Endoscopic surgery: hysteroscopy and laparoscopy (2023)

Endoscopy is a technique that involves inserting a tube connected to a camera (endoscope) to look inside an organ or cavity. The device is inserted through a small incision or natural opening, such as the vagina or anus.

Until recently, these programs were useddiagnosisjust for reference. Today, however, the endoscopic approach also allows for correctionbaveTreat the pathology in a less aggressive way.

Gynecological endoscopy does not require hospitalization, and patients can go home on the day of the procedure. Two ways can be distinguished between them:Hysteroscopy and laparoscopy.

Below is the 7-point index that we will expand on in this article.


What is endoscopy?

Endoscopy is a diagnostic procedure that involves the introduction ofnatural hole or small incisionLook inside an organ or cavity. In this way, information can be obtained that cannot be reliably provided by other external techniques such as X-rays. It is a surgical procedure that is performed when:local or regional anesthesia or sedation.

An endoscope is an instrument consisting of a lighted tube that is inserted into a cavity or canal for observation.

Gynecological endoscopic surgery is an emerging discipline with two purposes: diagnosis and treatment of pathology. In this case, to visualize the female genital cavity, the endoscope can be introduced in two ways:

  • Through the vagina (hysteroscopy).
  • through a small incision in the abdomen (laparoscopy).

Endoscopic gynecological surgery

Advantages of endoscopic surgery

Endoscopic surgery is considered the technique of choice in some situations due to multiple advantages:

  • Get well soon.
  • hospital for several hours.
  • The scars are smaller.
  • There is less possibility of bleeding and blood loss.
  • If the woman is not sedated, there will be communication between the patient and the doctor during the test.

Due to the mentioned characteristics, the endoscopic technique is calledminimally invasive surgery.

gynecological hysteroscopy

Hysteroscopy is a technique for diagnosing and treating pathologies of the uterine cavityuterine cavityBy direct visualization. A small hysteroscope (3-5 mm) is introduced through the opening of the cervix. In addition, carbon dioxide or saline must be injected to expand the cavity.

A hysteroscope is a thin gynecological instrument that can be rigid, semi-rigid or flexible.

Depending on the purpose and thickness of the hysteroscope, there are two types of hysteroscopy:Diagnosis and surgery. In both types, women are in a gynecological position. The doctor then places a speculum to widen the opening of the vagina and cleans the cervix with an iodine solution.

After cleaning the area, the doctor gently inserts the hysteroscope into the cervix, releasing fluid to dilate the area, which will help to clearly see the uterine cavity. With the help of the monitor, the specialist will examine the uterus in detail. Also, if the procedure is done to treat an injury, additional instruments will be inserted through the hysteroscope.

Hysteroscopic removal of uterine fibroids

Below we list each type of hysteroscopy.

diagnostic hysteroscopy

In this hysteroscopic model,smaller caliberHysteroscopy is performed on an outpatient basis without anesthesia and sedation.

The optimal time for hysteroscopy in patients of reproductive age isproliferation phasefrommenstrual cycle, that is, between the sixth and tenth day. This reduces bleeding andendometriumthinner.

Diagnostic hysteroscopy is indicated when:

  • When the uterus attaches,endometrial polyps,fibroidsOr suspected uterine septum.
  • When coils and other devices are removed.
  • For testing infertility and implantation failure.
  • Assess menstrual changes.
  • Evaluation of the endometrial cavity.

Using this technique ensures good reliability of image interpretation,minimize, in turn, the risk of complications. However, secondary complaints may occur, such as pain in the pelvis or abdomen.

hysteroscopic surgery

This model of hysteroscopy is performed when any endometrial or uterine changes are diagnosed.

In hysteroscopic surgery, the hysteroscope isfatterIt is performed in the operating room under sedation or regional anesthesia.

Furthermore, hysteroscopes are equipped with gynecological tools to perform various types of procedures, whether they require resection or manipulation. In addition, the cervix must be more dilated in surgical hysteroscopy than in diagnostic hysteroscopy.

Cases requiring hysteroscopic surgery are described below:

  • Ablation or reduction of the endometrium.
  • Removal of fibroids or polyps.
  • Eliminate intrauterine adhesions.
  • Hysterectomy.

When to use hysteroscopy


Thanks to technological progress, hysteroscopy has become a fundamental technique in gynecological practice.

In general, hysteroscopy is considered a safe technique, so the chances of complications are low, but not impossible. There is a small chance that the uterus will perforate and cause bleeding.

Other complications of hysteroscopy are described below:

  • reflex syncope: due to inexperience and the diameter of the hysteroscope. This complication usually causes a feeling of discomfort, warmth and paleness.
  • gas embolism: Serious but unusual. This is a side effect of carbon dioxide expansion.
  • pelvic infection.

Therefore, it is crucial to notice the signs of complications in order to avoid endangering a woman's health.

