Hysteroscopic Surgery for Fibroids
What is Hysteroscopy?
Hysteroscopy is camera examination of the uterine cavity (Hysteros = uterus; scopy = to have a look). A small camera attached at the end of a tube is inserted through the neck of the uterus into the uterine cavity under direct vision. Pictures and video recording of the procedure can be taken for review. This procedure allows the surgeon to assess the uterine cavity and also see if the fibroids are growing within the cavity (submucous fibroids).
How is resection performed?
Hysteroscopic or Transcervical Resection of fibroids is performed using a wire loop electrode attached at the end of the telescope. Low voltage electrical current is passed through the wire loop which is then used to remove strips of fibroid under direct vision.
Which fibroids can be resected using the Hysteroscopic approach?
Submucous (indenting on the cavity of uterus) fibroids less than 4cm in size and a safe distance away from the outer border of the uterus can be resected through a trans-cervical approach. Not all submucous fibroids would be suitable for this treatment and thorough assessment before and during the procedure is of critical importance.
What are the advantages of this procedure?
This is a day case procedure with no surgical incisions involved and the recovery is very quick. The bleeding is minimal and uterine cavity can be normalised using this procedure. Pound for pound, this is the most effective treatment in terms of improving symptoms but may not be suitable for all fibroids. A normal uterine cavity is associated with reduced menstrual blood loss and improved pregnancy outcomes.
What are the disadvantages?
Not all fibroids would be suitable for this procedure and careful assessment is vital. The procedure carries risk of uterine perforation, but this can be minimised by using careful surgical technique under direct vision and ultrasound guidance. A submucous fibroid may not be resected completely in a single procedure and sometimes a second stage procedure is required.