SURGICAL PROCEDURES

Hysteroscopy

Hysteroscopy is the inspection of the uterine cavity that allows for the diagnosis and treatment of various uterine conditions, some of which could lead to fertility problems. Hysteroscopy may be performed in a doctor’s office, surgicenter or hospital. During the procedure, the patient can be fully awake, under light anesthesia or completely asleep under general anesthesia, depending on the complexity and length of the surgery being performed.

Hysteroscopy is usually an outpatient or same day procedure – patients do not typically need to be admitted overnight to a hospital.

Embryoscopy

Embryoscopy (also known as fetoscopy) uses fiber optics to look inside the uterus (hysteroscopy)¬. Like a dilation and curettage (D&C), a hysteroscopy is usually performed in a hospital or surgical center under anesthesia.

Once the cervix is dilated large enough to allow passage of a fiber optic telescope, salt water (saline) is used under high pressure to hold the uterine cavity open to allow adequate visualisation.

With direct visualisation, the implantation site can be located in the uterus. The fetus grows inside of a spherical structure called the gestational sac. The sac can be opened to identify the placental tissue and the fetus.

The hysteroscope has multiple channels. These channels allow for the insertion and removal of fluid that keep the uterine cavity clear to the observer, optics transmission and illumination, allowing for the passage of instruments into the uterus. Using grasping instruments, the placental tissue or fetus can be removed.

This is a great advantage over the D&C because the tissue removed is essentially “pure” (i.e. tissue of interest is obtained for observation). There is little or no chance for the mother’s uterine cells to “contaminate” the specimen.

There are several benefits of the hysteroscopy approach for the evaluation of the causes for miscarriage. Abnormalities in the development of the fetus can be seen in some cases. The specimen is kept sterile and so the chances for the cells to be grown by the genetics lab is enhanced when fetal tissue is collected this way.

Another advantage occurs when there is loss of a twin pregnancy. During a D&C, the tissue from both twins gets mixed together. A result may indicate one, both or neither of the fetuses.

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