Uteroscopy (med. hysteroscopy) allows the gynecologist to perform an extremely informative inspection of the inside of the uterus. This easy-to-perform and largely low-complication examination method can be used for diagnostic purposes, therapeutic interventions, and to optimize fertility treatment. Because of the relatively short procedure (between five and 60 minutes, depending on the problem), the natural access through the vagina and the short recovery time, uterine endoscopy is performed in most cases on an outpatient basis.
What is endometrial endoscopy?
Because of the relatively short procedure, natural access through the vagina, and short recovery time, uteroscopy is performed in most cases on an outpatient basis. Uteroscopy (hysteroscopy) is one of the standard procedures in gynecology and can also be combined with laparoscopy, depending on the medical issue. During uterus endoscopy, the doctor slides a very thin tube (hysteroscope) through the vagina and through the cervix directly into the uterus under constant visual control in order to assess it professionally from the inside and to prepare and perform any necessary medical interventions there. The camera connected to the light source enables the gynecologist to assess the structure and mucosa of the uterus, as well as the outlets of the fallopian tubes for possible changes. With two to five, maximum ten millimeters, the rod optics are very thin, so that often no or only slight stretching of the cervix or cervix is necessary. The uterus, on the other hand, must be unfolded – for example with a gas containing carbon dioxide or a sterile liquid – in order to ensure an optimal view during endoscopy and thus the best possible diagnostic or therapeutic results. If there is no time pressure, the procedure should be performed in the first half of the cycle due to the more favorable visibility. In most cases, uterine endoscopy is performed under a short general anesthesia.
Function, effect, and goals
The main areas of application of uterine endoscopy are diagnostic, therapeutic and fertility treatment. During purely diagnostic uterus endoscopy, existing complaints or unclear sonographic findings can be clarified and, in the context of aftercare, the success of operations or possibly recurrences of tumor diseases can be determined. Due to the excellent visibility, unexplained causes of bleeding, fibroids (muscular nodules), polyps (outgrowths of the mucous membrane), malignant neoplasms or changes in the mucous membrane can be detected with a high degree of certainty and, moreover, very gently during a uterus endoscopy. Uteroscopy has a special significance in fertility diagnostics, since a large number of possible reasons for infertility or frequent miscarriages (for example, unfavorable conditions for embryo implantation such as a congenital partition or bleeding disorders) are detected. If findings exist, uterine endoscopy is also used for surgical procedures – often in the following cases:
- Ablation of fibroids, polyps or malformations, as well as the severing of congenital partitions (uterine septum).
- Scraping of the uterine cavity
- Ablation of the endometrium (endometrium) in case of heavy menstrual bleeding (only if the desire to have children is no longer present!). This form of therapy can save the patient the removal of the uterus in case of success.
- Solution of adhesions and adhesions after inflammation of the uterus.
- Removal of IUDs that have migrated into the uterus for contraception.
In a variety of diagnostic and surgical procedures, uterine endoscopy is associated with the collection of tissue samples for subsequent histologic examination.
Risks, side effects and dangers
Uteroscopy is a very gentle procedure with few complications in most cases. Heavier bleeding occasionally occurs during surgical endometrial procedures and can usually be well controlled with the aid of a catheter. The risk of penetrating the wall of the uterus with the hysteroscope is extremely low, as the procedure is performed under constant visual control from the beginning.The risk of infection is very small during uterine endoscopy due to the sterile surgical conditions. The risk of infection after the operation can be significantly minimized by conscious behavior on the part of the patient (refraining from using tampons, swimming and sexual intercourse during the healing phase). Normal after-effects of hysteroscopy are a menstrual-like pulling sensation in the lower abdomen, slight bleeding from the wound, and drowsiness as a result of anesthesia. Important: Every hysteroscopy must be preceded by a comprehensive explanatory discussion and a thorough examination. A hysteroscopy should not be performed if the patient is pregnant, has cancer of the cervix or uterus (even if it is strongly suspected), or has an acute infection.
