Hysteroscopic Resection of Fibroids

 Fibroids can be located in different places within the womb. The location of the fibroid and the symptoms determine which method is used to remove a fibroid when required.

 Fibroids located within the cavity of the uterus or impinging into it, known as submucosal fibroids, may cause heavy bleeding or difficulty conceiving. One option for treating these is through hysteroscopy.

Frequently Asked Questions

What is a hysteroscopic resection?

A hysteroscopic resection is also known as Transcervical Resection of Fibroids (TCRF). It is a procedure for removing fibroids that occur on the inside of the uterus. The procedure is done using an instrument called hysteroscope which has a long and thin optical lens attached to a camera and is used to provide vision inside the uterine cavity.

The hysteroscope is inserted through the natural opening of the uterine cervix hence not requiring surgical incisions. Using a small cutting device which is inserted through the hysteroscopy, the fibroid is removed in small fragments.

 What are possible complications of a hysteroscopic resection? 

By and large, there are not many significant complications associated with the procedure. The main one is a uterine perforation. That means that an instrument is inserted too deep into the uterine cavity and can cause a small puncture to the uterine wall. The hysteroscope can then reach inside the abdominal cavity and, worst case scenario, can damage intra-abdominal organs such as the bowel. Uterine perforations are fairly rare (1/200 procedures) and serious complications, such as bowel damage, are extremely rare (< 1/1000).

 What are the pre-surgery requirements?

It is important to have a good evaluation of the fibroid using imaging tests such as ultrasound and, in restricted cases, Magnetic Resonance Imaging (MRI). The ultrasound can describe important features such as size of the fibroid and its position in relation to the uterine cavity. These are helpful in planning the procedure.

Blood tests may be required, especially in women who have been bleeding very heavily because of the fibroid.

Ideally, the procedure should not be done when the woman is having her period, as the presence of blood may make visualization inside the uterus difficult.

 Will the whole fibroid be removed in one operation?

In the case of large fibroids, you may be given a two stage surgical procedure, with the second operation to take place 6 to 8 weeks after the first one. This means that part of the fibroid will be removed during the first procedure and the rest second time around.

A two-stage procedure is also applicable if a significant portion of the fibroid lies within the muscle of the uterus. After a period of time, the uterus contracts and allows any remaining fibroid to move further into the cavity to allow it to be removed in the second stage.

 How is the operation performed?

Under general anaesthesia, the cervix is gently dilated. The tip of the hysteroscope is then inserted through the cervix into the uterine cavity.

Under the direct vision supplied by the camera attached to the hysteroscope, the surgeon operates a surgical instrument that has a circular cutting edge and, with repetitive movements, slices the fibroid a small piece at a time.

 What is the recovery from the surgery like?

The procedure does not require any skin incisions. Therefore, the post-operative period is not very painful.

Women are discharged home a couple of hours after the procedure and can expect to resume work and all regular activities after one or two days.

It is common to experience vaginal bleeding for a few days. There usually isn’t much pain.

If the fibroid resection was partial, you will be informed straight away and a second procedure will be booked within a couple of months.

 Advice at home

You can resume normal activities the day after the operation. Some women need a few days to feel completely recovered and return to physical activities.

You may get vaginal bleeding lasting 2-4 weeks and it should settle after that.

Avoid using tampons and sexual intercourse for the first 10 days.