See it for yourself: Why opt for an awake hysteroscopy?

There are many reasons why patients may wish to undergo an ‘awake’ hysteroscopy where they are given medication to ensure they are relaxed and don’t experience any discomfort, but are not asleep during the procedure. We invited highly respected London-based women’s health expert and consultant gynaecologist Mr Mahantesh Karoshi to share his specialist insight on what’s involved in an awake hysteroscopy and why some women chose to be actively so involved in their procedure.

What is an awake hysteroscopy?

While undergoing an ‘awake’ craniotomy, part of the patient’s astrocytoma is resected, with the ‘patient-investigator’ working in collaboration with her neurosurgeon to take key decisions during the surgery. Put simply, the patient is awake during her brain surgery and she can guide her surgeon through the procedure, including at what point it should conclude.

This situation is in some ways similar to my patients as they undergo a procedure known as awake hysteroscopy, which I perform routinely. Patients often feel that being part of their procedure in this way is empowering as they get to see for themselves deep inside their body and discover exactly what is responsible for their symptoms. Not only this, but they also get to participate in their own journey to good health.

In an awake hysteroscopy, some women may wish to stop half way through the procedure once they have seen the issue at hand. In other cases, women want to have all lesions (such as uterine polyps) removed at this point as they are worried that they may be cancerous.

As long as the trust between the surgeon and patient continues to be a mutually respected partnership, this enables the patient to feel that she can take part in a surgical procedure, where she will have an opportunity to understand her condition better and will also have the power to withdraw consent should she wish to.

What are the benefits of undergoing an awake hysteroscopy for patients?

For women who have suffered years of infertility, for instance, an awake hysteroscopy allows them a clear and instant opportunity to see the problem for themselves and understand better the issues at hand. Many patients feel privileged and empowered by this sort of participation in their treatment.

Awake interventional procedures give the patient an in-depth perspective on their pathology. By seeing for themselves, they gain a closer and three dimensional understanding of why they have been troubled with irregular bleeding or infertility from polyps or submucosal fibroids.

Awake surgical procedures also give the patient an opportunity to assess the surgeon’s dexterity and to better understand the challenges faced by the clinician and assisting staff.

A key part of this type of intervention is a thorough pre-procedure discussion, where the prospective patient is informed on what to expect. It’s also important to note that it is perfectly acceptable to have divergent path during the procedure, such as an incomplete view of the intervention or to abandon the procedure for any reason. I’ll never forget the key lessons I learnt from my mentor - The patient is the boss and if at any stage, they wish to stop, my hands will freeze and we stop - that’s guaranteed.

Undergoing hysteroscopy or being referred for the procedure has become a norm for all sorts of reasons and suspected cancer remains the key motivation. However, one should be aware that in more than ninety-five per cent of cases, hysteroscopy findings reveal normality. This other five percent, therefore is of key importance. The future of a patient’s treatment and quality of life will be hinged on successful resection of a pathology, such as the removal of a sinister looking or suspicious polyp) and accurate communication with a tissue biopsy reporting specialist.

If you require a hysteroscopy and wish to discuss your individual case, you can schedule a consultation with Mr Karoshi, by visiting his Top Doctors profile.