Hysteroscopy Surgery in Pune

1. Accurate Diagnosis : 

Hysteroscopy allows for direct visualization of the uterine cavity, enabling gynecologists to identify the exact location and nature of abnormalities like Polyps, Fibroids, adhesions or Growth ( Cancer or noncancer )

2. Minimally Invasive : 

Compared to traditional open surgeries, hysteroscopy is a minimally invasive procedure, often performed as an office procedure, an outpatient procedure, or a day care surgery, resulting in less pain, faster recovery, and reduced scarring. 

For example, huge submucous Fibroids can be removed by Hysteroscopy in two settings, and that will be an even more minimally invasive procedure than laparoscopy.

3. Office Hysteroscopy:

Where a doctor uses a tiny hysteroscope of size 2.9 or 1.9 mm to diagnose and treat conditions in OPD settings without any sedation or anaesthesia, and patients can go home immediately like an OPD consultation.

4. Outpatient Procedure:

Many hysteroscopies can be performed in an outpatient setting with potential sedation or anaesthesia. Minimizing hospital stays and allowing for quicker return to normal activities. 

5. Diagnosis and treatment in the same setting : 

Hysteroscopy can help identify structural abnormalities in the uterus that may contribute to recurrent miscarriages, and the same may be rectified to prevent further miscarriage.

6. Improved Fertility : 

By addressing uterine issues that may hinder implantation or cause recurrent miscarriages, hysteroscopy can improve the chances of successful conception and pregnancy, especially when combined with IVF. 

7. Reduced Need for Hysterectomy :

In some cases, hysteroscopy can be used to treat conditions like Fibroids or polyps that might otherwise require a hysterectomy, potentially preserving the uterus and its related functions. 

When is the hysteroscopy performed?

The ideal time for hysteroscopy is immediately after stopping menstrual bleeding.

Types Of Hysteroscopy :

1. Office Hysteroscopy

2. Outpatient Hysteroscopy

3. Diagnostic Hysteroscop

To examine the uterine cavity for conditions like post menopausal bleeding, missing thread of IUD, like CuT.

Post menopausal bleeding – 

Previously, cancer of the uterus was considered the most common cause for post menopausal bleeding, but with the advancement of Hysteroscopy, it is now clear that a polyp is the most common cause for post menopausal bleeding.

Missing IUCD thread by doing ultrasonography, we can confirm the presence of an IUCD, but with Hysteroscopy, we can diagnose and remove the device in an office Hysteroscopy.

4. Operative Hysteroscopy : 

Can be a continuation of diagnostic Hysteroscopy or planned operative Hysteroscopy for conditions like Fibroids, adhesions, septum…

To treat the conditions identified during diagnostic Hysteroscopy or other imaging tests such as USG, MRI etc.

Procedure Of Hysteroscopy : 

A Hysteroscopy is a simple procedure performed on an outpatient or day-case basis.

A local/general anaesthesia is preferred according to the surgical procedure to be performed.

The procedure usually takes between 5 to 30 minutes.

It again depends on the type and severity of the disease.

While performing  Hysteroscopy, normal saline is used as a distension medium. Inspection of the vagina, cervix, cervical canal, and uterine cavity is performed, and if any pathology is noticed can be treated at the same time.

A hysteroscope is inserted into the uterus through the vagina.

Most of the conditions are treated without dilatation of the cervix using five fringe instruments. Sometimes, cervical dilatation may be required to deal with bigger masses(Fibroid) where a resectoscope is required to be introduced through the cervix.

Whereas in operative Hysteroscopy, is performed to treat a condition such as fibroids or polyps, fine surgical instruments can be passed along the hysteroscope. 

These are used to cut or burn away the abnormal tissue

Hysteroscopic surgeries/ operations :

Hysteroscopic polypectomy : 

Most commonly carried out hysteroscopic procedure.

Polyps are one of the leading causes of infertility, postmenopausal bleeding, and abnormal uterine bleeding 

Office hysteroscopy is the best way to diagnose and remove the polyp.

2. Hysteroscopic Myomectomy : 

Submucous Fibroids(FIGO type 0,1and 2)  are known for causing excessive, heavy, or prolonged menstrual bleeding, intermenstrual bleeding, and pain in the pelvis.

