Gynaecological Endoscopy

Overview

Endoscopy is the direct observation of an organ or cavity through natural orifices or tiny incisions using an endoscope. We receive more accurate and reliable information in this manner than with other external exploratory strategies.

Gynaecological endoscopy is a surgical procedure that employs optical devices specifically developed to aid in the diagnosis of common female illnesses and pathologies such as infertility, minor vaginal hemorrhages, and endometrial polyps, among others. Hysteroscopy and laparoscopy are used in gynaecological endoscopy for these objectives.

Gynaecological endoscopy as we know it now is possible because to significant technological advances, as well as the sophistication and miniaturization of the equipment used. Modern anaesthesia has also played a significant role in the evolution of surgical techniques. 

This medicine is very effective, wears off quickly, and has had its negative effects decreased such that it may be used efficiently in ambulatory surgery. This, among other things, enabled so-called minimally invasive surgery, which gets its name from the fact that extremely small incisions are made and the intervention is ambulatory.

Endoscopic surgery can determine the cause of vaginal bleeding or structural changes without requiring surgical intervention. Endometrial changes (atrophies or hyperplasia), Endometrial polyps, Endometrial adhesion, Uterine septa or deformities, and Myomas can all be identified.

In situations of endometriosis and ovarian malignancies, gynaecological endoscopic surgery eliminates the necessity for a major procedure. It is the quickest method of tubal ligation and is efficient in detecting specific cases of infertility.

What are Types of Gynaecological Endoscopy?

In obstetrics and gynaecology, there are three forms of endoscopic surgery: laparoscopy, hysteroscopy, and salpingoscopy.

1. Laparoscopy. As technology advances, laparoscopic surgery is rapidly and gradually replacing traditional surgery, with the exception of the most challenging situations. Diagnostic laparoscopy is an useful technique for evaluating patients with persistent pelvic discomfort, infertility, adhesions, and endometriosis, as well as an aid in the grading of gynaecological malignancies. The clear visualization of the peritoneal cavity not only helps with diagnosis, but also allows for an accurate assessment of the severity of these disorders. Laparoscopic surgery is now the procedure of choice for treating myoma uteri, ovarian tumors, ectopic pregnancy, infertility, endometriosis, and inflammatory masses.
2. Hysteroscopy. In screening individuals with atypical uterine bleeding, postmenopausal bleeding, infertility, and recurrent pregnancy loss, hysteroscopy has shown to be beneficial. The uterine cavity is dilated with fluids before a resectoscope or hysterofiberscope is used during hysteroscopy. Many operative procedures may now be performed hysteroscopically due to the introduction of hysteroscopes with operating channels and equipment such as scissors, biopsy forceps, snares, and electrosurgical operating devices such as ball and loop electrodes. Submucous myoma uteri, uterine abnormalities, and Asherman syndrome are the most common reasons for hysteroscopic surgery. Female sterilization can also be done hysteroscopically using a variety of mechanical occlusive devices or plugs (e.g. Essure).
3. Salpingoscopy. Salpingoscopy is a valuable pre-operative diagnostic technique for inspecting the tubal cavity and a powerful tool for tubal recanalization. Salpingoscopy provides for direct examination of the ampullary tubal mucosa during laparoscopy. When examining individuals with tubal infertility, the state of the tubal mucosa is the best prognostic indicator. A fiberoptic endoscope - salpingoscope is placed into the cervical canal during the Salpingoscopy technique to directly see the uterus and fallopian tubes. This information can subsequently be utilized to detect and treat blockages, adhesions, and other diseases and ailments. Salpingoscopy has improved the identification of individuals who are tubal surgery candidates.

Ambulatory Gynaecological Surgery

Gynaecological endoscopic surgery is a new science that combines advances in gynaecological endoscopy and minimally invasive surgery to allow for surgical procedures without requiring a large operation. The patients' recovery is quick, and they may resume their normal activities right away. Local, regional, or short-term general anaesthesia are employed. The surgery is performed in a fully equipped operating theatre for security reasons.

Ambulatory gynaecological surgery uses modern optical instruments such as a hysteroscope, which is introduced via the neck of the uterus, or a laparoscope inserted via a minute incision in the navel.

Gynaecological Endoscopy Indications

1. Hysteroscopy

• Diagnostic:

Diagnostic hysteroscopy is performed to diagnose uterine abnormalities. Other tests, such as hysterosalpingography, are also performed to confirm the results of diagnostic hysteroscopy (HSG). The uterus and fallopian tubes are examined with an X-ray dye test called HSG. Diagnostic hysteroscopy is frequently performed in an office environment.

Furthermore, hysteroscopy can be performed in conjunction with other procedures such as laparoscopy or prior to operations like as dilation and curettage (D&C). Your doctor will put an endoscope (a thin tube connected with a fiber optic camera) into your belly to inspect the outside of your uterus, ovaries, and fallopian tubes during laparoscopy. The endoscope is inserted through an incision in or near your navel.

