Hysteroscopic Surgery

Hysteroscopy involves the insertion of a hysteroscope – a form of laparoscope with a lighted end – through the cervix and into the uterine cavity. It allows our fertility specialists in Cape Town to examine the uterine lining, and is useful in diagnosing and treating various conditions, such as determining the cause of unusual bleeding, identifying and operating on polyps and fibroids, or to locate the possible reason for repeated miscarriages.

The process and what to expect

Diagnostic hysteroscopy is also often used in conjunction with hysterosalpingography (HSG) and an X-ray dye test to examine the fallopian tubes, which can also be done in a standard laparoscopy procedure.

The procedure is generally quick, lasting around 30 minutes, and does not require an overnight stay. Anaesthetic is not typically required, though we may administer a local anaesthetic to numb the cervix if you experience discomfort during the procedure (if done in an office setting. Depending on the pathology expected, the hysteroscopy is sometimes done under sedation (in very light forms of anesthesia) if too much discomfort is anticipated in the office setting.

Here are some of the conditions we use hysteroscopy to diagnose and treat:

Congenital Uterine Anomalies

Congenital Uterine Anomalies refer to malformations of the reproductive tract which the patient has been born with. They are rare, occurring in about 5% of the female population, but cause a significant number of repeated miscarriages and premature babies. 

Some of the more common congenital uterine anomalies include the septate uterus and bicornuate uterus. A septate uterus refers to a uterus which appears normal externally, but is divided by a connective tissue membrane. A bicornate uterus has two endometrial cavities and an abnormal indented surface.

Often these abnormalities have little impact on fertility, but when they do, hysteroscopic surgery can be used to correct them, depending on the complexity of the individual case. Whether surgery is feasible or not can be ascertained through diagnostic hysteroscopy (and/or a detailed internal ultrasound scan, preferably done by a fertility specialist).


Polyps are growths on the inside of the uterine cavity which vary from extremely small to as large as a golf ball. They are normally benign, but can cause heavy menstrual bleeding and difficulty conceiving, recurrent pregnancy loss, or may be precursors to uterine cancer. 

Hysteroscopy can be used both to take a sample of the polyp or polyps for laboratory testing, or to remove them.  

Uterine Fibroids

Uterine fibroids are similar to uterine polyps, but are made from connective tissue rather than an extension of the uterine lining itself. They are also known as leiomyomas or myomas

While they almost never develop into cancer, and in rare cases will go away by themselves untreated, in most cases they can lead to complications such as anaemia, difficulty passing urine or frequent urination, and heavy bleeding during menstruation. In these cases, hysteroscopic surgery is one option for removing them.

Uterine Adhesions / Asherman’s Syndrome

Intrauterine adhesions, also known as Asherman’s Syndrome, results when the inner walls of the uterus bind together with scar tissue. It typically occurs as a result of a surgical procedure such as a pregnancy termination, or medical intervention in cases of severe bleeding after childbirth.

Sometimes no symptoms are present, but in more severe cases intrauterine adhesions can cause pelvic pain, extremely painful periods, miscarriages, and infertility. Hysteroscopy combined with a hysterosalpingogram is normally successful in treating Asherman’s Syndrome.

Reach out
Please feel free to get in touch if you have any questions or would like to come in for a consultation. Our knowledgeable fertility specialists in Stellenbosch are standing by to help!