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Operative Hysteroscopy Tips

Diagnostic Hysteroscopy - How Can It Be Of Help?

Dr. Pragnesh Shah 87% (121 ratings)
MD, MBBS
Gynaecologist, Ahmedabad
Diagnostic Hysteroscopy - How Can It Be Of Help?

Indications:

  1. Primary Infertility
  2. Secondary Infertility
  3. Investigating & treating a case of B.O.H.
  4. Investigating & treating Abnormal bleeding P/V
  5. Investigating & treating case of mass inside the uterine cavity

Objective:

Hysteroscopy is the commonest type of work up in the entire Infertility patient along with Diagnostic Laparoscopy. Only diagnostic hysteroscopy is the commonest work up recommended before IVF. We record Hysteroscopy diagnostic & operative procedure for future important record in Infertility patient, for second opinion & for deciding future treatment protocol. 

Benefits of Hysteroscopy Surgery:

  1. Shorter Hospital stay.
  2. Earlier return to your routine work.
  3. Cosmetically no scar on abdomen.
  4. Less pain after operation.
  5. Best fertility enhancement & Fertility results following hysteroscopy
  6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
  7. Patient discharged within 2-4 hours after procedure.
  8. Patient can resume to her normal routine work within 12-24 hours after the procedure.

Pre-operative Check Lists:

  1. Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.Etc.); Pelvic Trance vaginal USG report.
  2. Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc. If The couple is infertile)
  3. Operation planned from 4th to 10th day of Menstrual Cycle.
  4. Preparation of local parts.
  5. No. Of Cuts on Abdomen: Nil 

Average Stay in Hospital:
2 to 4 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
2 to 10 minutes

Average Blood loss during Surgery:
Negligible

Average time after operation to resume normal activities/work:
Within 12-24 hours.

Anesthesia:

General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)Procedure:Patient is given general anesthesia. Patient is put on lithotomy position. Local parts cleaning & paintings with antiseptic solution & draping are done. After P/V examination cervix is checked with uterine sound. For Diagnostic hysteroscopy after removing the air, hysteroscopy (varsascope/1.9 mm/ 2.9 mm Hysteroscopy along with irrigation of Normal saline is introduced inside the cavity. Systemically both corneal openings, cavity, both lateral walls and anterior & posterior wall of the uterine wall is noticed for any lesions or normalcy. For operative/therapeutic hysteroscopy cervix is dilated up to 7mm / 10 mm for introduction of Operating hysteroscopic sheath or resectoscope for operative hysteroscopy. Hysteroscopy requires dilatation of the uterine cavity to create working space inside the uterine cavity and flushes both fallopian tubes with high pressure fluid helps in achieving very good fertility enhancing results following Hysteroscopy in infertility patients. Addressing all the infertility related lesions like broad septum from the fundus, intra-uterine adhesions, polyps or tubal cannulation helps us in treating infertility patients in the same sitting
                        
Post-operative Course:

Patient remains drowsy/sedated for 1-2 hours after hysteroscopy but conscious & pain free. Patient can take fluids 1-2 hours after hysteroscopy & light food after 2-4 hours. She may feel little discomfort after hysteroscopy for 6-8 hours but it can be relieved with pain killer tabs. Most of the patients can walk normally without support and can take normal diet 6-8 hours after the hysteroscopy. She can be discharged on the same day of the operation. Few patients may feel nausea & vomiting after hysteroscopy, which can be very well controlled with injection in post-operative room. Patient can do her normal activity within 12-24 hours after hysteroscopy. Patient is advised to take antibiotics & analgesic tabs for 5 days following hysteroscopy. Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately. Patient is advised to come for follow up 7 days after the next period or on the day for IVF protocol & preparation for IVF. In case you have a concern or query you can always consult an expert & get answers to your questions!

3819 people found this helpful

Does Hysteroscopy Improves Chance Of IVF Success?

Dr. Arun Muthuvel 85% (10 ratings)
MCH - Reproductive Medicine & Surgery, MS - Obstetrics & Gynaecology
IVF Specialist, Chennai
Does Hysteroscopy Improves Chance Of IVF Success?

