With the development of medicine and technology, surgery tends to be less invasive, shorter hospital stay and faster recovery, so minimally invasive surgery has been developed in full swing. Today, let me lead you into the minimally invasive world of gynecology to understand how a real minimally invasive surgery is performed. Today’s topic is hysteroscopic surgery. Hysteroscopic surgery is a surgical procedure performed through a woman’s natural cavity, the vagina, and has the advantages of minimal trauma, short hospital stay (usually one day), quick recovery, and so on. Who should undergo hysteroscopy? Of course, not all women with gynecological problems need to undergo the procedure, and not all patients with related problems needing hysteroscopic surgery can undergo the procedure, which is a bit tongue-in-cheek, so patients should probably be confused, not to sell off, in the end, who should undergo hysteroscopic surgery? The main categories include irregular uterine bleeding, endometrial polyps, mucosal fibroids, abnormal intrauterine device, uterine adhesions, unexplained infertility, recurrent miscarriage, uterine malformation, tissue residue after miscarriage or uterine evacuation, abnormal endometrial hyperplasia, etc. By doing this surgery, we can clearly see the situation in the uterine cavity, including the morphology of the uterine cavity, the condition of the endometrium, and whether there is a raised mass, etc. We can obtain tissues for pathological examination at the same time as performing the corresponding surgical treatment, so that we can finally make a clear diagnosis and provide a scientific basis for the subsequent treatment of the disease. Who can’t have this surgery? As already mentioned, not all patients who need hysteroscopic surgery can undergo the procedure, so who can’t undergo the procedure even if they have the above mentioned symptoms? For example, acute or subacute reproductive tract infections or pelvic inflammatory disease cannot be performed because they can cause inflammation to spread; and patients with serious medical or surgical comorbidities that cannot tolerate the operation cannot undergo the procedure. Of course, there are some patients who should weigh the pros and cons and consider the operation carefully, such as those with body temperature >37.5℃, which indicates the possibility of infection and should not be operated for the time being, and can be done after the body temperature is normal; patients with heavy uterine bleeding and severe anemia should not do the operation because the hysteroscope cannot be seen when there is heavy bleeding; those with recent history of uterine perforation or uterine surgery (within the last 3 months) should not do the operation because the operation will lead to The procedure is not recommended for those with a recent history of uterine perforation or uterine surgery (within the last month) because it may lead to re-injury to the uterus, and surgery can be considered after the uterus has been repaired. As the saying goes, a good start is the key to success, so preoperative preparation is the key to success, including the patient’s psychological and physical preparation, the doctor’s preoperative evaluation, setting the surgical plan, preoperative case writing and talking and signing. Although hysteroscopic surgery is not a major surgery, it still requires careful preparation to make the surgery successful. The preparation includes the timing of the surgery, which is usually best 3-7 days after menstruation, but if there has been irregular bleeding, the surgery can be performed at any time; the patient needs to refrain from sexual intercourse after menstruation or 3 days before the surgery to prevent infection; the patient needs some preoperative tests, including blood pressure and pulse, infectious disease tests, electrocardiogram, and routine leukorrhea; some patients have a hard cervix or postmenopausal atrophy and need medication to soften the cervix to prevent damage to the cervix; and some patients have a diameter of the cervix. Some patients with fibroids ≥4cm in diameter or severe anemia can be treated with drugs for 2-3 months to reduce the size of the fibroids and correct the anemia before considering surgery, which has two advantages: firstly, it makes the surgery less difficult because the cavity itself is small and the fibroids are so large that the cavity space is even smaller so that the surgical instruments cannot be extended and the surgery cannot be performed smoothly. The second advantage is that patients with anemia will have less menstrual flow after taking the medication, so they will be able to tolerate the surgery better and recover faster after the surgery; on the day of the surgery, the patient needs to abstain from food and water (more than 6 hours). The procedure: After talking for so long, patients must be eager to understand how the operation is actually performed, so today I will unveil the mysterious operation and tell you all about it. During the surgery, the patient is placed in the lithotomy position, which is the usual position for gynecological examinations in the outpatient clinic. After the anesthesia is administered, the nurse will open an intravenous line in case of emergency. Because there are risks associated with any surgery, hysteroscopy also has certain surgical complications, and in the event of a complication, this intravenous access can help the medical staff gain a few precious minutes to save the patient. The surgeon disinfects the patient and prepares the instruments, while the nurses are also working in an orderly manner to ensure that the preparations are accurate, and then the surgeon begins the operation. The hysteroscope is inserted into the vagina and slowly enters the uterine cavity through the cervix. At the same time, a lot of pontium media, mainly saline, is injected into the uterine cavity to help expand the cavity so that the surgeon can clearly examine the cavity carefully without missing every abnormality. The abnormalities in the uterine cavity are detected and treated accordingly. The operation time varies depending on the disease. Generally, the operation time is about 10 minutes for endometrial polyps or abnormal bleeding or IUD insertion plus about 30 minutes for anesthesia and preparation, and longer for more complicated operations such as larger submucosal fibroids or uterine malformations requiring plastic surgery, but generally not more than 1 hour. The long duration of hysteroscopic surgery can easily lead to complications such as water intoxication due to excessive absorption of saline, which can lead to life-threatening conditions. Surgical risks Surgical risks are surgical complications. I think everyone, including doctors and patients, would like to have 100% safe surgery without any complications, but this is not possible, because there are still many unknown areas in medicine and many insurmountable difficulties, so surgery cannot be guaranteed to be absolutely safe. However, with a good preoperative preparation, skillful intraoperative surgeons and careful operation, as well as good patient cooperation, surgical complications should be reduced to a minimum. The main complications of hysteroscopy include perforation of the uterus, bleeding, water poisoning, air embolism, electrical burns, abdominal pain (uterine adhesions), and infection. Air embolism is the most dangerous and can lead to death, which has occurred in the early stages of hysteroscopy development. But don’t be nervous and don’t be afraid, the procedure is very mature and the surgeon is very careful and cautious, so the chance of these complications is very low and there are ways to deal with them. However, if the diagnosis and treatment of the disease is delayed because of the fear of the risks of surgery, it will be more than worth the loss. There are still things that need attention, including rest for at least one week, because the patient’s resistance will be reduced after the surgery, so if you don’t rest well, you will easily get infected; if you have abdominal pain, fever, vaginal bleeding, etc., come to the hospital immediately after the surgery; if you have excised tissue, you can come to the hospital one week after the surgery to get the pathology report; after the surgery, sexual intercourse and bathing are prohibited for one month to prevent infection. So, dear patients, if you have some similar problems and your doctor recommends hysteroscopy, don’t be nervous because it is a minor surgery with little trauma, quick recovery, and also can solve the problem and obtain clinical information quickly.