Hysteroscopy (Operative)

Operative hysteroscopy is a procedure that uses a thin scope inside the uterus to treat problems found there. Small instruments pass through a channel in the scope, the hysteroscope. The procedure moves directly from inspection to treatment. The same view of the uterine cavity becomes the surgical field. In most cases, it needs no incision in the abdomen and no separate hospital stay.¹²

Common uses include removal of polyps of the uterine lining and of fibroids that bulge into the cavity (submucosal leiomyomas). Surgeons also use it to divide a uterine septum. They can cut scar bands inside the uterus in Asherman syndrome or repair an isthmocele. They can also remove a misplaced IUD or pass a thin tube into the fallopian tubes (tubal cannulation).

Many of these procedures can take place in the office. Results are often similar to those in the operating room. Office procedures also avoid general anesthesia and cost less.¹²

In a root-cause fertility evaluation, the procedure addresses structural problems inside the uterus. These problems hinder implantation or add to pregnancy loss. Examples include a septum that divides the lining, scar bands that shrink the cavity, or a polyp at the site where an embryo would implant. These causes are correctable. Their treatment restores the uterus instead of bypassing it.

A cesarean scar can leave a defect in the lower uterus. Hysteroscopic isthmocele repair addresses that defect.

First, a diagnostic hysteroscopy or SIS defines the problem. When the two steps happen back to back, diagnosis and treatment take place in one procedure.²