Combination

Dilation and Curettage (D&C)

During a D&C procedure, the cervix is dilated (widened) to allow the insertion of an instrument called a curette into the uterus. The curette is used to scrape lining of the uterus (endometrium) and collect the tissue from inside the uterus. It may be performed to remove tissue for diagnostic examination, to remove small tumors or to treat abnormal uterine bleeding. A D&C may also be performed to remove remaining material after an incomplete miscarriage or abortion. This is called an aspiration or suction D&C and removes tissue from the uterus with a vacuum device.

Cervical Conization

Also called cone biopsy, this is a more extensive form of cervical biopsy and is performed to follow up when colposcopy or a cervical biopsy have failed to provide enough information for a definitive diagnosis. A cone-shaped wedge of tissue from the cervix is removed by one of several methods depending on your circumstance.

• Cold knife conization performed with a scalpel.
• Laser conization. The cone of tissue may be removed or destroyed by vaporization.
• Loop electrosurgical excision procedure (LEEP). A thin wire loop that emits a low-voltage high-frequency radio wave is used to remove tissue.
• Large loop excision of transformation zone (LLETZ).
• Combined conization. A procedure started with one technique, such as the use of a laser, may be completed with another, such as a cold-knife technique.
• Harmonic scalpel (HS) conization. Ultrasonic mechanical vibrations are used to cut and coagulate.

In some cases, the cone biopsy treats the problem because all the diseased tissue is removed.

Hysteroscopy

This procedure is done to look for uterine abnormalities. A thin, telescope-like instrument (a fiberoptic endoscope called a hysteroscope) is inserted through the vagina and cervix into the uterus. If an abnormality is detected during a diagnostic procedure, a surgical procedure can often be performed immediately by substituting a surgical hysterosope (one that allows operating instruments to be inserted through it to the uterus). Surgical procedures may include:

• Removal of polyps, fibroid tumors, scar tissue, or tissue overgrowth [hyperplasia]
• Opening blocked fallopian tubes [recanalization]
• Treating abnormal bleeding with [endometrial ablation]

Pelviscopy (pelvic laparoscopy)

This procedure is done to examine and treat abdominal and pelvic organs through a small surgical viewing instrument (laparoscope) inserted into the abdomen at the navel.

Selective Salpingography

This X-ray test is used to identify fallopian tube disease or obstructions. A fine catheter is passed into the fallopian tube, then dye is injected to look for abnormalities or obstructions. Occasionally, the pressure of the dye may be all that is needed to open a blocked fallopian tube. If not, a wire guide canalization or transcervical balloon tuboplasty can be performed during your salpingography test.