IVF is one of the most common ways to treat infertility. This procedure can be described as one where the woman’s eggs and the man’s sperm are harvested and combined in a laboratory to form an embryo. Two or more embryos are then inserted into the woman’s womb where they will develop during the pregnancy. IVF has a high success rate but there are a number of factors that could interfere with this. Issues with the woman’s uterus such as the presence of scar tissue or polyps could be one such factor. Thankfully, this issue can be identified and treated before undergoing IVF so as to increase the chances of its success.

  1. A hysteroscopy is a procedure through which the doctor can take a look inside the woman’s uterus. This is an invasive procedure that is performed while the woman is under general anesthesia. It involves inserting a narrow tube with a telescope at one end into the uterine cavity.
  2. The cavity may or may not be filled with a gas or a fluid. The telescope then captures and transmits images of the uterus to a screen where it can be viewed by the doctor. Any malformations such as polyps, scar tissue, fibroids etc. will be made visible through this procedure. If any such issues are seen, the doctor will then proceed to remove them. In this case, the procedure is not only diagnostic but operative as well.
  3. The fertilized embryos are then inserted into the woman’s uterus. Since all the scar tissue and uterine abnormalities have been addressed, the embryos then have a higher chance of being successfully implanted. This boosts the chances of a successful IVF pregnancy.
  4. A hysteroscopy may not be very effective for a patient with recurrent IVF failures but for a woman who is undergoing IVF treatment for the first time, this could be quite helpful. It is rare for a hysteroscopy to have side effects. Infection caused by this procedure is very rare. In some cases, women may experience temporary bloating or cramps after the procedure. This does not affect her fertility in any way. A hysteroscopy is not a typical part of the IVF procedure and hence there are additional costs associated with it. However, in the long run, by increasing the chances of having a successful pregnancy, these costs may be offset by negating the need for a second round of IVF treatment. In the end, the choice is a personal one.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2906 people found this helpful

Uterine Bleeding - Can Hysteroscopy Help?

Motherhood 88% (259 ratings)
Speciality Birthing Care
Gynaecologist, Bangalore
Uterine Bleeding - Can Hysteroscopy Help?

Abnormal uterine bleeding, also known as AUB, is one of the most common causes requiring gynecologic evaluation. Hysteroscopy is a procedure wherein a thin camera called hysteroscope is introduced into the uterus via the vagina and this light helps in a thorough examination of the uterus. In cases where there are cysts or fibroids or even cancerous growths, this is used to get more details on the lesions. However, hysteroscopy also has a therapeutic use in that it is used to treat conditions like abnormal uterine bleeding. Read on to know more about AUB and how hysteroscopy helps in treatment. 

Causes of Abnormal Uterine Bleeding: Vaginal bleeding that occurs more often than 21 days and farther apart than 35 days is known as abnormal uterine bleeding. The bleeding is also abnormal if it lasts longer than 7 days and more than 80 mL of blood is lost during each cycle. 

Some causes include: 

  1. Hormonal imbalance 
  2. Cancer 
  3. Uterine polyps 
  4. Uterine fibroids 
  5. Cervical infections 

Diagnosis/Treatment: 

When a woman has abnormal bleeding, further diagnosis is required to confirm the exact cause of the bleeding. This is where the hysteroscopy comes into the picture. Hysteroscopy, literally translates to viewing the uterus from inside directly through a camera. 

How it is done: 

Hysteroscopy is done as an outpatient procedure and normally takes about 3 to 4 hours. General or spinal anesthesia may be used depending on complexity and overall patient health. The uterus is filled with a fluid like saline or glycerin and a thin lighted instrument called the hysteroscope is inserted through the vagina, up the cervix, and into the uterus. This tube is flexible and so can be moved across the uterus to identify any areas of abnormality. It also has a camera and so can be used to take pictures of suspicious areas. 

Causes for infertility may also be detected using hysteroscopy. Small knives can also be used to remove the lesion like fibroid or polyp. These are often the cause of abnormal bleeding. Samples can also be taken for biopsy to confirm if any cancerous growth is detected.

Hysteroscopy is a safe and effective way to examine the cervical canal and uterine cavity. It is better to accompany D&C with hysteroscopy instead of going for blind dilatation and curettage, especially in women who are peri or premenopausal. Hysteroscopy is a safe procedure if done by a doctor, specialised in gynecological endoscopy and helps in both diagnosis and treatment of abnormal uterine bleeding. In case you have a concern or query you can always consult an expert & get answers to your questions!