Contraindications for hysteroscopy

Although hysteroscopy is one of the main techniques in gynecology, there are certain situations in which it should not be performed. Some of them are described below:

  • In women in the acute phase of pelvic infection, the endometrium or fallopian tubes may spread.
  • Excessive bleeding from the uterus because it prevents accurate visualization of the area.
  • Cervical cancer.
  • The beginning of evolution.

Contraindications for hysteroscopy

Exceptionally, a pregnant woman can undergo a hysteroscopy to remove the spiral, provided that this is done before the 10th week of pregnancy.

gynecological laparoscopy

Laparoscopy is a surgical procedure to detect problems in the abdomen or the female reproductive system (uterus, fallopian tubes and ovaries). A thin tube (laparoscopy) is inserted through a small incision in the navel. It is a minimally invasive technique so that patients can return to their daily lives72-78 sati.

Gynecological laparoscopy requires the patient to fast the day before the procedure and take laxatives to empty her bowels.

Like hysteroscopy, laparoscopy has two simultaneous goals: on the one hand, the examination is aimed at diagnosis, and on the other hand, it solves problems that arise during the intervention.

Laparoscopic front view

diagnostic laparoscopy

Recovery from this procedure is quick and painless. Laparoscopy is necessary for diagnosis when the following are suspected:ENDOMETRIOSIS, infertility, bleeding from the ovaries and pain in the abdomen and pelvis, for which no explanation could be found.

The time of diagnostic laparoscopy always depends on the purpose and opinion of the specialist.

laparoscopic surgery

Today, laparoscopic surgery is a fairly safe surgical method of treating gynecological diseases. For this, doctormali groundThrough this procedure, a trocar will be inserted so that you can use surgical tools such as scissors, forceps, etc.

The procedure is performed under general anesthesia so that the woman does not feel pain during the procedure. Most gynecological reconstructive surgeries can be performed laparoscopically. Below we will consider in detail the main indications for laparoscopic surgery:

  • Removal of ovarian cyst from uterine fibroids.
  • Treat endometriosis.
  • eliminateectopic pregnancy.
  • Hysterectomy or hysterectomy.

Indications for laparoscopic surgery

When patients undergo laparoscopic surgery, they must take antibiotics before surgery to reduce the risk of infection.


Women who undergo laparoscopy recover quickly, often with some medicationanalgesic.

Another aspect of recovery that can be changed is the use of carbon dioxide for better visualization, as this gas can cause abdominal discomfort in the first few days after surgery. This is completely normal and the symptoms will disappear as the carbon dioxide is absorbed. As for sexual activity, women can have intercourse after the bleeding stops.

Risks of laparoscopy

As with any other surgery, laparoscopy can cause some complications. Common risks include bleeding at the insertion site or incorrect application of visualization gas.

Other risks of gynecological laparoscopy are:

  • Damage to the inside of the stomach, intestines, bladder or ureters.
  • Adverse reactions to anesthesia.
  • blood clot
  • Swollen belly.

Risks associated with laparoscopy

Frequently asked user questions

Can uterine fibroids be removed laparoscopically?

Daniel Sosa, MD, MS (gynecologist).

Yes, in skilled hands, the laparoscopic approach can be used to resect subserosal and intramural fibroids.

However, the fibroids most associated with reproductive problems are submucosal fibroids, which can be removed by hysteroscopy.
Read more

Can hysteroscopy be done during menstruation?

Author: Marta Barranquero Gómez BSc, MSc (embryologist).

Not. Hysteroscopy is usually performed during the proliferative phase of the menstrual cycle, but can be performed at any stage of the cycle when the patient is not bleeding and pregnancy is unlikely.

Is gynecological hysteroscopy painful?

Author: Marta Barranquero Gómez BSc, MSc (embryologist).

Diagnostic hysteroscopy is usually painless, but period-like discomfort may occur after the procedure.

There is no pain during hysteroscopy because it is done under anesthesia.

What are the recommendations after hysteroscopy?

Author: Marta Barranquero Gómez BSc, MSc (embryologist).

In general, patients should avoid bathing, but showering is acceptable. Also, sex is not recommended for about two weeks.

Bed rest is not necessary, but rest in the first 24 hours is necessary.

If your abdominal discomfort is similar to menstruation, you can take painkillers.

Are hysteroscopy and ultrasound the same?

Author: Marta Barranquero Gómez BSc, MSc (embryologist).

No. Hysteroscopy and hysterosonography are two different examinations.

Hysteroscopy involves inserting a tube with a camera attached through the cervix (hysteroscopy); A sonohysterogram is a transvaginal ultrasound that uses a catheter to insert a saline solution into the cervix.

recommended for you

Women who have difficulty conceiving due to problems with the uterus will be advised to have a gynecological endoscopic examination. You can read more about it in the following articles:

Hysteroscopy is also one of the examinations to assess a woman's fertility. You can learn more about other complementary techniques in the following articles:Fertility tests in women - How can I know if I am infertile?

If you want to check the patency of the fallopian tubes, see:How is a hysterosalpingogram (HSG) performed?


