A hysteroscope is placed through the cervix (birth canal) with no incision after dilation (stretching) of the cervix. The dilation is less than that for a D&C (dilation and curettage). With a hysteroscope, we can see inside the uterus. Dr. Martin is usually assisted by surgical assistants or by hospital personnel. Other doctors in practice or in training will be introduced to you if they are present.
Laparoscopy is done the same time when tubal cannulation is performed. This is to decrease the chance of damage to the tube and look for other problems.
These are generally out-patient procedures.
- You may be asleep from 15 minutes to 1 hours.
- Common side effects include cramping (particularly with D&C or ablation), vaginal bleeding, bloating, itching if the hair is shaved, bladder spasm and sore throat.
- Nausea and vomiting may occur following surgery. Have a plastic bag and towels in your car on the chance this happens on the way home.
- About 1 in 50 patients stay overnight due to nausea, drowsiness, pain or excess fluid absorption after resection of fibroids or ablation.
Other complications such as bleeding, infection, allergy, and urinary retention, require hospitalization in 1 in 400 patients. Major complications may require surgery or blood transfusion in 1 in 1,200 cases. Some difficult cases may require open surgery to complete the surgery or for complications. Complications such as hysterectomy, decreased sexuality, colostomy, paralysis, coma or death are rare.
The chance of complications increases with the time and difficulty of the case. Due to this, certain parts of the surgery may be avoided if these appear to significantly increase the risk. In case of large fibroid tumors or septae with partial miscarriage, it may be safer to do a partial operation and come back later to complete the surgery.
Pictures may be taken during surgery to show you what was seen and done. They are also used to teach other patients and other surgeons.
- You should avoid any activities that require concentration for 2 days.
- You can usually return to work and normal tasks by 2 to 5 days.
- You can usually start having sex at 3 days to 3 weeks.
- You may have cramps for 1 day to 3 weeks.
- You may need 1 to 6 weeks for your energy to return.
At the time of hysteroscopy, open surgery (laparotomy) may be needed to care for an emergency or it may be seen as a better approach. We are always ready to do open surgery in an emergency. However, additional preparation such as medication, bowel prep or banking your own blood may be useful in other situations. Also, open surgery generally requires 1 to 12 days in the hospital and 3 to 8 weeks for recovery. If there are reasons for this before surgery, we will make plans for decisions about open surgery. Otherwise, we will stop and make decisions at a later date.
Your insurance plan may not cover the total cost of extensive operative hysteroscopy. In addition, some insurance plans have participating physicians. You should clarify your insurance coverage before you schedule surgery.