5674 people found this helpful

Hysteroscopy - How IT Can Help In Diagnosing Infertility?

Dr. Rita Bakshi 87% (2899 ratings)
MBBS, DGO, MD, Fellowship in Gynae Oncology
Gynaecologist, Delhi
Hysteroscopy - How IT Can Help In Diagnosing Infertility?

Hysteroscopy is considered as a therapeutic modality and a valuable detection in the management or treatment of infertility. It is a process whereby a doctor checks the uterus cavity to treat the cause of abnormal menstrual bleeding which may be impeding chances of conception. It is performed with the help of a hysteroscope (a thin tube) inserted in the uterus to detect and examine the cervix (lower end of the uterus). Its role has changed and modified overtime.

Hysteroscopy is performed to find out certain causes of infertility; which may be:

  1. Problem in the size or shape of the uterus.

  2. Repeated miscarriages.

  3. Endometrial cancer (a cancer of the uterus).

  4. Scar tissue in the uterus.

How and when to prepare for hysteroscopy?

  1. The best time for hysteroscopy to be carried out is when one is not on her menstruating cycle.

  2. Make sure not to insert tampons or use vaginal medicines 24 hours prior to the surgery.

  3. An anesthetic will be given to relax you before hysteroscopy.

How is it performed?

The procedure begins with the administration of anesthesia.

  1. The cervix will be widened (dilated) by the doctor to insert the hysteroscope.

  2. The hysteroscope is then inserted into the uterus through the vaginal tract and the cervix.

  3. The uterine cavity is expanded by the usage of carbon dioxide gas. The blood and mucus is then cleared. This is done once the hysteroscope is put into the uterine cavity.

  4. The hysteroscope light allows the doctor to see and diagnose the problem in the uterine cavity by observing the openings of the fallopian tubes (tubes through which the eggs travel from ovaries to the uterus).

Expectations after the procedure:

  1. You will have to be observed for a few hours before you are allowed to go home.

  2. Post-surgery vaginal bleeding or cramping is also common.

  3. In case carbon dioxide gas is used in the surgery, mild shoulder pain might be another botheration. However, it should subside within a day or two.

  4. It is also completely normal to feel slightly sick or even have a few bouts of fainting.

Certain complications which might require medical attention are:

  1. Heavy vaginal discharge or bleeding

  2. Acute fever

  3. Acute abdominal pain

In case you have a concern or query you can always consult an expert & get answers to your questions!

3734 people found this helpful

Why Go For Hysteroscopy In Case Of Uterine Bleeding?

Dr. Rashi Sinha 82% (140 ratings)
MBBS, MS, DNB, Rcog London
Gynaecologist, Muzaffarpur
Why Go For Hysteroscopy In Case Of Uterine Bleeding?

Abnormal uterine bleeding, also known as AUB, is one of the most common causes requiring gynecologic evaluation. Hysteroscopy is a procedure wherein a thin camera called hysteroscope is introduced into the uterus via the vagina and this light helps in a thorough examination of the uterus. In cases where there are cysts or fibroids or even cancerous growths, this is used to get more details on the lesions. However, hysteroscopy also has a therapeutic use in that it is used to treat conditions like abnormal uterine bleeding. Read on to know more about AUB and how hysteroscopy helps in treatment. 

Causes of Abnormal Uterine Bleeding: Vaginal bleeding that occurs more often than 21 days and farther apart than 35 days is known as abnormal uterine bleeding. The bleeding is also abnormal if it lasts longer than 7 days and more than 80 mL of blood is lost during each cycle. 

Some causes include: 

  1. Hormonal imbalance 
  2. Cancer 
  3. Uterine polyps 
  4. Uterine fibroids 
  5. Cervical infections 

Diagnosis/Treatment: 

When a woman has abnormal bleeding, further diagnosis is required to confirm the exact cause of the bleeding. This is where the hysteroscopy comes into the picture. Hysteroscopy, literally translates to viewing the uterus from inside directly through a camera. 

How it is done: 

Hysteroscopy is done as an outpatient procedure and normally takes about 3 to 4 hours. General or spinal anesthesia may be used depending on complexity and overall patient health. The uterus is filled with a fluid like saline or glycerin and a thin lighted instrument called the hysteroscope is inserted through the vagina, up the cervix, and into the uterus. This tube is flexible and so can be moved across the uterus to identify any areas of abnormality. It also has a camera and so can be used to take pictures of suspicious areas. 

