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 primary goal is to provide real-time imaging assistance, helping physicians accurately determine the cause and execute treatment, with advantages of minimal invasiveness and quick recovery.
This procedure is often applied in complex gynecological cases, such as suspected endometrial abnormalities, intrauterine adhesions, or residual tissue after miscarriage. Depending on clinical needs, a diagnostic hysteroscopy may be performed 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 uterine cavity images to a monitor via the endoscope 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 hysteroscope, providing a direct view of the uterine cavity, and using distension media (such as saline solution) 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 procedure."
Hysteroscopy is suitable for various gynecological issues, including endometriosis, submucosal fibroids, Asherman’s syndrome (intrauterine adhesions), and recurrent spontaneous miscarriage diagnosis. 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 intrauterine anatomical abnormalities. When ultrasound or MRI suggests possible intrauterine lesions, hysteroscopy can provide immediate histological analysis via tissue biopsy, enhancing diagnostic accuracy.
Hysteroscopy is usually performed in outpatient or day surgery settings, 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 operation. 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 at 50-80W) are controlled to prevent tissue burns. Postoperative care instructions are adjusted based on the extent of 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, hypersensitivity to distension media, or short-term bleeding post-surgery. About 5-10% of patients may experience uterine perforation, especially in cases of abnormal uterine shape. Rarely, cases may lead to thermal burns or infections, requiring close monitoring of temperature and discharge changes.
Serious complications include uterine rupture or massive bleeding, requiring immediate surgical hemostasis. Postoperative mild abdominal pain or minor bleeding may occur, usually resolving 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 activity and tampon use to reduce infection risk. Patients with a history of uterine surgery should inform the physician to assess uterine wall elasticity.
Hysteroscopy may work synergistically 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 and reduces the risk of over-curettage of normal tissue. Patients with severe intrauterine adhesions may need hysteroscopic adhesiolysis before other treatments.
Studies show that hysteroscopy has an accuracy rate of up to 95% in diagnosing intrauterine lesions, especially superior to ultrasound in locating submucosal fibroids. The success rate of fibroid removal via therapeutic hysteroscopy is 85-90%, with a postoperative menstrual reduction rate exceeding 70%.
Clinical data indicate that patients with intrauterine adhesions undergoing hysteroscopic adhesiolysis have a pregnancy rate increase 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 provides three-dimensional images of the uterus but cannot offer immediate treatment.
Traditional curettage is less costly but may cause damage to non-target tissues. Laparoscopy allows external uterine observation but cannot directly visualize the intrauterine structure. The unique advantage of hysteroscopy lies in combining diagnosis and treatment, providing immediate 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 a therapeutic procedure (such as adhesiolysis) was performed, sexual activity should be avoided for 1-2 weeks as advised by the physician.
What anesthesia options are available for hysteroscopy? How is the choice made?Outpatient hysteroscopy typically uses local anesthesia combined with sedatives, while therapeutic procedures may require general anesthesia. The choice depends on the scope of the examination, patient age, and lesion location. The physician will evaluate the uterine size and patient tolerance to determine the safest anesthesia plan.
How long does vaginal bleeding last after the procedure? When is it considered normal? When should I seek urgent medical care?Light vaginal bleeding or brownish discharge usually lasts 3-7 days and 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 I resume normal work and exercise after hysteroscopy?Most patients can return to light work the day after diagnostic procedures, but should avoid prolonged standing. After therapeutic surgery, rest for 3-5 days is recommended; recovery from invasive procedures like polyp removal may take 1-2 weeks. High-intensity exercise should be delayed until the uterus is fully healed, typically 4-6 weeks.
How does hysteroscopy impact future pregnancy compared to traditional open surgery?The minimally invasive nature of hysteroscopy 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 rates depend on the severity of the condition.
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