High-Volume Diagnostic and
Surgical Hysteroscopy Center
Introduction
Hysteroscopy is a minimally invasive endoscopic technique for diagnosis and treatment that allows visualization of the uterine cavity using an instrument called a hysteroscope.
If it is limited to diagnosis, the method is called Diagnostic Hysteroscopy.
When it is used to perform surgical procedures, it is referred to as Operative Hysteroscopy, Hysteroscopic Surgery, or Resectoscopic/Mini-Resectoscopic Surgery.
The Hysteroscopy Center at Malzoni Research Hospital has 2 Surgical Clinics (at Diagnostica Medica) and 3 Operating Rooms (at Malzoni Research Hospital) fully dedicated to Diagnostic and Surgical Hysteroscopic, Resectoscopic, Mini-Resectoscopic Procedures, or procedures assisted by a Diode Laser.
Advantages
Hysteroscopy offers undeniable advantages: it does not require opening the abdomen or uterus, which reduces trauma to pelvic organs and avoids internal or external scars. Consequently, the risk of infections due to environmental contamination is also reduced. Overall, recovery of normal work and social activities is faster compared to traditional surgical procedures.
Complications
Diagnostic hysteroscopy is almost risk-free, whereas operative hysteroscopy can rarely pose the following risks: nausea and vomiting due to anesthesia; possible but very rare uterine perforation; cardiovascular overload during the procedure, known as intravasation.
Surgical Technique
DIAGNOSTIC HYSTEROSCOPY
The examination is performed in almost all cases in an outpatient setting without anesthesia and without any special preparation. During the examination, a biopsy sample may be necessary. In certain cases (such as severe cervical canal stenosis preventing hysteroscope entry into the uterine cavity or excessive patient anxiety) that discourage outpatient execution, the exam may be performed in a day-surgery setting or in an outpatient setting with sedation or peripheral anesthesia.
During the procedure, the woman may experience some discomfort due to uterine dilation, which usually lasts only a few minutes. After the exam, minor vaginal bleeding may occur.
In rare cases, a vagal reaction may occur. Generally, the patient can resume her usual activities immediately after the exam, and only rarely is a brief observation period of a few minutes required following the procedure.
OPERATIVE HYSTEROSCOPY or RESECTOSCOPY/MINI-RESECTOSCOPY
The procedure is performed in the operating room or a dedicated surgical clinic and requires anesthesia (sedation with mask-assisted respiration or spinal anesthesia) due to the use of instruments with a larger diameter than those needed for diagnostic procedures and the necessity of cervical canal dilation.
With these instruments, it is possible to perform resection using monopolar and bipolar current for intracavitary conditions (polyps, fibroids, adhesions, septa, early neoplasms) and their removal.
For certain operative hysteroscopy procedures (especially for large fibroids), preoperative therapy may be necessary for several months with medications aimed at reducing the size of the condition and intraoperative bleeding. Despite preoperative therapy, sometimes the surgical procedure cannot be completed in one session, requiring a second procedure and a new hospitalization (two-stage surgery).