The uterus (womb) is an inverted triangle shaped organ and incorporates the cervix, Fallopian tubes and ovaries. It is suspended within the pelvis with strong ligaments and blood vessels. It is responsible for periods (shedding the endometrium) and developing pregnancies.
The uterus can grow abnormal structures like fibroids and polyps. Whilst rarely cancerous, fibroids and polyps can cause problems like pain, heavy vaginal bleeding and difficulty falling pregnant.
The location of the fibroid and polyp in the different layers of the uterus will influence the way in which they can be removed. Minimally invasive surgery can be used to visualise and remove fibroids and polyps that grow in or affect the inside lining (the endometrium) of the uterus.
Adhesions and scar tissue can also form within the uterus. This can lead to a condition called Ashermann Syndrome, which can lead to absence of a period and difficulty falling pregnant.
Why is hysteroscopic resection performed?
Uterine fibroids, polyps and other abnormalities may be suitable for hysteroscopic resection when women experience the following scenarios:
- abnormal and problematic periods
- irregular, heavy and painful periods
- difficulties falling pregnant
- concern for suspicious or pre-cancerous cells
- abnormal vaginal discharge
How is hysteroscopic resection performed?
In the hours leading up to a hysteroscopic resection of uterine abnormality, a tablet that dissolves under the tongue may be given to soften the cervix (neck of the womb). Hysteroscopic resection typically requires a general anaesthetic from the anaesthetist. The abdomen and pelvis are swabbed with antiseptic cleaning solution and sterile drapes are applied to reduce the risk of infection. A urinary catheter is placed to drain the bladder.
A hysteroscope is a thin instrument that houses a small medical video camera. The hysteroscope passes through the vagina and the cervix, and into the uterus. Once inside the uterus, the endometrium and the internal openings to the Fallopian tubes can be visualised under magnification and the video is relayed onto a screen in real time.
The hysteroscope also houses narrow channels through which specially designed medical instruments can pass, to allow procedures to be performed within the uterus. The instruments are specially designed to allow dissection of fibroids, polyps and other abnormalities, to break them down into smaller fragments for removal from the uterus and to simultaneously ensure control of any bleeding. This is done under direct vision using the highly magnified vision on the screen.
FAQ
HOW LONG DOES IT TAKE?
About 30-60 minutes depending on the fibroid or polyp being removed.
CAN PREGNANCY STILL OCCUR AFTER IT?
Yes, Removing abnormalities that disrupt the lining of the womb may improve the likelihood of conceiving spontaneously or conceiving with medical assistance.
It is typically recommended to not fall pregnant for at least one to three months after corrective surgery – depending on the type of surgery performed. This gives the womb time to adequately heal.
WHAT ARE THE BENEFITS ?
This is usually a ‘day procedure’ – meaning you come into hospital and leave the same day as your procedure. You don’t typically need to stay in hospital overnight.
There are no visible scars
This procedure can be diagnostic and therapeutic – meaning it allows for information to ensure clear understanding of the type of uterine abnormality as well as reduce the symptoms associated with the abnormality.
It allows direct visualisation of endometrial cavity and assessment of any abnormal structures or uterine features (for example – a septate uterus, uterine didelphys)
WHAT ARE THE RISKS?
Uterine perforation and injury to the genital tract (vulva, vagina and cervix)
Recurrence of fibroids, polyps, scarring and adhesion formation
Inadequate resolution of subfertility or period problems
Injury to adjacent organs and structures (like bladder, bowel, ovaries and blood vessels). Additional surgery may be needed to identify and repair an injury
Electrolyte imbalance and fluid overload can affect the heart, brain and lungs when excessive hysteroscopy fluid is absorbed by the patient
Repeat or sequential procedures to manage complex or large abnormalities
Infection can affect any site from the incisions on the skin to the internal organs
Bleeding from the site of the procedure. In very rare scenarios, heavy bleeding relating to surgery that is life threatening may require a hysterectomy
Future pregnancy risks including unplanned caesarean section, uterine rupture (separation of the uterine wall) and abnormal development and adherence of the placenta into the womb.
Read more general anaesthetic and surgical risks in the Patient Information section
WHAT ARE THE OPTIONS?
Surveillance with ultrasound or MRI
Medical and hormonal treatment to shrink fibroids and promote normal menstrual bleeding. This is usually temporary and symptoms may recur after the medication has stopped. Hormone treatments are not compatible with falling pregnant, if this is important.
Hysterectomy to definitively manage the abnormality. This may be suitable amongst women who do not wish to conserve their uterus.
WHAT IS THE RECOVERY?
Recovery after hysteroscopic resection of fibroids and polyps is typically short, minimally painful and well tolerated. You can resume your normal daily functions from the day or two after surgery. This is because it is a minimally invasive (‘keyhole’) procedure which does not require any skin incisions.
Any pain or discomfort is typically very mild and can be managed with paracetamol and ibuprofen. You will be able to eat and drink as usual. Your bowels might be slower than usual and can be eased with stool softeners (like Movicol® or Coloxyl®). You are unlikely to notice any difference in bladder function, but any changes are typically temporary and mild.
You might experience vaginal bleeding after your procedure. This may occur for up to 2 to 4 weeks, but will typically be less than a period. Avoid tampons in the first 2 weeks post surgery. Your period may return anytime in the first 4-8 weeks after surgery.
If the fibroid resection was partial, then a further procedure may be booked in the months ahead.
Pregnancy should be deferred for at least 1-3 months. Discuss your situation with Dr Dunn.
Hospital stay: Your hospital stay will typically be just for the day of surgery, allowing you to recover at home. If you need admission for observation and recovery this will easily be arranged.
Returning to work: This depends on the type of work you are returning to. Women can return to office-based work usually within 2-3 days after hysteroscopic resection of fibroid. More extensive hysteroscopic resections or more physically demanding work may require additional recovery days. In this situation, consider if there are alternative, less-physically demanding roles you can do to ease your return to work.
Driving and travel: Typically, you can drive about 2 weeks after your minimally invasive surgery and 4-6 weeks after a laparotomy. Always check with your vehicle insurance provider and comply with any instructions they provide you. Before flying, you typically need to wait at least 2 days after minimally invasive surgery and at least 5 days after a laparotomy. Check with your airline so you can safely time your surgery and travel.
Intimacy, exercise and other activities: You should defer penetrative intercourse for 2 weeks and until any abnormal vaginal bleeding has settled. You can resume your usual physical activity and exercises 2-3 weeks after your surgery.
Please remember your recovery is individual. Each day following surgery you can expect to have made some improvement in how you feel. Dr Dunn will happily discuss your specific recovery circumstances.
Please read more about recovery in the Patient Information page.
WHAT VISIBLE SCARS ARE LEFT AFTERWARDS?
There are no abdominal or vaginal scars from this procedure.
WILL MY PERIOD AFFECT WHEN I CAN HAVE SURGERY?
No not typically. It may be preferrable to try to time surgery to just after your period so the endometrium is already thinned out. However, this is not essential.
