Video hysteroscopy, or hysteroscopy, is a procedure where the inside of the cervix and uterus is visualized using a camera attached to the TV monitor. Two types of the procedure are generally performed: diagnostic and operative hysteroscopy.
Diagnostic hysteroscopy allows the visualization of the inside of the uterus and diagnosis of such common conditions as fibroids, uterine polyps, uterine septum, etc.
During the procedure, which can be done either in the office settings under local anesthesia or in the operating room under general anesthesia, the camera (hysteroscope) is placed through the vagina and the cervix into the uterus. In majority of cases, there is no need to dilate (open) the cervix. The inside of the uterine cavity is examined and problems, if any, are noted. In cases of abnormal uterine bleeding, a physician can choose to take a sample of the endometrial lining utilizing tiny suction tube.
Operative hysteroscopy is usually done in the operative room under general anesthesia. This procedure is reserved for patients with known intrauterine pathology such as previously diagnosed fibroids that may cause bleeding and infertility, uterine polyps, uterine septum, blocked Fallopian tubes, etc.
The cervix will need to be slightly dilated to allow the passage of the operative hysteroscope inside the uterus. Sterile fluid is also infused into the uterus to allow for better visualization. Certain types of fibroids, polyps, or any other defects can be treated and removed by using electrical and mechanical hysteroscopic instruments. Very often the biopsy of the endometrial lining is performed at the same time (known as D & C).
One of the subtypes of the operative hysteroscopy is a procedure known as endometrial ablation. Endometrial ablation is indicated in women who have finished their reproductive years and have heavy and/or irregular bleeding. After uterine cancer as a cause of bleeding is ruled out, which is often done by the in-office diagnostic hysteroscopy, the endometrial ablation can be performed. Result of multiple studies have shown very good outcomes and satisfaction among women who underwent endometrial ablation.
In complicated cases of pelvic pain and/or infertility, a physician might choose to perform hysteroscopy together with laparoscopy (looking inside your abdomen and pelvis).
Read more about different types of endometrial ablation from American College of Obstetricians and Gynecologists or from Ob/Gyn Management.