Hysteroscopy is a procedure that is used for the diagnosis and treatment of intrauterine pathology. At ACFS, we commonly use hysteroscopy to remove uterine polyps or fibroids, which are often detected through evaluation for abnormal menstrual periods or infertility. Hysteroscopy can also be used in the diagnosis and treatment of intrauterine adhesions (scar tissue) or a uterine septum.
Hysteroscopy is performed as an outpatient procedure, typically under IV anesthesia. The procedure is minimally invasive and does not require any incisions. The reproductive surgeon will pass a thin videoscopic lens (hysteroscope) through the vagina and cervix into the uterine cavity. At the same time, sterile saline solution is infused into the uterus to permit visualization of the entire uterine cavity. The surgeon can then use the hysteroscope to capture photos of the findings and to introduce small operating instruments that can be used to remove any abnormalities that may be found.
There are a variety of instruments available for the removal of fibroids and polyps, but, at ACFS, we prefer to use hysteroscopic morcellation for a majority of our cases. The hysteroscopic morcellator is an instrument that can simultaneously cut and aspirate tissue. The morcellator works on a mechanical design and eliminates the risks of using electrical energy in the uterus, which can cause thermal damage to surrounding normal endometrial tissue. Targeted, visualized tissue removal with morcellation reduces the risks of endometrial damage, provides greater control over blind procedures (e.g. sharp or suction curettage, or D&C), and reduces the risk of uterine perforation because the tip of the morcellator is blunt. The morcellator also works with an advanced fluid management system that tracks the amount of fluid going into and out of the uterus. This is especially important during a longer procedure, such as the removal of larger submucosal fibroids, where it is critical to avoid excessive fluid absorption by the patient.
After the procedure, the woman is in the recovery room for about an hour and then is discharged to home without any restrictions other than to avoid placing anything in the vagina and to refrain from intercourse for two weeks. She might have light bleeding or spotting, as well as some mild cramping for the next day or so after the hysteroscopic morcellation removal of the filling defect.
Arizona Center for Fertility Studies has a tremendous amount of experience and expertise with hysteroscopic morcellation of filling defects, especially being able to remove large fibroids that ordinarily would not be able to be removed except with an open incision in the abdomen (laparotomy) and then having to open the uterus.
At ACFS, the primary goal with hysteroscopic surgery is to restore and preserve the integrity of the uterus for the purpose of future fertility
Sonohysterogram (SHG)showing probable endometrial polyps
Hysteroscopic morcellation of a fibroid