Hysteroscopic resection of fibroids or hysteroscopic myomectomy is a minimally invasive surgical procedure specifically designed for the removal of fibroids. These non-cancerous growths arise from the inner layer of the uterus.
This technique is particularly beneficial for fibroids that are located within the uterine cavity (submucosal fibroids) or those that are distorting the uterine cavity, although it's also applicable for certain types of fibroids on the uterine wall.
The procedure is performed using a hysteroscope, a thin, telescope-like instrument that is inserted through the vagina and cervix into the uterus. The hysteroscope is equipped with a light and camera, allowing the surgeon to clearly view the interior of the uterus on a monitor. Small specialised surgical instruments are then introduced through the hysteroscope to carefully and precisely cut away and remove the fibroids.
One of the key advantages of hysteroscopic resection is that it requires no abdominal incisions, which significantly reduces the risks associated with open surgery and promotes a quicker recovery. The procedure is performed as a day case and under short general anaesthesia (where the patient is asleep throughout), although out-patient approach in the clinic and under local anaesthesia (where the patient remains awake) is common and can be used in certain cases.
The hysteroscopic approach to fibroid removal is extremely precise, offering the surgeon excellent control and visibility. This precision is important for preserving the health and integrity of the uterine tissue, which is particularly important for women seeking to maintain or improve their fertility.
If you’re interested in this article, you may also want to read: myomectomy vs hysterectomy for fibroids.
Why is hysteroscopic resection preferred for fibroid treatment?
Hysteroscopic resection has become a preferred method for fibroid treatment for several compelling reasons, particularly when it comes to treating fibroids that impinge on the uterine cavity. This preference is rooted in the procedure's minimally invasive nature, its effectiveness, and the array of benefits it offers over traditional surgical methods.
Minimally invasive approach:
Unlike traditional surgical methods such as abdominal myomectomy or hysterectomy, which require large incisions, hysteroscopic resection is minimally invasive. This method involves using a hysteroscope inserted through the vaginal canal, eliminating the need for external cuts. This approach significantly reduces the risk of infection, scarring, and contributes to a much quicker recovery time, allowing patients to resume their normal activities much sooner.
Preservation of uterine health and fertility:
For women who wish to preserve their fertility or maintain the integrity of their uterus, hysteroscopic resection is particularly advantageous. The precision of the procedure ensures that only the fibroids are removed while minimising trauma to the surrounding uterine tissue. This aspect is important for future pregnancy outcomes and reduces the risk of complications associated with fertility.
Reduced hospital stay and recovery time
Because it's minimally invasive, patients often undergo the procedure on an outpatient basis, meaning they can return home the same day. The recovery period is significantly shorter compared to traditional surgery, with many patients able to return to their regular activities within a few days. This efficiency is particularly beneficial for the clinic's target clientele, who often have demanding professional and personal schedules.
Effectiveness and safety
Hysteroscopic resection has a high success rate in removing fibroids and alleviating symptoms such as heavy menstrual bleeding, pelvic pain, and pressure symptoms. Additionally, the risks of complications are considerably lower compared to traditional surgical methods, making it a safer choice for many patients.
Technological advancements
The procedure benefits from the latest advancements in medical technology, including high-definition cameras and precision instruments that enhance the surgeon's ability to safely and effectively remove fibroids. The clinic's state-of-the-art facilities and expertise in advanced gynaecology scanning further ensure that patients receive the best possible care.
What are the benefits of choosing hysteroscopic resection of fibroids over other treatment methods?
Choosing hysteroscopic resection of fibroids presents multiple benefits, making it a standout option for patients seeking relief from fibroid symptoms. These advantages span from reduced impact on the patient's body to enhanced recovery times and improved long-term outcomes.
Targeted treatment with maximum preservation:
The precision of hysteroscopic resection allows for targeted treatment of fibroids located within or impacting the uterine cavity. This specificity ensures that normal uterine tissue is preserved to the greatest extent possible, which is particularly beneficial for future fertility and overall uterine health.
