so we can not do any less surgery. Sometimes, depending upon the specifics of your case, a surgical alternative may be removal of the uterus, known as hysterectomy. Hysteroscopy, this minimally invasive surgery, should do the job to remove the tissue from the inside of the uterus. Hysterectomy is removal of the entire uterus. This will definitely do the job, but it may not be necessary to do that much.

Risks

The following information is very detailed, and is simply meant to be complete. This is a VERY safe surgery. The topic is complicated. All surgery has the risk of bleeding, infection and damage to internal organs. Anything that is damaged during the procedure will be fixed either by the doctor performing the operation, or by a specialist, if necessary. This is rare. Complications can extend the time you need to stay in the hospital OR slow your recovery. 

There are some risks specific to hysteroscopy. Hysteroscopy is surgery done to the inside of the uterus through the cervix (without an incision). The uterus is inflated with a liquid that allows us to see and operate inside the uterus. The liquid is called Glycine. The “cutting” is done with electricity. Glycine does not conduct electricity, which allows for safe surgery. Glycine is SAFE unless the body absorbs too much. One Liter is too much glycine to absorb. The surgery Must be Stopped if your body absorbs more than One Liter of the fluid. We have a very special measuring machine to keep track of how much glycine is absorbed during the surgery. Glycine, when absorbed, acts like water without salt, and dilutes your cells. In extreme cases this can result in low sodium count, and a seizure.

Perforation: Or an accidental small hole in the uterus can occur during the procedure. A hole in the uterus is not a problem for the uterus, but may be a problem for other things. When the hole is made in the uterus the surgery is stopped because the uterus deflates, and I can not see or cut safely.  Perforation can  happen at two times in the surgery: when dilating the cervix and placing the hysteroscope OR during the cutting.

  • The cervix is dilated to permit the tools into the uterus. Sometimes a hole is made in the uterus during this dilation process. This is not dangerous, but it usually means we have to reschedule the procedure for another day, after the hole in the uterus heals. This delay is usually 4-6 weeks.
  • Perforation can also happen when cutting. The cutting is done with electricity, so perforation when cutting can lead to significant complications.  If the perforation occurs during cutting then you will need a laparoscopy. A telescope will be placed in your belly button to look for damage to your internal organs, like the bowels and bladder and blood vessels. If there is significant damage to internal organs you may need a more open operation, with a regular incision, to fix things. This is very rare, but it can happen.

Hysterectomy: Some women would elect to have the uterus removed (the ovaries are not removed) if , AND ONLY IF, there was the need for an open-up surgery due to a complication. Removing the uterus is called a hysterectomy. We would identify your preference before any surgery begins…[read more]

Second Hysteroscopic Surgery: A second surgery is scheduled to finish up what was left undone IF the first surgery is stopped before finished. Perforation is one reason to stop the first surgery; absorbing too much fluid is the other reason to stop the first surgery.

Limitations

Sometimes removing the polyp or fibroid does not fix the entire problem. The limitations to the surgery depend on what the surgery is intended to do. No Matter What, we will be able to examine the tissue under the microscope to make sure there are no dangerous or abnormal cells. The question that may remain is whether removing the polyp or fibroid will: prevent miscarriage from happening, or happening again, or fix the abnormal bleeding.

Recovery

Typical Time in Hospital: This is same day surgery. You arrive approximately 2 hours before the scheduled time of surgery. The surgery takes approximately one hour. Most women are ready to leave the hospital around 3 hours after the procedure.

Post Surgery Vaginal Discharge: This is part of the healing, and a watery, somewhat smelly discharge may continue for 4-6 weeks after surgery.  The discharge is not from an infection, rather it is part of the healing.

Back to Regular Activity/Work: You are usually up and running within 2-3 days. The first day after surgery is usually marked by an anesthesia hangover. You will likely be ready for anything in one week, but I would allow two weeks before you are back to 100%.