Operative hysteroscopy is a minimally invasive surgical procedure used to diagnose and treat various intrauterine conditions. It involves the insertion of a hysteroscope—a thin, lighted telescope-like device—through the cervix into the uterus. This technique allows direct visualization of the uterine cavity, enabling surgeons to perform a variety of therapeutic interventions with precision. Here, we delve into the key aspects of operative hysteroscopy, including its indications, techniques, benefits, and potential complications.

Indications
Operative hysteroscopy is indicated for the treatment of several intrauterine pathologies, including:

Endometrial Polyps: Benign growths of the endometrial lining that can cause abnormal uterine bleeding.
Submucosal Fibroids: Fibroids located within the uterine cavity that can cause heavy menstrual bleeding and infertility.
Intrauterine Adhesions (Asherman's Syndrome): Scar tissue within the uterine cavity that can lead to menstrual abnormalities and infertility.
Septate Uterus: A congenital uterine anomaly where a septum divides the uterine cavity, potentially leading to recurrent miscarriages.
Retained Products of Conception: Residual placental or fetal tissue following a miscarriage or delivery.
Foreign Bodies: Such as intrauterine devices (IUDs) that may need removal.
Chronic Endometritis: Persistent inflammation of the endometrium.
Technique
Operative hysteroscopy is typically performed under general anesthesia, although local anesthesia or conscious sedation may be used in some cases. The procedure involves several key steps:

Patient Preparation: The patient is positioned in the lithotomy position, and the cervix is dilated if necessary.
Insertion of the Hysteroscope: A hysteroscope is inserted through the cervix into the uterine cavity. The uterine cavity is distended with a liquid (normal saline or glycine) or gas (carbon dioxide) to provide better visualization.
Diagnostic Assessment: The uterine cavity is inspected for abnormalities.
Therapeutic Intervention: Using specialized instruments passed through the hysteroscope, the surgeon can perform various procedures such as polypectomy, myomectomy, adhesiolysis, septum resection, or foreign body removal.
Hemostasis and Closure: Bleeding is controlled using various techniques, and the hysteroscope is carefully removed.
Benefits
Operative hysteroscopy offers several advantages over traditional surgical approaches:

Minimally Invasive: The procedure is performed without abdominal incisions, resulting in less postoperative pain and faster recovery.
Direct Visualization: Provides clear and magnified visualization of the uterine cavity, allowing precise diagnosis and treatment.
Reduced Hospital Stay: Most patients can go home the same day.
Fertility Preservation: Allows for treatment of conditions that can affect fertility while preserving the uterine structure.
Potential Complications
While operative hysteroscopy is generally safe, complications can occur. These include:

Uterine Perforation: Accidental puncture of the uterine wall, which may require additional surgical intervention.
Infection: Risk of introducing infection into the uterine cavity.
Fluid Overload: Excessive absorption of distension fluid can lead to electrolyte imbalances.
Bleeding: Uncontrolled bleeding may necessitate further surgical management.
Adhesions: Formation of intrauterine adhesions post-procedure.
Conclusion
Operative hysteroscopy is a valuable tool in the armamentarium of gynecologic surgery, offering a minimally invasive option for the diagnosis and treatment of various intrauterine conditions. Its ability to provide direct visualization and precise treatment makes it an essential procedure for managing conditions such as endometrial polyps, fibroids, adhesions, and congenital anomalies. As with any surgical procedure, careful patient selection, thorough preoperative assessment, and adherence to surgical principles are crucial to optimizing outcomes and minimizing complications.

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World Laparoscopy Training Institute
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