Hysteroscopic Surgery
Hysteroscopy is a technique which involves looking inside the uterus with a small telescope type instrument introduced through the cervix, to enable visualisation of the uterine cavity and also the right and left tubal ostea, where the fallopian tubes connect to the main part of the uterine cavity. If the cavity of the uterus appears normal, no surgical procedure is needed. It is usual to take a tissue sample from the lining of the uterus at the time of hysteroscopy, that tissue is evaluated under the microscope. The information obtained can help to ascertain whether or not the stage of development of the endometrium is appropriate for the day of the cycle when the sample was taken, and also to look for any signs of infection. The latter is particularly important because any inflammation of the lining of the uterus will prevent even a healthy embryo from implanting.
Intrauterine Polyps
A polyp is an overgrowth of tissue leading to a small projection into the cavity of the uterus. The size of polyps can vary from a few millimetres to a centimetre or even larger. Small polyps typically consist of endometrium (this is the name for the type of tissue that lines the uterus); the larger polyps are often due to fibroids (this is an overgrowth of muscle tissue from the wall of the uterus). Polyps can interfere with the implantation process right at the very beginning of pregnancy, in much the same way that an intrauterine contraceptive device will inhibit implantation. It is usual therefore to remove polyps if they are diagnosed.
Various techniques can be used for this. Small polyps can be removed with tiny hysteroscopy scissors and grasping forceps; sometimes used in conjunction with small instruments using bipolar electric current. Larger polyps, such as those due to fibroids, usually need resecting with the operating hysteroscope. This is a larger instrument than a diagnostic hysteroscope and is introduced through the cervix after first of all dilating the cervix. The polyp is removed under direct vision with a loop-cutting instrument connected to either a monopolar or bipolar diathermy machine. For the larger polyps, it helps to inject some Pitressin into the cervix (this helps to prevent any bleeding). To prevent post-operative adhesion formation (this is when the front and back walls of the uterus can stick together), I often either insert an intrauterine contraceptive device (IUCD) or a small balloon device made by Cook. The balloon is normally removed after a few days. If I insert an IUCD, this can remain in place for a little longer before it is removed.