Reduced recovery time and lower risk of complications
Since the procedure is minimally invasive, patients typically experience less postoperative pain, fewer complications, and a significantly quicker return to normal activities. This contrasts sharply with more invasive procedures like abdominal myomectomy, which involves longer recovery periods and increased risk of infection or scarring.
No abdominal incisions
One of the most compelling benefits is the lack of abdominal incisions, which not only reduces the risk of external scarring but also lessens the chance of internal adhesions. Adhesions can lead to chronic pain and fertility issues, making the hysteroscopic method particularly advantageous for women concerned about these risks.
High success rate and symptom relief
Hysteroscopic resection effectively alleviates symptoms associated with fibroids, such as heavy menstrual bleeding, pelvic pain, and pressure sensations. Many patients report significant improvements in their quality of life following the procedure, with a high degree of satisfaction and symptom relief.
Outpatient procedure
The ability to perform hysteroscopic resection on an outpatient basis is a significant advantage for patients. It minimises the disruption to their daily lives and eliminates the need for an extended hospital stay, aligning well with the lifestyle of the clinic's target clientele in central London.
Compatibility with future pregnancies
For women wishing to conceive, preserving the uterus's integrity is paramount. Hysteroscopic resection offers a fertility-friendly option, often improving the chances of pregnancy by removing fibroids that may interfere with implantation or increase the risk of pregnancy-related complications.
Advanced technology and expertise
Leveraging the latest in medical technology and surgical techniques, the clinic ensures that patients receive the most advanced care available. Coupled with the specialist's expertise in advanced gynaecological scanning and bilingual communication, patients can expect a comprehensive and personalised treatment experience.
Are there any risks associated with hysteroscopic resection of fibroids?
While hysteroscopic resection of fibroids is highly regarded for its safety and efficacy, it's important for patients to be aware of the potential risks involved, although low compared to more invasive surgical methods. Understanding these risks is essential for making an informed healthcare decision.
Infections are a consideration, though the risk is minimised due to the procedure's minimally invasive nature. The introduction of instruments through the vagina and cervix might lead to infections, which are typically preventable with pre and post-operative antibiotics. Light bleeding may occur post-procedure, but significant bleeding is rare and generally associated with the removal of large fibroids.
One of the rarer complications includes the possibility of uterine perforation. This occurs when the surgical instruments create a small hole in the wall of the uterus, a situation that usually resolves itself but can require additional treatment in certain cases.
Fluid overload is another risk to consider. A specific fluid is used to expand the uterus for a clearer view during the procedure, and there's a slight chance that this fluid can be absorbed in excessive amounts, potentially leading to an electrolyte imbalance. This is closely monitored to avoid complications. Sometimes more than one treatment session is needed, especially if the fluid deficit level is reached without before complete resection of the submucosal fibroid.
Additionally, the procedure carries a minimal risk of causing internal scarring within the uterus, which could impact fertility. However, the targeted nature and the direct visualisation capabilities of the hysteroscopic method significantly lessens this risk, making it a preferred option for women concerned about future pregnancies.
Adverse reactions to anaesthesia are also a potential risk, as with any surgery requiring anaesthesia. Patients undergo thorough screening to minimise this risk, ensuring that the procedure is as safe as possible.
The surgeon's expertise and the healthcare facility's quality are paramount in minimising these risks. The clinic's central London location and its advanced facilities, coupled with Mr Naji’s proficiency in advanced gynaecological procedures, provide patients with a level of care that greatly reduces the likelihood of complications.
It is important for patients contemplating hysteroscopic resection of fibroids to discuss these potential risks with their healthcare provider, gaining a comprehensive understanding of the procedure's safety in the context of their individual health needs and treatment objectives.
How should I prepare for a hysteroscopic resection procedure?
Preparing for a hysteroscopic resection procedure involves several steps to ensure the best possible outcome and minimise the risk of complications. The clinic and its specialised team, located in the heart of central London, provide comprehensive guidance to patients, emphasising the importance of following pre-operative instructions carefully. Here's what patients can generally expect in terms of preparation:
Consultation and evaluation
Initially, patients undergo a thorough consultation, including a detailed medical history review and a physical examination. This step may include advanced gynaecological scanning to assess the size, number, and location of fibroids. This is important for tailoring the procedure to the patient's specific needs.