Causes for infertility may also be detected using hysteroscopy. Small knives can also be used to remove the lesion like fibroid or polyp. These are often the cause of abnormal bleeding. Samples can also be taken for biopsy to confirm if any cancerous growth is detected.

Hysteroscopy is a safe and effective way to examine the cervical canal and uterine cavity. It is better to accompany D&C with hysteroscopy instead of going for blind dilatation and curettage, especially in women who are peri or premenopausal. Hysteroscopy is a safe procedure if done by a doctor, specialised in gynecological endoscopy and helps in both diagnosis and treatment of abnormal uterine bleeding.

5 people found this helpful

Tips On Post Operative Care!

Dr. Sandeep Kumar 86% (32 ratings)
MBBS Bachelor of Medicine and Bachelor of Surgery, MS - General Surgery, Phd
General Surgeon, Lucknow
Tips On Post Operative Care!

You probably think many more things can go wrong during a surgery as compared to after a surgery. However, you are wrong. The chances of infection after a surgery are very high and it used to be the highest cause of unsuccessful surgery in the past before it was known just how deadly an infection is. A doctor, however, cannot monitor everything afterwards. Therefore, it is crucial you know and take care after the surgery. Here are some ways in which you can do so:

  1. Keep it dry: It is crucial that you keep the incision dry for whatever period of time the doctor tells you to keep it dry as otherwise the chances of infection increase dramatically. Some of the things you should do to keep it dry is to not take a bath, scrub the incisions or put lotions on it. In fact, you should also not expose it to sunlight.
  2. Keep the incisions: You must trust your doctor as the doctor is trained and usually knows better than you. Therefore, if the doctor tells you to keep the incisions then keep them. Do not scrub, rub or put powder on them either.
  3. Check for signs of infection: This may be the easiest thing to do as there are many symptoms of an infection. These include a change in the color, size, or odor of the incision, fever, redness, hardening or heating of the surrounding area or in extreme cases more bleeding and pain than usual.
  4. Changing a dressing: This is a major cause of infections among surgery patients and the only way to prevent it is to follow the doctor's instructions to a tee. Once again, trust your doctor and remember to wash your hands and put on medical gloves. Do not put alcohol, iodine or hydrogen peroxide either.

In case you have a concern or query you can always consult an expert & get answers to your questions!

1846 people found this helpful

Cut Out Herbs Before Operation

MBBS, MS - General Surgery
General Surgeon, Kota
Cut Out Herbs Before Operation

Some herbal supplements – Ginger, ginseng, and feverfew – can cause increased bleeding during surgery, warn surgeons. It may be wise to stop taking all medication, including herbal supplements, at least two weeks before surgery, and inform your surgeon about your herbal use.

Hernia Operation - Factors You Must Take Care Of!

Dr. Amitava Chakraborty 86% (11 ratings)
MS - General Surgery, MBBS Bachelor of Medicine and Bachelor of Surgery
General Surgeon, Kolkata
Hernia Operation - Factors You Must Take Care Of!

Hernia may be defined as the protrusion of an organ into an adjacent connective tissue or muscle. The protrusion usually occurs through a tear or a weakened area in the muscle (Fascia). Hernia can be an Inguinal Hernia, Umbilical Hernia, Hiatal Hernia or Femoral Hernia. It can also originate from an incision (Incisional Hernia).

The Inguinal Hernia is commonly observed in males. Here, the intestine squeezes through a tear in the abdominal wall into the groin (Inguinal canal). At times, the small intestine bulges through the abdominal wall (weak spot) near the belly button, which results in Umbilical Hernia. In Hiatal Hernia, the upper part of the stomach passes into the chest through the diaphragm, and of all the hernia types, the Inguinal Hernia is the most common.

Severe strain and muscle tear or weakness can result in Hernia. Obesity, chronic constipation, chronic coughing and sneezing, ageing, damage caused by injury, medical conditions like Cystic Fibrosis, contribute to increased incidences of Hernia. In case of Hernia, the affected area tends to protrude or bulge out. If left untreated; Hernia can prove to be detrimental. One needs to consult a physician for proper diagnosis and treatment. Physical examination can help in the diagnosis of Inguinal Hernia. An ultrasound is needed to diagnose Umbilical Hernia. A Barium X -ray or endoscopy can be of great help in the diagnosis of Hiatal Hernia.

