Hysteroscopic surgery can also be performed to treat a condition of the uterus in which bands or adhesions develop (septate uteri). Studies have shown that pregnancy rates of 70% to 80% can be expected (Fayez, 1986), which is better than open surgery . It can also be performed to remove a dislodged intrauterine device (IUD), sometimes even during early pregnancy. Hysteroscopic surgeries cannot be performed if there are acute pelvic infections, cervical cancers, uterine cancers or unusual hyperplasia.
Sometimes, complications (such as uterine perforation, damage to the tissues and blood vessels, gas embolism, infection, and post-operative bleeding) can develop following hysteroscopic surgery. Studies have even shown that small quantities of endometrial tissues left behind can re-grow and form cancers, several years later (Copperman et al, 1993) . This occurred when hormone replacement therapy was not advocated. The patient has to be explained the benefits and the risks of the procedure before treatment.
They have to be shown the advantages and the limitations hysteroscopic surgery has over conventional surgeries. Before performing the surgery, diagnostic tests such as ultrasound, diagnostic hysteroscopy and biopsy, need to be conducted to ensure the feasibility of hysteroscopic surgery. Hysteroscopic procedures are usually performed following the postmenstrual phase of the menstrual cycle (as the bleeding is minimal, chances of pregnancy are absent, and the endometrium is relatively normal or not thick).
Sometimes, medications (such as medroxyprogestrome and danazol) are administered before the surgery to alter the menstrual cycle and condition the endometrium. Minor hysteroscopic surgeries may not require admission to the hospital. The procedure usually requires administration of an anesthetic agent (local, spinal or general anesthesia) to make the patient comfortable during the procedure. Before inserting the instrument, the cervix is thoroughly cleansed with saline. Cervical dilators are usually not required, in the postmenstrual phase.
After the procedure, the individual should not exercise for 3 to 4 weeks due to the risk of bleeding. Usually, complications are very rare following hysteroscopic surgery, and the individual may be able to perform regular activities within 2 to 3 weeks. Some level of activities can be performed within 4 to 5 days after the surgery. A few individual may have mild pain in the lower portion of the abdomen for a few days after the surgery.
References: Chen, P. (2004). Asherman’s syndrome. Retrieved November 26, 2006, From Medical Encyclopedia Medline Plus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001483.htm