Medication review
Patients should inform their healthcare provider about all medications, supplements, and herbal remedies they are currently taking. Some medications, especially those that affect blood clotting, such as aspirin or other blood thinners, may need to be adjusted or temporarily discontinued before the procedure.
Fasting
Depending on the type of anaesthesia to be used, patients may be instructed to fast for a certain period before the procedure, typically around 6 to 8 hours before the scheduled time. This is a standard precaution to prevent complications during and after anaesthesia.
Post procedure care plan
Understanding the post-procedure care plan is essential for a smooth recovery. This includes knowing when to resume normal activities, medication management for pain or discomfort, and recognising signs of potential complications that warrant immediate medical attention.
What can I expect during the recovery period after hysteroscopic resection of fibroids?
Recovery from a hysteroscopic resection of fibroids varies from patient to patient, but thanks to the minimally invasive nature of the procedure, most individuals find the process manageable and relatively swift. The clinic’s comprehensive aftercare program, tailored to meet the needs of each patient, plays an important role in ensuring a smooth recovery. Here’s a general overview of what patients can typically expect during the recovery period:
Immediate post-procedure care
After the hysteroscopic resection, patients are monitored in a recovery area as the effects of anaesthesia wear off. This monitoring period allows healthcare professionals to ensure the patient's vital signs are stable and to manage any immediate discomfort. Most patients can leave the hospital or the clinic on the same day, although a short hospital stay may be necessary in some cases.
Pain management
It's common to experience some cramping or mild discomfort in the first few days following the procedure. The clinic provides pain management advice and medications to help ease these symptoms, ensuring patients remain as comfortable as possible.
Vaginal discharge and bleeding
Light vaginal bleeding or a watery discharge is normal in the first few weeks post-procedure. Patients are advised on how to manage this and are provided with signs to watch for that might indicate a complication requiring medical attention.
Activity level
Patients are generally encouraged to rest and avoid strenuous activities for a few days after the procedure. Gradually, as they feel better, they can return to their normal daily activities. Specific guidance on when to resume exercise and other more vigorous activities is provided, tailored to each patient’s unique situation.
Follow-up appointments
Follow-up appointments play a vital role in the recovery process, allowing the healthcare provider to monitor healing and address any concerns. These appointments are also an opportunity to discuss the results of the procedure and any implications for future fertility or menstrual cycles.
How does hysteroscopic resection of fibroids improve fertility and pregnancy outcomes?
Hysteroscopic resection of fibroids has been beneficial for many women experiencing fertility issues linked to fibroids. By precisely removing fibroids that distort the uterine cavity or interfere with the implantation site, this procedure can significantly enhance fertility outcomes and improve the chances of a successful pregnancy. Here’s how hysteroscopic resection of fibroids contributes to improved fertility and pregnancy outcomes:
Improvement in uterine environment
Fibroids, especially those that encroach upon the uterine cavity, can create an inhospitable environment for implantation and early pregnancy development. By removing these fibroids, hysteroscopic resection restores the natural shape and function of the uterine cavity, making it more conducive to embryo implantation and growth.
Reduction in miscarriage rates
Research has shown that women with fibroids are at a higher risk of miscarriage. This risk is particularly pronounced with fibroids that deform the uterine cavity. By eliminating these fibroids, hysteroscopic resection can reduce the likelihood of miscarriage, offering hope to women who have experienced recurrent pregnancy loss.
Enhanced embryo implantation rates
For women undergoing assisted reproductive technologies (ART) like IVF, the presence of submucosal fibroids can negatively impact embryo implantation rates. The removal of these fibroids can thus enhance the effectiveness of ART procedures, increasing the chances of pregnancy.
Reduced risk of pregnancy complications
Apart from improving fertility, the removal of fibroids through hysteroscopic resection can also decrease the risk of pregnancy-related complications, such as preterm labour, placental abruption, and foetal growth restriction. A healthier uterine environment supports a full-term pregnancy and the growth of a healthy foetus.
