The indications for operative hysteroscopy include: abnormal uterine or heavy menstrual bleeding, submucosal leiomyoma, uterine polyps, uterine septum, uterine adhesion, or blockage of fallopian tubes.
Intrauterine diseases are usually involved with pathologic lesions (like endometrial polyp, submucosal myoma, or uterine synechiae) or congenital malformation of uterus (like bicornuate or septate uterus). Diagnostic hysteroscopy provides the most direct way to visualize and evaluate the interior of the uterus. When the patients with intrauterine disease suffer from symptoms of abnormal vaginal bleeding, spontaneous abortion or infertility, an operative hysteroscopy would be a therapeutic treatment for these conditions.
The operative hysteroscope can serve not only for the insertion of ancillary devices (ex. scissors or grasper) to perform surgical procedures inside the uterine cavity, but also assist some specific procedures like cannulation of fallopian tube under hysteroscopy. A specialized electrosurgical hysteroscope, called resectoscope, would be also commonly utilized to do the resection of endometrial polyp, uterine myoma or uterine septum.
- The patient is placed in a lithotomy position and is given anesthesia.
- The cervical canal is carefully dilated with Hegars dilators, and the operative hysteroscope is inserted into the uterine cavity under direct vision.
- During the process, we instill the media (usually normal saline) to distend the uterine cavity sufficiently, and the cavity could be scanned with all of the landmarks.
- The operative procedure is then performed through the system of operative hysteroscope.
- Sometimes, a simultaneous laparoscopy is required during specific situations.
The process of an operative hysteroscopy carries risks, including:
- Distending media-related adverse events: excessive fluid absorption (fluid overload) and electrolyte imbalance
- Uterine perforation
- Intra-operative bleeding
- Thermal injury: such injury may occur at adjacent sites like cervix, vagina, and vulva; it could also occur to intraperitoneal structures like bowel if a perforation of uterus happens
- Infection of endometrium or myometrium
- Post-operative intrauterine adhesion
The procedure cost is about 90,000~100,000NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.
Cutting loop is used to shave the myoma body
Hysteroscopic resection of uterine septum