The severity of the Hernia depends upon its size. In case the Hernia is rapidly increasing in size, a surgery is needed for the repair. The surgery performed can be open or laparoscopic. In open surgery, Hernia is identified through an incision. Once located, the Hernia is removed from the adjacent tissues. In laparoscopic repair, small incisions are made in the affected region. Through these incisions, specialized instruments are inserted. It is through these instruments that the surgeon visualizes and performs the surgery.

In such repairs, a mesh, held in place by sutures is used as a scaffold. This facilitates the growth of new tissues in the affected person. This technique significantly lowers the chance of a recurrence.

Certain factors must be well addressed, before performing a Hernia operation:

  • Hernia operations, laparoscopic in particular, should be performed by experienced surgeons. Inexperienced surgeons will do you more harm than good.
  • Laparoscopic Hernia operation should be avoided in case a patient has adhesions from previous surgery.
  • Extreme care should be taken while performing a Hernia operation in infants and children.
  • In some cases, Hernia surgery might affect or injure the vas deferens in men. This in turn can affect fertility in men.

Hernia Operation - What To Know About It?

Dr. Ashok Gupta 92% (5463 ratings)
MS - General Surgery, MBBS
General Surgeon, Delhi
Hernia Operation - What To Know About It?

Hernia may be defined as the protrusion of an organ into an adjacent connective tissue or muscle. The protrusion usually occurs through a tear or a weakened area in the muscle (Fascia). The hernia may be Inguinal Hernia, Umbilical Hernia, Hiatal Hernia or Femoral Hernia. The hernia can also originate from an incision (Incisional Hernia). The Inguinal Hernia is commonly observed in males. Here, the intestine squeezes through a tear in the abdominal wall into the groin (inguinal canal). At times, the small intestine bulges through the abdominal wall (weak spot) near the bellybutton. This results in Umbilical Hernia. In Hiatal Hernia, the upper part of the stomach passes into the chest through the diaphragm. Of all the hernia types, the Inguinal Hernia is the most common. 

Severe strain and muscle tear or weakness can result in hernia. Obesity, chronic constipation, chronic coughing and sneezing, ageing, damage caused by injury, medical conditions like Cystic Fibrosis, contribute to increased incidences of hernia. In case of hernia, the affected area tends to protrude or bulge out. If left untreated; hernia can prove to be detrimental. One needs to consult a physician for proper diagnosis and treatment. Physical examination can help in the diagnosis of Inguinal Hernia. An ultrasound is needed to diagnose Umbilical Hernia. A Barium X -ray or endoscopy can be of great help in the diagnosis of Hiatal Hernia.  

The severity of the hernia depends upon its size. In case the hernia is rapidly increasing in size, a surgery is needed for the repair. The surgery performed can be Open or Laparoscopic. In open surgery, hernia is identified through an incision. Once located, the hernia is removed from the adjacent tissues. In Laparoscopic Repair, small incisions are made in the affected region. Through these incisions, specialized instruments are inserted. It is through these instruments that the surgeon visualizes and performs the surgery.  In such repair, a mesh, held in place by sutures is used as a scaffold. This facilitates the growth of new tissues in the affected person. This technique significantly lowers the chances of a recurrence.

Certain factors needs to be well addressed before performing hernia operation-

  1. Hernia operations, Laparoscopic in particular, should be performed by experienced surgeons. Inexperienced surgeons will do you more harm than good.
  2. Laparoscopic hernia operation should be avoided in case a patient has adhesions from previous surgery.
  3. Extreme care should be taken while performing a hernia operation in infants and children.
  4. In some cases, hernia surgery might affect or injure the vas deferens in men. This in turn can affect fertility in men.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2580 people found this helpful

Every Abscess Doesn't Mean Operation!

Dr. Puneet Agrawal 91% (446 ratings)
MBBS, MS - General Surgery
General Surgeon, Agra
Every Abscess Doesn't Mean Operation!

Every abscess doesn't mean operation.Many abscesses are caused by tuberculosis bacteria. In these abscesses we just aspirated and give drugs to fight tuberculosis.Most patients recover without surgery luckily.

2 people found this helpful
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