HYSTEROSCOPY
Hysteroscopy is a procedure that allows a doctor to look inside the uterus in order to diagnose and treat causes of abnormal bleeding. The hysteroscope is a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. The procedure can be either diagnostic or operative.
Diagnostic hysteroscopy is used to diagnose problems of the uterus. It is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes. Diagnostic hysteroscopy can often be done in an office setting.
Additionally, hysteroscopy can often be used to identify the cause of unexplained bleeding or spotting in postmenopausal women.
Operative hysteroscopy is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy. If an abnormal condition was detected during the diagnostic hysteroscopy, an operative hysteroscopy can often be performed at the same time, avoiding the need for a second surgery. During operative hysteroscopy, small instruments are used to correct the condition. These instruments are inserted through the hysteroscope.
Procedures that may be performed during a hysteroscopy include:
-
Polyp removal: Polyps are small benign growths in the uterus. They can cause heavy or irregular periods and sometimes interfere with pregnancy.
-
Fibroid removal: Fibroids are noncancerous tumors in the uterus that can cause pain, heavy bleeding, and complications during pregnancy.
-
Adhesion removal: Adhesions or scar tissue in the uterus can lead to changes in menstrual flow as well as infertility.
-
Endometrial ablation: This procedure can help control heavy, prolonged menstrual bleeding. It works by permanently removing or destroying the lining of the uterus (the endometrium).
-
Endometrial biopsy: During this procedure, a small sample of the lining of the uterus is taken to be examined under a microscope.
Anesthetic Implications for Hysteroscopy
Anesthesia type: General, neuraxial, or local
Airway: ETT or LMA
Preoperative:
-
Patients may be hypovolemic and anemic if done for uterine bleeding
-
Neuraxial anesthesia (spinal to the T10 level)
-
Lithotomy position can impair respiratory mechanics
-
Common peroneal nerve injury can occur from pressure on the nerve over the fibula
-
Hyperflexion of the hip joint can cause femoral nerve injury
-
Avoid finger injuries from positioning (place arms on arm boards)
-
The sensory nerve supply of the vagina arises from the pudendal nerve (S2, S3, S4)
-
The sympathetic and parasympathetic nerve supply arise from the hypogastric plexus (L1-L3) and sacral nerves
Intraoperative:
-
Vagal nerve stimulation can occur from traction on the uterus and cervical dilation
-
Monitor the patient for signs of fluid overload (hyponatremia, hypervolemia, and decreased osmolarity)
-
Dilute solutions of vasopressin and epinephrine may be injected locally in the cervix and cause hypertension
-
Position: Lithotomy, Trendelenburg with arms out
-
Duration: 30-60 minutes
Postoperative:
-
PONV prophylaxis
-
Pain management
Complications:
-
Infection
-
Bleeding
-
Fluid overload
-
Air embolism
-
Uterine perforation
-
Bowel perforation
-
Cerebral edema
-
Pulmonary edema
-
Electrolyte imbalances
-
Nerve injuries
.
Sources:
Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.