**7.3. Resection of polyps/fibroid**

In the past, the treatment of benign uterine lesions metrorrhagia; Hysteroscopic surgery is effective to treat menorrhagia and leiomyomas, and other lesions, such as septate uterus and synechiae. In the last 20 years there has been an increased acceptance of hysteroscopic surgery into the gynecological surgery. Diagnostic hysteroscopy is a highly sensitive and specific technique for the management of uterine bleeding problems. It may distinguish between myomas or polyps and provides additional information about surrounding endometrium. Endometrial polyp is the commonest pathology among the structural uterine abnormalities. A polyp is attached to the intestinal wall either by a stalk, peduncles, or by a broad base. The sizes of uterine polyps range from a few millimeters — no larger than a sesame seed — to several centimeters — golf ball sized or larger. Many women with myomata, polyps, uterine septae, and synechiae may now benefit from the convenience of hysteroscopic therapy compared to more aggressive surgical techniques. Hysteroscopy is the first choice in the resection for the treatment of endometrial polyps in women with abnormal uterine bleeding and postmenopausal metrorrhagia. The greatest advantage of hysteroscopic myomectomy is the quick recovery time. The prevalence of malignancy or atypical hyperplasia is 3.2% in women with symptoms and 3.9% in those without symptoms. Transcervical resection is the gold standard for treatment of endometrial polyps. Uterine polyps most commonly occur in women in their 40s and 50s.

#### **7.4. Intrauterine adhesions- adhesiolysis**

Intrauterine adhesions develop as a result of intrauterine trauma. Intrauterine adhesions can be asymptomatic and of no clinical significance. Symptoms associated with clinically significant intrauterine adhesions include:


The diagnosis is based upon visualization of intrauterine adhesions either directly by hysteroscopy, or indirectly by imaging. The standard treatment of intrauterine adhesions is surgery with lysis under direct visualization. Intrauterine adhesions are cut hysteroscopically using current so that the uterine cavity appears normal. This is usually performed as an ambulatory procedure using operative hysteroscopy. Postoperative management is focused upon reducing the risk of reformation of adhesions.

The Role of Endoscopy in Management of Infertility 23

advantageous both to the patient and the physician. Office-based hysteroscopy has many benefits to diagnose and treat uterine defects which should improve embryo implantation and pregnancy rates. Hysteroscopy can be performed in a routine office exam room. Office hysteroscopy has been performed using carbon dioxide. Diagnostic office hysteroscopy is a safe procedure, with few significant complications, and the patient can resume normal

Complications occur rarely during hysteroscopy A possible problem is uterine perforation when either the hysteroscope itself or one of its operative instruments breaches the wall of the uterus. Injury of the bowel during a perforation, the resulting peritonitis can be fatal. Cervical laceration, intrauterine infection, electrical and laser injuries, and complications caused by the distention media can be frequently encountered. The use of insufflations media can lead to serious and even fatal complications due to embolism or fluid overload with electrolyte imbalances. Other possible complications include allergic reactions and bleeding. The overall complication rate for diagnostic and operative hysteroscopy is 2% with serious complications occurring in less than 1% of cases. The complications of

activities immediately.

**7.9. Complications** 

hysteroscopy:


**Author details** 

**8. References** 

2009.



*Department of Obstetrics and Gynecology, University of Szeged, Hungary* 

feasible option.". *J Obstet Gynaecol Res. 2009 Feb;35(1):173-5.*

American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists position statement on metabolic and cardiovascular consequences of polycystic ovary syndrome. National Guideline Clearinghouse. Accessed August 28,

Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. *Obstet* 

Bhatla N, Dash BB, Kriplani A, Agarwal N. (2009). "Myomectomy during pregnancy: a


Jozsef Daru and Attila Kereszturi

*Gynecol*. 2003;101:778–84.
