Dr Croak is now able to offer office hysteroscopy for many patients as an alternative to a procedure performed in the hospital. For those patients who safely meet criteria, office hysteroscopy involves local sedation without the need for heavy anesthesia.
A thin lighted telescope with a video camera, called a hysteroscope is gently inserted up through the uterine cervix and into the uterine cavity. Gas or liquid is instilled into the uterus in order to see the overall uterine cavity and the uterine walls.
Hysteroscopy may be performed in women who have an abnormal Pap test, dysfunctional uterine bleeding, or postmenopausal bleeding. It may be used to help diagnose causes of infertility or repeated miscarriages. Hysteroscopy may also be used to evaluate uterine adhesions (Asherman’s syndrome), polyps, and fibroids, and to locate and remove displaced intrauterine devices (IUDs).
Therapeutically, hysteroscopy may be used to help correct uterine problems. For example, small adhesions and fibroids may be removed through the hysteroscope, often eliminating the need for open abdominal surgery. Endometrial biopsy or ablation (removal of the endometrial lining) may be performed via hysteroscopy.
Endosee Office Hysteroscopy
A game-changing device that lets OB/GYNs directly visualize the uterine cavity at the point-of-care, to get a diagnosis quicker. The all-in-one, handheld, portable, cordless system allows you to complete a diagnostic hysteroscopy in an average of 3 minutes. The Endosee procedure is well-tolerated, similar to an EMB - anesthesia is usually not required.
A less invasive form of tubal sterilization, called Essure may also be completed in the office through the use of the hysteroscope. The Essure procedure is the first and only FDA approved female sterilization procedure to have zero pregnancies in the clinical trials. The Essure procedure is permanent and is NOT reversible. Therefore, you should be sure you do not want children in the future.
The Essure procedure is different than the traditional method of a surgical tubal ligation. With Essure there is no cutting into the body. Instead, Dr. Croak inserts spring-like coils, called micro-inserts, through the body’s natural pathways (vagina, cervix, uterus). For more infomation on the Essure procedure, please visit: www.essure.com
Risks of the Procedure
As with any surgical procedure, complications may occur. Some possible complications of hysteroscopy may include, but are not limited to, the following:
pelvic inflammatory disease
perforation of the fallopian tubes uterus (rare)
post procedural tubal pain or coil migration
You may experience slight vaginal bleeding and cramps for a day or two after the procedure.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
Certain factors or conditions may interfere with a hysteroscopy. These factors include, but are not limited to, the following:
pelvic inflammatory disease
Before the Procedure
Your physician will explain the hysteroscopy procedure to you and offer you the opportunity to ask any questions that you might have.
You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
For certain more invasive hysteroscopy procedures: In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
Depending on the type of procedure to be performed, you may be asked to fast before the procedure if you are to receive local or general anesthesia. The procedure may be performed with local or regional anesthesia or without anesthesia depending on what other procedures are to be performed at the same time.
If you are pregnant or suspect that you may be pregnant, you should notify your physician.
Notify your physician if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).
Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
Depending on the procedure to be performed, you may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
You will be scheduled to undergo the procedure after menstrual bleeding has ended and before ovulation. This allows better visualization of the uterus and avoids damaging a newly formed pregnancy.
Dress in clothes that permit access to the area or that are easily removed.
Based upon your medical condition, your physician may request other specific preparation.
During the Procedure
A hysteroscopy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.
Generally, a hysteroscopy follows this process:
You will be asked to remove clothing and will be given a gown to wear.
You will be asked to empty your bladder prior to the procedure.
An intravenous (IV) line may be inserted in your arm or hand.
You will be positioned on an operating table, lying on your back with your feet in stirrups.
The vaginal area will be cleansed with an antiseptic solution.
The cervix may be dilated prior to the insertion of the hysteroscope.
The hysteroscope will be inserted into the vagina, through the cervix, and into the uterus.
A liquid or gas will be injected through the hysteroscope to expand the uterus, allowing for better visualization.
The wall of the uterus will be examined for abnormalities. Photographs or video documentation may be made. Biopsy specimens may be taken.
If a procedure such as fibroid removal is to be performed, instruments will be inserted through the hysteroscope.
For more detailed or complicated procedures, a laparoscope (a type of endoscope inserted through the abdomen) may be used to view the outside of the uterus simultaneously.
When the procedure is completed, the hysteroscope will be removed.
After the Procedure
Your recovery process will vary depending upon the type of anesthesia that is given. If general anesthesia or a sedative was used, your blood pressure, pulse, and breathing will be monitored until they are stable and you are alert. When stable, you will be discharged to your home. Hysteroscopy is usually performed on an outpatient basis.
Otherwise, there is generally no special type of care following a hysteroscopy.
You may experience cramping and vaginal bleeding for a day or two after the procedure.
You may experience flatulence (gas in the digestive tract) and pains resulting from the gas administered during the procedure for about 24 hours. You may feel pain in your upper abdomen and shoulder.
Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
You may be instructed to avoid vaginal douching and sexual intercourse for two weeks after the procedure, or for an alternate period of time recommended by your physician.
Other activities and normal diet may be resumed unless your physician advises you differently.
Your physician may give you additional or alternate instructions after the procedure depending on your particular situation.
Patients should alert their health care provider if they develop any of these symptoms: