Hysteroscopic Myomectomy

When do you need a hysteroscopic myomectomy?

A myomectomy is advisable when the symptoms causing fibroids disrupt the normal activities of the patient. The type of myomectomy depends on the location, size and number of fibroids present. A hysteroscopic myomectomy is performed using a hysteroscopic resectoscope.

A surgeon may suggest hysteroscopic myomectomy in the following cases:

• The patient has submucosal fibroids
• The fibroids in the uterus are small
• If the fibroids are located significantly into the uterus and not within the uterus wall
• If the uterine fibroids are causing fertility problems
• Bleeding after menopause
• Abnormal uterine bleeding

This procedure, like abdominal myomectomy and laparoscopic myomectomy, does not remove the uterus and allows the patient to remain fertile.

How can you prepare for a hysteroscopic myomectomy?

Doctors may conduct several tests to ensure that the patient is fit for the surgery. The doctors will determine the tests based on the risk factors involved. Some of the tests include:

• Blood test
• MRI scan
• Pelvic ultrasound
• Electrocardiogram

In addition, the doctor may prescribe medication to reduce the size of the fibroids, making them easier to be removed. The medications may include drugs to block estrogen and progesterone production to put the patient in temporary menopause. Patients are advised to discuss the consumption of any other medications, including vitamins and supplements, in advance with the doctor. This will reduce risks during the surgery and any complications post-surgery as well.

How is a hysteroscopic myomectomy performed?

A hysteroscopic myomectomy is performed in the following manner:

• The patient is placed under general anesthesia or Monitored Anesthesia Care (MAC)
• The surgeon inserts a thin, lighted scope through the vagina and cervix and into the uterus
• The surgeon may insert a liquid, usually a sterile salt solution, into the uterus to expand it, allowing them to see the fibroids clearly
• The surgeon may either use a wire loop resectoscope or a hysteroscopic morcellator to cut the fibroids and take the pieces out of the uterus completely

Note: In the case of fibroids not being removed completely in one surgery, a second surgery may be required.

What are the possible risk factors involved in this procedure?

The chances of becoming pregnant post-surgery depend on the procedure, the number and the type of fibroids. Myomectomy possesses the following risks and challenges:

• Excess bleeding: Several patients may have low blood count due to heavy menstrual bleeding. This may lead to blood loss at the time of surgery. Surgeons may use medications, tourniquets or clamps to control or block the flow from uterine arteries. Patients may also face heavy menstrual bleeding post-surgery.
• Scar tissue: There might be a development of scar tissues post-surgery if any incisions are made in the uterus to remove fibroids. This may also block the fallopian tube and lead to fertility problems.

Risks in a hysteroscopic myomectomy is rare, and the procedure does not cause any scars. However, the following complications may occur:

• Infection
• Need for another myomectomy due to the development of new or recurring fibroids
• Pelvic pain
• Damage to surrounding organs

What does the post-operative care for hysteroscopic myomectomy involve?

Patients may experience light vaginal bleeding post-surgery and are advised to consult their doctors for post-surgery tips and care to avoid any risks or complications. Recurrence of fibroids is possible, especially in younger and pre-menopausal women.

Some post-operative instructions are as follows:

• Avoid sexual intercourse for a certain period of time
• Avoid the use of tampons
• Avoid swimming or use of bathtubs
• Avoid heavy lifting or any strenuous activities
• Consume healthy food
• Take proper rest

How long does the recovery take?

Patients might experience pain and spotting post a hysteroscopic myomectomy for a few days to a few weeks. However, it is an outpatient surgical procedure and takes only 2-3 days for recovery compared to abdominal and laparoscopic myomectomy. In addition, patients who have undergone a hysteroscopic myomectomy can return to their normal activities from the next day unless recommended otherwise.