• Operative:

Hysteroscopy may be used by your doctor to treat the following uterine conditions:

• Fibroids and polyps: Hysteroscopy is performed to remove these non-cancerous uterine growths.
• Uterine adhesions: It's also known as Asherman's Syndrome, are bands of scar tissue that can develop in the uterus and cause alterations in menstrual flow and infertility. Hysteroscopy can assist your doctor in locating and removing adhesions.
• Septums: Hysteroscopy can help establish whether you have a uterine septum, which is a congenital abnormality of the uterus.
• Bleeding: Hysteroscopy can assist in determining the source of excessive or prolonged menstrual flow, as well as bleeding between periods or after menopause. Endometrial ablation is a technique that employs the hysteroscope and other instruments to remove the uterine lining in order to cure some causes of excessive bleeding.

2. Gynaecological laparoscopy:

Gynaecological laparoscopy is used to determine the source of specific symptoms as well as to treat a variety of disorders. These include: 

• Diagnosing and treating endometriosis - a condition in which cells similar to those that line your womb are found in other parts of your body removing scar tissue (adhesions) - scars can form after infections such as pelvic inflammatory disease or as a result of endometriosis. 
• Treating an ectopic pregnancy - a condition in which a fertilized egg begins to develop outside your womb.
• Performing a sterilisation, which means closing your fallopian tubes so that you can no longer get pregnant.
• Removing an ovarian cyst.
• Removing your womb (hysterectomy) or ovaries (oophorectomy).
• Treating fibroids.

3. Hysterosalpingoscopy: 

An HSG can help your doctor determine if your fallopian tubes are open or obstructed. This information can assist your provider in diagnosing fertility issues. Open fallopian tubes provide a clear channel for conception. To fertilize an egg, sperm travels through the fallopian tubes. The fertilized egg (embryo) passes via your fallopian tubes to your uterus (womb), where it develops and grows into a healthy child.

Blocked fallopian tubes obstruct these processes and are a primary cause of infertility.

An HSG can also allow your provider to:

• Check the success of a tubal ligation or tubal reversal: An HSG can determine whether a tubal ligation treatment effectively closed your fallopian tubes, preventing pregnancy. It can also indicate whether or not the surgery was successfully reversed.
• Arrange for more imaging: An HSG can reveal uterine abnormalities (fibroids, atypical shape) that your physician can utilize to plan for additional imaging, such as sonohysterography and hysteroscopy. A sonohysterogram can refine the results of an HSG and offer a definitive diagnosis, whereas hysteroscopy can treat particular uterine disorders.

Procedure Preparation

Plan your test during a time when you will not be having your period. Your doctor may advise you to have the test performed shortly after your menstruation has ended and before your ovary produces an egg (ovulates). This time allows your doctor to have a closer look into your uterus. It also prevents you from taking the test if you are pregnant.

Your doctor may prescribe medication to assist open your cervix prior to the test. This medication can be injected or taken as a tablet. You can also go to your doctor's office the day before the surgery to have a little sponge inserted into your cervix. This also aids in the opening of your cervix.

You may be requested to abstain from using douche, tampons, or vaginal medicines for 24 hours before the hysteroscopy.

Inquire with your doctor whether you will require transportation home. Anesthesia and pain medication might make driving or getting home on your own dangerous.

Understand the operation in detail, including the risks, advantages, and alternate possibilities.

Inform your doctor about All of the medications, vitamins, supplements, and herbal therapies you use. Some may raise the likelihood of complications during your surgery. Your doctor will advise you whether and when you should stop taking any of them before the surgery.

Ask your doctor if you should stop taking aspirin or another blood thinner before your procedure. Make sure you understand everything your doctor wants you to do. These medications increase the likelihood of bleeding.

Make a copy of your advance directive for your doctor and the hospital. If you don't have one, you should make one. It informs people about your health-care preferences. It is useful to have before any form of surgery or operation.

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How the Procedure is Preformed?

• Gynaecological laparoscopy

If you're undergoing a gynecological laparoscopy to identify a disease, it should take approximately half an hour to an hour. If your doctor needs to treat a problem, it will take longer.

One or more tiny cuts in your lower belly, including one in your tummy button, will be made by your doctor (navel). They'll next insert a tube through one of these incisions and gently inflate your stomach so they can look better.

Your doctor will next insert a tiny telescope with a camera (laparoscope) into another incision. The laparoscope's camera transmits images of the inside of your tummy to a display where your doctor may view them. If your doctor has to obtain tissue samples or treat a problem, he or she may pass other equipment through the cuts. Your doctor will seal the wounds with stitches or glue at the end of the process.