Preservation of uterine integrity
Unlike more invasive surgical options that can affect the structural integrity of the uterus, hysteroscopic resection is targeted and minimally invasive. This approach preserves the uterus's overall health and function, which is important for carrying a pregnancy to term.
It's important for patients considering hysteroscopic resection for fertility enhancement to consult with a fertility specialist and their gynaecologist. The clinic’s comprehensive approach to patient care ensures that individuals receive personalised advice and treatment plans based on their specific fertility goals and health profiles.
With the Rylon clinic’s advanced gynaecological scanning capabilities and the expertise of its medical team, patients can feel confident in their choice to pursue hysteroscopic resection as a pathway to improving their fertility and pregnancy outcomes.
Can hysteroscopic resection of fibroids be performed on an outpatient basis?
Hysteroscopic resection of fibroids, with its minimally invasive nature, is ideally suited to be performed on an outpatient basis. This aspect of the procedure is particularly appealing to many patients, as it allows them to return home the same day, minimising the disruption to their personal and professional lives. The clinic's advanced facilities and experienced medical team further facilitate a seamless outpatient experience. Here’s what patients need to know about outpatient hysteroscopic resection:
Procedure efficiency
The efficiency of hysteroscopic resection lies in its use of a hysteroscope, a specialised instrument inserted through the vagina and cervix into the uterus, avoiding the need for abdominal incisions. This technique not only reduces the risk of complications but also shortens the procedure time, making it suitable for an outpatient setting.
Same-day recovery
After the procedure, patients spend a short period in the recovery area to ensure they're awake and comfortable post-anesthesia, and to monitor for any immediate complications. Once cleared by the medical team, patients can return home, usually within a few hours after the procedure.
Benefits of outpatient care
Outpatient hysteroscopic resection offers several advantages, including reduced healthcare costs, lower risk of hospital-acquired infections, and the comfort of recovering in one’s own home. It aligns with the clinic’s commitment to patient-centred care, offering a convenient and efficient treatment option without compromising on safety or outcomes.
Preparation and aftercare
To ensure a smooth outpatient procedure and recovery, patients are given detailed pre-procedure instructions, including fasting requirements and medication adjustments. Post-procedure, pain management and symptoms monitoring advice are provided, along with clear guidelines on when to seek medical attention if necessary.
Follow-up and support
Outpatient care doesn’t mean out of sight. The clinic schedules follow-up appointments to monitor the patient's recovery and address any concerns. This comprehensive aftercare support is important for ensuring patient safety and optimising recovery outcomes.
Choosing outpatient hysteroscopic resection of fibroids means embracing a modern approach to fibroid treatment that prioritises patient convenience and well-being. With the Rylon clinic's prime location in central London and its dedication to leveraging advanced medical technologies, patients can expect high-quality care tailored to their needs and lifestyles.
Conclusion
Hysteroscopic resection of fibroids stands out as a highly effective, minimally invasive procedure that offers a multitude of benefits for women suffering from fibroids, particularly those looking to optimise fertility and overall uterine health. The procedure's ability to be performed on an outpatient basis further enhances its appeal, providing a convenient option that minimises disruption to patients' lives while ensuring a swift return to daily activities.
Our established private gynaecology clinic, nestled in the heart of central London, is dedicated to offering an unparalleled level of service that encompasses both patient education and exceptional clinical care. Our unique value proposition lies in our advanced gynaecological scanning capabilities and our bilingual service, ensuring clear communication and understanding.
Our location and affiliation with the prestigious NHS base at Guy's and St Thomas' Hospital underscore our commitment to providing top-tier care. We are pleased to offer an online booking system, making access to our services as seamless as possible.
Author: Mr Osama Naji
Mr Naji offers a “one-stop” gynaecology clinic for instant detection of various gynaecological cancers as well as providing all the diagnostic and treatment services needed under one roof.
Mr Naji provides advanced gynaecology scanning which is essential when conducting any gynaecology consultation, he is bilingual in English and Arabic and has an NHS base at the highly reputable Guy's and St Thomas' Hospital in London.
He is passionate about raising awareness of various subtle signs and symptoms of gynaecological conditions that are often overlooked by patients.