During diagnostic hysteroscopy the hysteroscope is used just to observe the inside of the uterus During operative hysteroscopy, the resectoscope, a type of hysteroscope, is used, which has revolutionized surgery inside the uterus. The resectoscope has channels through which it is possible to insert very thin surgical instruments. It also has a wire loop that uses high-frequency electrical current to cut or coagulate tissue. These instruments can be used to remove polyps and fibroids, to cut adhesions, and do other intra uterine procedures. Procedures using the resectoscope are done in an operating room setting, under general anaesthesia, but as an outpatient procedure. There are no stitches with this procedure.

Abnormal uterine bleeding may be due to a hormone imbalance or the presence of abnormal tissues such as fibroids (myomas), polyps, or cancer of the endometrium or uterus. If a specific cause for abnormal bleeding is identified, treatment is directed to that cause. If no specific anatomical cause is identified or if hormone disturbances do not improve with hormonal therapy, endometrial ablation (destruction of the uterine lining) may be an alternative to hysterectomy.

Listed below are operative procedures that can be carried out through the hysteroscope :

Trans Cervical Endometrial Resection (Endometrial Ablation)

Endometrial ablation is a procedure to permanently remove a thin tissue layer of the lining of the uterus (the endometrium) to stop or reduce excessive or abnormal bleeding in women for whom childbearing is complete. The lining is destroyed with a mild electrical current or heat. This process prevents the lining from growing back. A woman cannot become pregnant after ablation though she still has her reproductive organs.

It is offered to those patients who do not want their organs removed and for patients who do not want or are not fit for major surgery.

An ablation is not recommended if :

• The patient desires to keep her fertility.
• The uterine cavity is very large (greater then 12 cms)
• Severe dysmenorrhea (menstrual cramps)
• Vaginal/cervical/pelvic infections

Most women are able to go home within an hour after the endometrial ablation. There may be mild cramping, which can usually be relieved by pain killers. After an ablation the bleeding decreases. For some women it may stop altogether. The first few periods may be heavy after the procedure but thereafter it settles down Even if the bleeding does not stop completely, the flow is likely to be much lighter.

Resection of myomas (hysteroscopic myomectomy) and polypectomy

Submucous and intracavitary myomas can often be removed through the cervix with a resectoscope . The fibroids are shaved off with a wire loop using a high-frequency electrical current to cut and coagulate tissue. Medication may be used prior to the surgery if the fibroids are too large. The procedure may be repeated if the fibroid is too large and cannot be removed in one sitting.

Uterine Polyps are small growths dangling in the cavity of the womb and can be removed in the same manner as a submucous myoma and is known as a polypectomy.

Lateral Metroplasty

This procedure is done to increase the size of the uterine cavity when the uterus has not developed sufficiently in size (hypoplastic uterus) due to congenital problems (problems from birth).

The procedure is done using the resectoscope, in patients with a T shaped uterus or a small uterine cavity. Vertical slits are made in the sides of the uterine wall to enlarge the uterine cavity. Pregnancy implantation rates are known to improve following this procedure.

Hysteroscopic Adhesiolysis

Hysteroscopic Adhesiolysis is the lysis of adhesions or bands in the uterine cavity. Intra uterine adhesions obliterating or distorting the uterine cavity can occur as a consequence of infection or surgery such as D&C (scraping of the uterus). They prevent the implantation of a pregnancy or cause recurrent miscarriages. These adhesions can be cut fairly successfully, using the resectoscope.

Septum Resection

A septum is a congenital malformation of the uterus where the uterine cavity is partially divided by a ‘curtain’ of uterine tissue. In effect it also reduces the size of the uterine cavity. It is possible to cut the septum with the resectoscope and make the uterine cavity uniformly one.