Hysteroscopy is just as the gem in the crown for managing infertility. Diagnostic and therapeutic both can be performed by hysteroscopy. It is an approach that permits the doctor to look inside the uterine cavity (Hystero means uterus and scopy means to see). This is performed under general anesthesia. This procedure comes up with the important information inside the womb. By using a small telescope which has a camera on it, is called hysteroscope which is inserted through the vagina and cervix into the uterine cavity.
Hysteroscope transmits the images to video monitor, which allows the doctor to view issues related with uterus and fallopian tubes. Gas or fluid is often used in this to inflate the womb in order to give a better view to surgeon. If there is need of operative hysteroscopy for surgery, then an endoscopic optical lens will be inserted through the vagina into the endometrial cavity to direct treatment such as biopsy, removal of polyps or other intrauterine treatments. It takes 10-30 minutes for whole procedure and rest depends on the situation.
It is a minimally invasive gynae approach. What more, the smaller diameter hysteroscopes has now permitted therapeutic hysteroscopy to become outpatient procedure which means the patient doesn’t need to stay at clinic for very long and can be perform in office setting. Operative Hysteroscopy : Uterine Synechia Dissection (Asherman Syndrome) This is a condition where uterine -wall gets adherent antero- posteriorly leading to mild to sever infection or injury. Adhesiolysis will restore menses and reproductive function. Adhesiolysis will also allow ample space of embryo to implant & grow. IUCD may be inserted post operatively to prevent re-adhesions.
Septate uterus is commonest Mullerian Anomaly. It presents commonly as Recurrent Pregnancy loss.Resection of septum will improve implantation index & allow space & blood supply for embryo to grow. Hysteroscopy allows precise excision of septum without injury to normal myometrial tissue.
Polyps are endometrial or myyometrial projections which prevents implantation by occupying space. Hysteroscopy excision by 5 fr scissors restores normal anatomy & also allows specimen for Histopathology.
Sub mucous variety of fibroid (less then 3 cm size and not more than 2 fibroid) can be removed through hysteroscope.
Retained products of conception (fetal bone) & lost IUCD can cause infertility by hampering implantation. Hysteroscopy can be used to remove these without any con current endometrial damage..
Cornual block of the fallopian tube can be negotiated with guide wire and tuble patency can be established.
Some times uterine cavity volume is less because of adhesions. Releasing these adhesions from fundus (fundal metroplasty) and from lateral wall (lateral metroplasty) will improve the chance of future pregnancy.
We have dedicated hi-tech operation theater for Gynae Endoscopy equipped with latest & quality instruments which enables us to perform even most tertiary surgeries with safety & ease.
Image HD Operating System (Karl Storz, Germany) :
gives crisp & sharp images with better depth perception & identification of blood vessels.
Mimics nature day light, better for clinical judgment & identification of tissue planes. It avoids excessive heat & dehydration.