• Hysteroscopy

Your doctor may prescribe a sedative before to the treatment to help you relax. You will subsequently be given anesthetic. The technique is carried out in the following order:

• To insert the hysteroscope, the doctor will dilate (widen) your cervix.
• The hysteroscope is placed into the uterus through your vagina and cervix.
• The hysteroscope is then used to introduce carbon dioxide gas or a liquid solution into the uterus to enlarge it and wipe away any blood or mucus.
• Then, using the hysteroscope, your doctor may observe your uterus and the apertures of the fallopian tubes into the uterine cavity.
• Finally, if surgery is required, tiny tools are placed via the hysteroscope into the uterus.

Hysteroscopy might take anything from five minutes to more than an hour to complete. The length of the procedure is determined by whether it is diagnostic or surgical, as well as whether an additional procedure, such as laparoscopy, is performed concurrently. In general, diagnostic hysteroscopy takes less time than surgical hysteroscopy.

• Salpingoscopy

The patient is in the dorsal decubitus posture and may see the surgery on a video screen. The posterior lip of the cervix is grasped with a tenaculum after disinfection with aqueous chlorhexidine solution, and a silicone balloon HSG catheter is inserted into the uterine cavity to allow dye hydrotubation. The tubo-ovarian structures are detected once the scope is infiltrated into the central part of the posterior fornix.

The intestine and tubo-ovarian structures must be kept afloat by saline irrigation during the process in order to locate the tubal ostium and place the scope into the ampullary section of the tube. As a result, the ampulla is traced to the tubal ostium, which is located under the antimesentric border.

After locating the tubal ostium, the 3.5-mm rigid scope or, if necessary, a 2.4-mm semirigid scope is inserted into the infundibulum, which is differentiated by its characteristic concentric folds. The scope is cautiously placed into the folds with a gentle saline infusion until the parallel main folds of the ampullary segment are detected.

What Happens During Your Recovery? 

After the surgery, nurses will check your vital signs. You'll be in the recovery room until the anaesthetic wears off. You will not be allowed to leave until you are able to urinate on your own. Urinary difficulty is a possible adverse effect of catheter usage.

The duration of recovery varies. It is determined by the technique used. You may be able to leave the hospital a few hours following surgery. You may also be required to spend one or more nights in the hospital.

Your belly button may be sore after surgery. Your stomach may have bruising. The gas inside you might cause pain in your chest, middle, and shoulders. There's also a potential you'll feel sick the remainder of the day.

Before you leave, your doctor will give you information on how to deal with any potential adverse effects. To avoid an infection, your doctor may give pain relievers or antibiotics.

Depending on the procedure, you may be advised to rest for many days or weeks. Returning to normal activities may take a month or more.

Serious complications from laparoscopy are uncommon. You should, however, contact your doctor if you have:

• Serious abdominal pain.
• Prolonged nausea and vomiting.
• Fever of 101°F or higher.
• Pus or significant bleeding at your incision site.
• Pain during urination or bowel movements.

The outcomes of these treatments are typically favorable. This technology enables the surgeon to easily see and diagnose a wide range of disorders. In addition, recovery time is reduced as compared to open surgery.

The process of hysteroscopy is relatively safe. However, problems are possible, as with any type of surgery. Complications from hysteroscopy occur in fewer than 1% of cases and might include:

• Risks associated with anesthesia.
• Infection.
• Heavy bleeding.
• Intrauterine scarring.
• Allergic reactions to the substance used to expand the uterus.
• Damage to an abdominal blood vessel, the bladder, the bowel, the uterus, and other pelvic structures.
• Nerve damage.
• Adhesions.
• Blood clots.
• Problems with urinating.

Conditions that increase your risk of complications include:

• Previous abdominal surgery.
• Obesity.
• Being very thin.
• Extreme endometriosis.
• Pelvic infection.
• Chronic bowel disease.

Conclusion

Endoscopy has been employed in Gynaecology and Obstetrics due to significant technical and medical developments, as well as the sophistication and miniaturization of the equipment used. Endoscopy has several uses in modern gynaecology, and the list grows by the year. Gynaecological endoscopy is a surgical procedure that employs optical devices specifically developed to aid in the diagnosis of gynaecological disorders and pathologies such as infertility, mild vaginal haemorrhages, and endometrial polyps. The discovery of these tiny devices that allow surgeons to operate within the body without requiring open surgery has greatly improved patients' circumstances.

Endoscopic surgery is likely the most significant advancement in surgical practice in Gynaecology. It is increasingly preferred over the abdominal technique due to well-known benefits such as minimum trauma, excellent vision, low incidence of complications, decrease of adhesions, shorter hospital stay, fast recovery, and aesthetically acceptable outcomes with minimal scarring. Endoscopy has cemented its place in the care of infertile patients, and endoscopic surgical methods will advance significantly in the near future to meet the diverse demands of female patients.