Hysteroscopy is a diagnostic and therapeutic procedure that utilizes endoscopic technology to observe the interior of the uterine cavity. This technique involves inserting a slender hysteroscope through the cervix into the uterine cavity, allowing direct visualization of the endometrium and uterine structure. It is used to diagnose abnormal bleeding, lesions, or to perform surgical excisions. Its main purpose is to provide real-time imaging assistance, helping physicians accurately determine the cause and perform treatment, with advantages of minimal invasiveness and quick recovery.
This procedure is often applied in complex gynecological cases, such as suspected endometrial abnormalities, uterine adhesions, or residual tissue after miscarriage. Depending on clinical needs, a diagnostic hysteroscope may be used solely for observation, or combined with surgical instruments for tissue biopsy, polyp removal, and other therapeutic operations.
Hysteroscopy is categorized into "diagnostic" and "therapeutic" types. Diagnostic hysteroscopy primarily focuses on imaging, transmitting images of the uterine cavity to a monitor via the endoscope camera to assist in interpreting abnormal lesions. Therapeutic hysteroscopy builds on diagnosis by using micro surgical tools (such as electrocautery or laser devices) to directly remove fibroids, excise abnormal tissue, or repair adhesions.
The mechanism involves high-resolution visualization through the endoscope, providing a direct view of the uterine cavity, while distension media (such as saline solution) are used to inflate the cavity and enlarge the field of view. This process can be combined with tissue biopsy or lesion removal, achieving the clinical benefit of "diagnosis and treatment in one session".
Hysteroscopy is suitable for various gynecological issues, including endometriosis, submucosal fibroids, Asherman’s syndrome (uterine adhesions), and recurrent spontaneous miscarriage. It can precisely locate lesions in patients with unexplained heavy menstrual bleeding or abnormal uterine shape.
Additionally, this technique is commonly used in infertility assessments to exclude uterine cavity anomalies. When ultrasound or MRI suggests possible intrauterine lesions, hysteroscopy can provide immediate histological analysis through tissue sampling, enhancing diagnostic accuracy.
Hysteroscopy is usually performed in outpatient clinics or day surgery units, with a procedure time of approximately 15 to 60 minutes. Patients may receive local anesthesia, sedation, or general anesthesia, depending on the complexity of the procedure. The physician will first dilate the cervix gradually using dilators, then insert the hysteroscope and inject distension media to maintain a clear view.
Therapeutic hysteroscopy may require additional use of electrocautery or laser devices. For example, when removing endometrial polyps, current parameters (such as electrocautery voltage set between 50-80W) are controlled to prevent tissue burns. Postoperative care instructions are adjusted according to the extent of tissue removal, such as recommended rest periods or medication use.
This technique also reduces radiation exposure as it does not rely on X-ray or CT scans, making it suitable for patients requiring repeated follow-up. Its minimally invasive nature is especially safe for elderly or high-risk patients.
Common short-term risks include cervical injury, allergic reactions to distension media, or short-term bleeding after surgery. About 5-10% of patients may experience uterine perforation, especially in cases with abnormal uterine shape. Rarely, cases may involve thermal burns or infections, requiring close monitoring of temperature and secretions.
Serious complications include uterine rupture or heavy bleeding, which require immediate surgical intervention to control bleeding. Postoperative mild abdominal pain or minor bleeding typically resolve within 24-48 hours. Patients experiencing severe abdominal pain, fever over 38.5°C, or heavy bleeding should seek medical attention immediately.
Patients should fast for 4-6 hours before the procedure and undergo cervical smear and infection screening. Within two weeks post-procedure, avoid sexual intercourse and tampon use to reduce infection risk. Patients with a history of uterine surgery should inform their doctor to evaluate uterine wall elasticity.
Hysteroscopy may synergize with other treatments, such as hormone therapy after polyp removal to improve pregnancy success rates. However, patients on anticoagulants (like warfarin) should discontinue use 7 days before surgery and switch to low-molecular-weight heparin.
Compared to traditional curettage, hysteroscopy allows precise lesion localization, reducing the risk of over-curettage of normal tissue. Patients with severe uterine adhesions may need to undergo hysteroscopic adhesion dissection before other treatments.
Studies show that hysteroscopy has a diagnostic accuracy of up to 95% for intrauterine lesions, especially superior to ultrasound in locating submucosal fibroids. The success rate of fibroid removal via therapeutic hysteroscopy ranges from 85-90%, with postoperative menstrual reduction rates exceeding 70%.
Clinical data indicate that patients with intrauterine adhesions who undergo hysteroscopic adhesiolysis have a pregnancy rate improvement of 30-40%. Compared to laparoscopy, its minimally invasive nature reduces postoperative pain by 40% and shortens hospital stay to an average of 0.5 days.
Alternative diagnostic methods include transvaginal ultrasound and 3D ultrasound, but these lack the spatial resolution to identify lesions smaller than 5mm. MRI can provide three-dimensional images of the uterus but cannot offer immediate treatment.
Traditional curettage is less costly but may cause unintended damage to non-target tissues. Laparoscopy allows external uterine observation but cannot directly visualize the uterine cavity. The unique advantage of hysteroscopy lies in combining diagnosis and treatment with real-time pathological evidence.
Within 24 hours post-procedure, avoid heavy lifting or vigorous exercise to reduce the risk of uterine bleeding or cramping. Wearing loose clothing is recommended to lessen abdominal pressure. If therapeutic procedures such as adhesion separation are performed, sexual activity may need to be suspended for 1-2 weeks as advised by the doctor.
What anesthesia options are available for hysteroscopy? What are the criteria for choosing?Outpatient hysteroscopy often uses local anesthesia combined with sedatives, while therapeutic procedures may require general anesthesia. The choice depends on the scope of examination, patient age, and lesion location. The physician will evaluate the safest anesthesia plan based on uterine size and patient tolerance.
How long is vaginal bleeding after the procedure considered normal? When is emergency care needed?Light vaginal bleeding or brownish discharge lasting 3-7 days is normal. If bleeding exceeds normal menstrual volume, or if severe abdominal pain, fever over 38°C, or foul-smelling discharge occurs, immediate medical attention is necessary to rule out infection or uterine perforation.
When can patients resume normal work and exercise after hysteroscopy?Most patients can resume light work the day after diagnostic procedures, but should avoid prolonged standing. Postoperative recovery for therapeutic procedures (such as polyp removal) typically takes 3-5 days, with more invasive treatments requiring 1-2 weeks. High-intensity exercise should be avoided until complete uterine healing, usually 4-6 weeks.
How does hysteroscopy compare to traditional open surgery regarding future pregnancy?Hysteroscopy’s low invasiveness allows direct removal of intrauterine lesions (such as adhesions or fibroids), reducing damage to the uterine wall and potentially improving natural conception rates. Compared to open surgery, it causes less tissue damage and has quicker recovery, making it suitable for patients planning pregnancy, although success depends on the severity of the condition.
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