Diagnostic Hysteroscopy – Office – Operative

What is Hysteroscopy?

Hysteroscopy is an endoscopic gynecological procedure that allows for the direct analysis of the health status of the uterine cavity, cervical canal, and endometrium, and, if necessary, therapeutic procedures. It is a minimally invasive technique that, through the use of a very thin camera optic and suitable instruments, enables the diagnosis (diagnostic hysteroscopy) and treatment (office and operative hysteroscopy) of various pathological conditions.

Hysteroscopy can be performed in women of all ages, provided they are not pregnant.

Is it Painful?

For the majority of patients, the examination is confined to discomfort or minimal tolerable pain, characterized by cramp-like sensations similar to menstrual cramps.

What is its Purpose?

Hysteroscopy is an endoscopic technique used for diagnosis and also for the treatment of certain pathologies (for example, removing adhesions or small polyps).

Diagnostic hysteroscopy is used to monitor the health status of the uterus, cervix, and endometrium in the presence of specific symptoms and abnormal conditions such as:

• Abnormal bleeding
• Couple infertility
• Recurrent miscarriages
• Previous gynecological tests with suspicious results (PAP tests and transvaginal ultrasounds)

How and Where is it Done?

Diagnostic hysteroscopy is performed on an outpatient basis (directly at the doctor’s office in cases of “office hysteroscopy”), with the only absolute contraindication being pregnancy.

No specific preparation or prophylaxis is required for undergoing diagnostic hysteroscopy. The patient does not need to fast or discontinue any drug therapies. However, she should inform the doctors if she is taking anticoagulant medications. The examination is not painful and does not involve the administration of medications, contrast agents, or anesthetics.

An electrocardiogram and a cardiac examination are recommended to prevent any vagal syndrome-related cardiac complications.

Office Hysteroscopy

Thanks to the continuous evolution of medical instruments, it is now possible to perform many treatments directly in the doctor’s office with the patient awake, without the need for anesthetics or sedatives.

With this technique, almost all benign pathologies can be treated directly during the observation phase (see and treat technique). It reduces the need for general anesthesia in the operating room by 25-30%, without requiring hospitalization.

All small and non-neoplastic pathologies (polyps, small fibroids, uterine synechiae, endometrial biopsies) can be treated in the office with hysteroscopy.

In particular:

• Endometrial polyps
• Endocervical polyps
• Intrauterine fibroids less than 1 cm (myomectomy)
• Uterine septa (septoplasty)
• Endocervical and endometrial intrauterine adhesions (synechiolysis)
• Endometrial biopsies
• Endocervical biopsies
• Removal or repositioning of intrauterine contraceptive devices (IUDs)
• Evaluation of patients taking Tamoxifen for breast cancer therapy for monitoring of endometrial hyperplasia

Operative Hysteroscopy is a true intervention that, in addition to its diagnostic value, also performs a surgical function. It is usually aimed at the removal of uterine polyps (endometrial or cervical), fibroids, or tumors that have been previously identified.

The procedure is performed in the operating room and requires anesthesia. Normally, operative hysteroscopy is performed on a Day Hospital basis, with a limited hospital stay of a few hours.

Operative hysteroscopy in the operating room is indicated for the treatment of:

• Large-sized polyps
• Complete uterine septa
• Severe synechiae
• Fibroids > 1 cm or with a prevalent intramural component