Operative hysteroscopy

A guide to understanding the procedure and its indications

Operative hysteroscopy allows certain abnormalities within the uterus to be treated using a hysteroscope and small surgical instruments introduced through the vagina and cervix. This makes it possible to treat the lesion directly without abdominal incisions.

Although it uses the same route of access as diagnostic hysteroscopy, its purpose is different. While diagnostic hysteroscopy is primarily used to examine and assess the uterine cavity, operative hysteroscopy allows more extensive therapeutic procedures to be performed.

What abnormalities can be treated with operative hysteroscopy?

Indications include endometrial polyps, certain submucosal fibroids, intrauterine adhesions and some malformations of the uterine cavity, such as certain uterine septa.

The procedure may also be used in specific circumstances to remove displaced intrauterine devices or other objects located within the uterus.

Not all abnormalities of the uterine cavity require surgical treatment. The decision depends on factors such as the type and size of the lesion, the patient’s symptoms, age, medical history and reproductive plans.

Endometrial polyps: do they always need to be removed?

Endometrial polyps are growths of the endometrium that protrude into the uterine cavity. They may be discovered during investigations into abnormal uterine bleeding or reproductive difficulties, or incidentally during an ultrasound examination.

The decision to remove them is made individually, taking into account the patient’s symptoms, the size of the polyp, her age and other clinical factors. When surgery is indicated, hysteroscopy allows the polyp to be visualised directly and removed under visual guidance.

Submucosal fibroids and hysteroscopic treatment

Submucosal fibroids grow wholly or partially into the uterine cavity and may be associated with heavy menstrual bleeding, anaemia, reproductive difficulties or other symptoms.

Whether they can be treated by hysteroscopy depends primarily on their size, location and the extent to which they extend into the muscular wall of the uterus.

Small fibroids located predominantly within the uterine cavity are generally more accessible using this approach. When fibroids are larger or extend deeply into the myometrium, the procedure may be more complex and, in some cases, treatment may need to be performed over more than one operation.

Hysteroscopic resection is one of the treatment options considered for submucosal fibroids in the management of heavy menstrual bleeding.

Diagnostic and operative hysteroscopy: what is the difference?

Diagnostic hysteroscopy is primarily intended to provide direct visualisation of the uterine cavity, identify abnormalities and obtain targeted biopsies when indicated.

Some straightforward procedures can be performed during diagnostic hysteroscopy, such as the removal of certain small lesions. However, when an abnormality requires more complex resection, additional instrumentation or specific anaesthetic arrangements, a separate operative hysteroscopy is scheduled.

This distinction allows the procedure to be tailored to the characteristics of each lesion and each patient.

How is operative hysteroscopy performed?

The hysteroscope is passed through the vagina and cervix into the uterine cavity. A liquid distension medium is used to expand the cavity and maintain a clear view during the procedure.

Different surgical instruments can be introduced through the hysteroscope to cut, resect or remove the tissue requiring treatment.

The type of instruments used, the duration of the procedure and the anaesthetic arrangements depend on the lesion, its size and complexity, and the patient’s individual characteristics.

Is operative hysteroscopy always performed in an operating theatre?

Not necessarily.

Some hysteroscopic procedures can be performed on an outpatient basis, while others require an operating theatre, sedation or general or regional anaesthesia.

Factors such as the size and location of the lesion, the anticipated complexity of the procedure, the patient’s tolerance and the instruments required help determine the most appropriate option.

Before the procedure, patients should receive information about what it involves and the available options for managing discomfort and pain.

“The Gynaecology Unit manages conditions related to clinical and aesthetic gynaecology, reproductive health and gynaecological surgery, among other areas.”

Operative hysteroscopy and fertility

Certain abnormalities of the uterine cavity, such as some polyps, submucosal fibroids, adhesions or septa, may be identified during fertility investigations.

In these circumstances, the decision to perform surgery does not depend solely on the presence of a lesion, but also on its characteristics, the patient’s reproductive history and the findings of the overall fertility assessment.

When surgery is indicated, hysteroscopy allows certain abnormalities to be treated using the natural route of access to the uterus, avoiding abdominal incisions.

What can be expected after the procedure?

After operative hysteroscopy, patients may experience period-like cramps and light vaginal bleeding during the first few days.

Recovery time depends on the complexity of the procedure, the type of lesion treated and the anaesthetic arrangements. Recovery is relatively quick after many procedures, but patients should follow the medical team’s specific recommendations regarding physical activity, sexual intercourse, tampon use and other activities.

When sedation or anaesthesia has been used, patients must also follow the specific advice provided about driving and other activities during the hours following the procedure.

Possible risks and complications

Operative hysteroscopy is a minimally invasive technique, but, like any surgical procedure, it is not entirely risk-free.

Possible complications include bleeding, infection and, rarely, perforation of the uterine wall. During certain procedures, the amount of fluid used to distend the uterine cavity must also be carefully monitored.

The level of risk depends partly on the complexity of the procedure and the type of lesion being treated. The medical team explains the specific circumstances of the planned intervention and the measures taken to minimise these risks beforehand.

When should you seek medical advice after operative hysteroscopy?

The medical team provides each patient with specific instructions following the procedure.

Medical advice should be sought if bleeding increases or becomes heavier than expected, if severe or worsening pain does not respond to the prescribed treatment, or if fever, significant malaise or unpleasant-smelling vaginal discharge develops.

If any symptoms occur that do not correspond to the expected recovery explained by the medical team, patients are advised to contact the clinic to determine whether a follow-up assessment is needed.

Further information

Below are the authorship details and references for the information provided on this page.