What is the recovery time for hysteroscopy and laparoscopy? ›

Following laparoscopy, 3-4 days of recovery is the average time most patients need to feel basically back to normal. Some amount of abdominal pain often persists for a few days, so please take the narcotics given to you to control this pain before it gets severe, rather than letting it get to out of control.

What is laparoscopy & hysteroscopy surgery for endometriosis? ›

With hysteroscopy and laparoscopy, reproductive surgeons can remove scar tissue, clear the fallopian tubes, and remove fibroids, cysts, or endometriosis lesions. They can also correct congenital abnormalities such as uterine septum or adhesions which can cause miscarriage or premature labor.

What is a hysteroscopy and laparoscopy for fallopian tubes? ›

Laparoscopy is performed to view and access the exterior of the uterus, ovaries, fallopian tubes and other structures within the pelvis. Hysteroscopy is performed to view the internal cavity of the uterus, identify abnormalities and perform certain corrective procedures.

Is endoscopic surgery the same as laparoscopic surgery? ›

While endoscopy is performed to examine and diagnose the digestive tract, laparoscopy is performed to examine and have a good view of the inside of the abdominal area.

How many days bed rest is needed after laparoscopy? ›

Recovery times

It depends on factors such as the reason the procedure was carried out (whether it was used to diagnose or treat a condition), your general health and if any complications develop. If you've had laparoscopy to diagnose a condition, you'll probably be able to resume your normal activities within 5 days.

How long do you have to stay in bed after a laparoscopy? ›

You don't need to stay in bed, but it's best to rest and take it easy for the remainder of the day. After 24 hours, there is no limit on your physical activity as long as you're not taking narcotic medication. DO NOT drive, participate in sports, or use heavy equipment while you're taking narcotic pain medication.

How long does a laparoscopy take to remove endometriosis? ›

Your surgeon can remove any endometriosis scarring and lesions during the laparoscopy, as well. Depending on how much endometriosis the surgeon has to remove, the procedure can last anywhere from 30 minutes to 6 hours or more.

Is endometriosis laparoscopy worth it? ›

Surgery may be beneficial if: You have chronic (long-standing) or severe pelvic pain. You need to remove areas of endometriosis in your pelvic area. Medication no longer relieves your endometriosis symptoms.

Does laparoscopy remove all endometriosis? ›

Not all endometriosis can be treated with laparoscopy, however. Sometimes endometriosis affects other organs such as the bowel or ureter (the tube from the kidney to the bladder). If this is the case, you may require further surgery at a later date. Further surgery is likely to involve other specialist surgeons.

Can hysteroscopy cure endometriosis? ›

Endometriosis is a condition that occurs when the endometrial tissue that ordinarily lines the uterus grows outside the uterus, causing pain and other symptoms. A hysterectomy may relieve endometriosis symptoms, but it is not a cure for endometriosis.

How successful is laparoscopy to unblock fallopian tubes? ›

The success rate of this method can be up to 85%; Laparoscopic surgery to remove adhesions of fallopian tubes and fallopian tubes: For cases where the fallopian tubes are attached due to inflammation, which can easily lead to ectopic pregnancy, the patient needs to undergo surgical dilation and removal of the fallopian ...

Can hysteroscopy unblock fallopian tubes? ›

Operative hysteroscopy can remove uterine fibroids and polyps, open blocked fallopian tubes, and perform endometrial ablation if endometriosis is present.

What is the hardest laparoscopic surgery? ›

Laparoscopic cholecystectomy (LC) is the gold standard cholecystectomy. LC is the most common difficult laparoscopic surgery performed by surgeons today.

Is endoscopic surgery a major surgery? ›

Endoscopy is a medical procedure that allows a doctor to inspect and observe the inside of the body without performing major surgery. An endoscope is a long, usually flexible tube with a lens at one end and a video camera at the other.

Can a hysteroscopy detect ovarian cysts? ›

The major difference between the laparoscopy and hysteroscopy is that laparoscopy can help physicians to diagnose many gynaecological problems such as uterine fibroids, endometriosis, ovarian cysts, adhesions, scar tissues, ectopic pregnancy and other structural disorders while hysteroscopy is used to look inside the ...

How long did you take off work after laparoscopy? ›

You can typically return to work three days after surgery.

How soon can I walk after hysteroscopy? ›

You may begin normal physical activity within hours of surgery. Start with short walks and gradually increase the distance and length of time that you walk. To allow your body time to heal, you should not return to a more difficult exercise routine until 2 days after your surgery.

What are the don'ts after hysteroscopy? ›

Don't douche or have sex for 2 weeks after the procedure, or as advised by your healthcare provider. You can go back to normal activity and diet unless your healthcare provider tells you otherwise. Your healthcare provider may give you other instructions based on your situation.

What is the fastest way to recover from a hysteroscopy? ›

Most people who have a hysteroscopy procedure as an out-patient without a general anaesthetic feel able to go back to their usual activities the same day. But you may want to take a day off work to recover. If you've had a general anaesthetic, you may need to rest for a few days before you get back to normal.


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