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.