FIGO type 0,1, and to some extent type 2 Fibroids are better removed by Hysteroscopy than by laparoscopy.

 Fibroids up to the size of 5 cm can be removed with the help of a saline plasma bipolar resectoscope in one setting.

3. Hysteroscopic Adhesiolysis : 

Intrauterine adhesions are caused after infection, following procedures like D & C, surgical abortion, operative Hysteroscopy, etc.

Adhesions are one of the etiological factors for infertility, Subfertility, and painful periods.

Adhesion bands are released and excised with hysteroscopic scissors Extensive intrauterine adhesions can cause obliteration of the Uterine cavity, leading to cessation or stoppage of menstrual bleeding, and this condition is called Asherman’s syndrome.

Sometimes, Asherman’s syndrome may require multiple settings of hysteroscopic adhesiolysis. To prevent adhesion formation or recurrence of adhesion following operative hysteroscopy, we can use an adhesion barrier inside the uterine cavity.

4. Hysteroscopic biopsy: 

Any suspicious growth of the endometrium or endocervical canal can be biopsied with a hysteroscopic grasper.

With the added advantage of taking an accurate biopsy from the precise area. 

5. Hysteroscopic septum resection:

Intrauterine Septum is a common cause for infertility, failure of implantation, Abortion, premature delivery, and undesired outcome during pregnancy. Hysteroscopic septum resection/ excision using scissors gives an excellent outcome in future pregnancies. 

6. Hysteroscopic removal of retained products of conception ( RPOCs ): 

Incomplete abortion by surgical method (dilatation and curettage) could be because of abnormal invasion of the placenta. This is an ideal situation to remove and ensure complete removal of tissue under vision with the hysteroscope.

 7. Hysteroscopic unification of a bicornuate uterus and other anomalies:

 Congenital anomalies are known for infertility and poor pregnancy outcomes. While organ development two horns unite to form a single uterus. Rarely, the fusion may not take place as deceased and result in various congenital anomalies. Hysteroscopic septum resection and unification of the two halves give excellent outcomes during future pregnancy.

 8. Hysteroscopic proximal tubal cannulation: 

Infertility patients diagnosed with Fallopian tube blockage on HSG is subjected to opening the blockage with the help of a technique called proximal tubal cannulation under hysteroscopic guidance and confirmed by laparoscopy in the same setting.

9. Hysteroscopic Uterine cavity enhancement or Hysteroscopic metroplasty:  

Lateral wall or fundal adhesions inside the uterus could be the reason for infertility or subfertility. Hysteroscopic lateral and fundal metroplasty is a good way to increase the size of the uterine cavity to its normal size and give a desired outcome during pregnancy.

10. Hysteroscopic TCRE ( Trans Cervical Resection of Endometrium ): 

Women with heavy menstrual bleeding with no obvious pathology and not desirous of pregnancy but willing to preserve the uterus are the ideal patients for TCRE. This procedure is carried out under anesthesia with the help of a loop resectoscope, where endometrial lining is removed, and the patient can be discharged on the same day.

This can prevent the removal of the Uterus (Hysterectomy), which is comparatively more invasive than TCRE.

11. Subendometrial Cavity / Adenomyoma Treatment: 

Sub-endometrial cavity or sub-endometrial adenomyoma can be the cause of painful periods (dysmenorrhoea), heavy menstrual bleeding, and infertility. Hysteroscopic removal of the cavity or Adenomyoma gives an excellent outcome with symptom relief and achieving a positive pregnancy.

12. Hysteroscopic foreign body removal (Cu T): 

Foreign bodies like a missing thread of CuT or residual foetal bone are best managed with the help of Hysteroscopy.

13. Hysteroscopic sub-endometrial PRP / stem cell injection: 

Various studies have proved that Infertility patients with poor endometrium and not responding to the medical line of management are best treated with sub-endometrial injection of platelet-rich plasma under hysteroscopic guidance.

Recovery After Hysteroscopy : 

A patient can go home soon after an Office  Hysteroscopy.  Typically, after a brief hospital stay of a few hours after Operative Hysteroscopy under anaesthesia.

Women can usually return to their normal activities later the same day or the following day if no anaesthetic or just a local anaesthetic was used. 

If one had a general anaesthetic, one may need to take things easy for a day or two.