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Operative instructions

Hysteroscopy

Hysteroscopy is performed as a short day procedure, under a general anaesthetic.

Diagnostic Hysteroscopy

A small (4mm) telescope, inserted gently via the cervical canal allows direct visualisation of the cavity of your womb.

Sterile saline is used to subtly inflate the uterus so that your doctor may understand its shape. Images are saved to help explain findings to you post-operatively.

The final stage of the procedure is a dilatation and curettage (D&C). Your cervix is gently dilated (typically to 8 or 9mm) and a sample of the endometrial lining is removed for assessment. Treatment of some minor abnormalities (for example removal of an endometrial polyp) may be performed at this time.

The ideal time to perform a hysteroscopy is soon after your menstrual period has ended, and prior your next ovulation. This timing corresponds to between days 5 and 10 of your menstrual cycle. Performing a hysteroscopy at this time maximises visual clarity and minimises the risk of affecting a pregnancy.

Operative Hysteroscopy

Operative hysteroscopy may be needed as a second stage procedure to correct more serious uterine abnormalities. Examples include very large endometrial polyps, a uterine septum, uterine adhesions, or sub-mucosal uterine fibroids.

Your cervix needs to be dilated to a greater degree (approximately 12mm) in order to accommodate a larger telescope. The type of fluid used is different (glycine).  This is important because the operative hysteroscope instrument uses electrical energy to perform your procedure. Glycine is used because it does not conduct electricity. It is not safe to use more than a prescribed amount of glycine at a single procedure. If your operation is complex (i.e. very large fibroid) it may need to be completed in several stages.

Potential Risks of Hysteroscopy

The risk of a serious adverse outcome occurring during a hysteroscopy is very rare (<1% of treatments )

Hypothetical complications include:

  • Anaesthetic complications
  • Bleeding
  • Infection
  • Injury or perforation of the cervix or of the uterus. If this occurs, you may need to remain in hospital for observation or undergo surgical repair.
  • Adhesion formation within the uterine cavity following curettage (Asherman syndrome)
  • Glycine overdose (water intoxication)
  • Inability to remove an entire polyp/fibroid in one operation.

Pre operative instructions

Fasting: Our anaesthetist insists that you consume NO food OR drink, in the 6-hours prior to your procedure.

Pre-medication: For operative hysteroscopy, 400mg of misoprostol is prescribed to be inserted vaginally 2-4 hours before your procedure. This allows a more natural and gentle dilation of your cervix

Post operative care

Hysteroscopy is a relatively quick procedure to perform. You will be able to go home on the same day after review. When you have woken from your anaesthetic, you will be able to eat and drink normally.

We suggest in the first 48-hours after your procedure that you take Paracetamol (two 500mg tablets up to every 6 hours) and Ibuprofen (two 200mg tablets up to every 8 hours) to treat mild uterine cramping. It is normal to experience some cramping and a small amount of vaginal bleeding following a hysteroscopy. This is likely to resolve reasonably quickly.

To reduce the risk of infection, you should avoid intercourse and deep water baths until you have attended you review appointment. Review will usually be approximately 1-2 weeks from the date of your procedure.

A significant amount of post-operative pain, bleeding or suspicion of infection should prompt you to immediately contact Women’s Health Melbourne for further advice. If you require urgent advice or assistance after hours, contact the Royal Women’s Hospital (03 9835 2000).

Laparoscopy

A Laparoscopy is a form of minimally invasive, small-incision gynaecological surgery, performed under a general anaesthetic. It involves two surgeons, your primary surgeon and an assistant. In many practices, the role of surgical assistant is performed by a junior doctor.

At Women’s Health Melbourne, your laparoscopy will be performed by two experienced gynaecologists, ensuring you receive the premium level of care. You will be introduced to the doctor who will be the assistant surgeon for your procedure.

Two small (5mm) incisions are made into the abdominal wall through which laparoscopic ports are inserted to reach the inner abdomen. The site of the first incision is usually at the umbilicus (belly button). The second incision is in the midline, cosmetically placed at the level of the pubic hair. The laparoscope and a secondary instrument access the abdomen and pelvis via these ports.  Gas is used to inflate the abdomen – allowing surgeons to move instruments around the abdomen/pelvis with care and finesse. Under laparoscopic vision, your  abdomen/pelvis is systematically examined. If pathology is found (e.g. endometriosis) 2 further incisions are usually required.

What is found will determine the action and the operating time required. In cases where unexpected pathology and extremely severe endometriosis (e.g. with bowel involvement) is diagnosed at laparoscopy, it may be necessary to plan treatment as a second stage procedure. Occasionally multi-disciplinary surgical collaboration is necessary (e.g. Advanced Laparoscopic Specialist Team and Bowel Surgeon or Urologist)

Operative Risks of Laparoscopy

Serious complications of laparoscopy are uncommon (<1% of cases)

Possible complications include:

  • Anaesthetic complications
  • Bleeding
  • Infection
  • Blood clots forming in the legs/lungs
  • Accidental injury to bladder, ureter (tube connecting kidneys and bladder), bowel or blood vessels
  • Conversion to open (large incision) surgery in the case of a significant complication occurring.
  • Inability to remove all of the pathology (e.g. fibroid or endometriosis) in one operation

Pre-operative instructions

Bowel Prep:

Where severe endometriosis is anticipated, a bowel preparation regimen is recommended. Picoprep can be purchased over-the-counter from your pharmacy.

On the day prior to surgery:

  1. Clear fluids only (e.g. water, tea without milk, and soup broths)
  2. Picoprep (1 sachet) at 1pm and
  3. Picoprep (1 sachet) at 4pm

This regimen will cleanse the bowel prior to surgery. It is important to maintain hydration with clear fluids.

Fasting: Our anaesthetist insists that you consume NO food OR drink, in the 6-hours prior to your procedure.

Post operative care

Many women will be able to undergo laparoscopy as a day-stay surgical procedure and go home on the same day or the following morning after review.

After your procedure, shoulder-tip discomfort is common. This pain is referred and due to diaphragm irritation from the gas used to inflate the abdomen. General abdominal tenderness for 3 to 7 days post-operatively is common (especially at the incision sites).

We suggest in the first 72-hours after your procedure that you take Paracetamol (two 500mg tablets up to every 6 hours) and Ibuprofen (two 200mg tablets up to every 8 hours). A prescription for stronger pain relief tablets will be given – take these as required.

A fibre supplement (e.g. Metamucil) should be used whilst taking pain relief medication as constipation is a common side effect.

To reduce the risk of infection, you should avoid intercourse and deep water baths until you have attended you review appointment. Review will usually be approximately 1-2 weeks from the date of your procedure.

In most cases sutures will dissolve and do not need to be removed.

Return to work

You will be provided with a medical certificate for 2 weeks. Some women feel ready to return to work after 1 week. How ready you feel will depend on factors including your work role and the extent of your surgery.

It is normal to experience some cramping and a small amount of vaginal bleeding following a laparoscopy. This is likely to resolve reasonably quickly.

A significant amount of post-operative pain, bleeding or suspicion of infection should prompt you to immediately contact Women’s Health Melbourne for further advice. If you require urgent advice or assistance after hours, contact the Royal Women’s Hospital (03 9835 2000).