Hysteroscopic resection is also known as Transcervical Resection of Fibroids (TCRF) is a precedure of removing fibroids that occurs on the inside of the womb (uterus), in the uterine lining via the vagina using an instrument called hysteroscope.
Key features of this surgical procedure include:
Suitable for fibroids are within or bulging into the uterine cavity (submucosal) or fibroids that are less than 10 cm in diameter. Any fibroid tissue within the wall of the womb will not be removed.
Aiming to remove the fibroids that cause menstrual problems or that may be interfering with the ability to conceive.
Hospital: one night’s stay or as a day-case.
Anaesthetics: general anaesthetic as an inpatient or local anaesthetic as an outpatient.
Duration of procedure: varied around 30 minutes to 1 hour, depending on the size of the fibroid.
Recovery period: 1 - 2 weeks.
What are the risks?
Like all surgical procedure, hysteroscopic resection carries some risks & complications (see table below).
Risks & Complications of Hysteroscopic resection
Infection
Small risk and usually presented as offensive vaginal discharge.
Treatable with antibiotics.
Bleeding occurring at the operation
If not controlled by diathermy coagulation, it may be necessary to use pressure from an inflated catheter inserted into the womb.
Organ perforation
Uterus puncture occurs in 1-2 per 1000 operations. Also, bowel perforation may happen.
Excessive fluid absorption
Occurs in 1-5% operations. This is managed by blood test monitoring, diuretics and may prolong hospital stay.
It is important that you understand the procedure, why and what to expect so we present a step-by-step guide for you.
What happens BEFORE the procedure?
Sometimes, the fibroids are too large, you may be prescribed GnRHa such as Zoladex injection monthly for 2 - 3 months to shrink them prior to surgery.
Or alternatively, you may be given option to have a 2-stage operation after 3 months of the first operation.
Pre-assessment is carried out about 1 week before the operation to check for:
- blood test for haemoglobin level.
- ECG and possibly chest x-ray.
- Medical history.
On the day of the operation, both gynaecologist and anaesthetist will see you to explain the procedure to you and obtain your consent.
One hour before the ops, you will be given anti-inflammatories & pain killers as well as anti-sickness/nausea medications.
Also to soften the cervix to make resectoscope entry easier, you may be given medications to insert into the vagina.
What happens DURING the operation?
Under general anaesthetics, the cervix is gently stretched by a number of gradually increased size dilators one after the other. Until sufficient stretch is achieved, the surgeon inserts a resectoscope into the womb.
The resectoscope is connected to the fluid system which is used to distend the womb to allow the surgeon a clearer view. Pictures are taken for comparison later.
The surgeon starts to shave off the fibroid by passing an electrical current through the cutting loop attached to the resectoscope and remove it piecemeal if it is larger than 5 cm. The electrical current in the cutting loop helps to ensure a cleaner cut and seal the blood vessels at the same time.
Pictures are taken to see the effects of the treatment.
A sample is taken to send to the labs to check for abnormality.
Endometrial ablation may also be carried out at the same time to thin the lining of the womb to make the periods lighter. This is ONLY done if you have completed your family or do NOT wish to become pregnant later.
During and at the end of the operation, all fluid used is collected checked for fluid balance.
What happens AFTER the operation?
You will be moved to the recovery room to be cared for by a specialist nurse until you are stable to be transferred to the ward.
You may have some cramping abdominal pains and pain relief is given for this.
Some vaginal blood loss may occur but not too excessive.
One you are fully recovered, you will be given a drink and a light meal before discharged home either later that day or early next day.
Care at home guide
For the first 24 hours, you may feel drowsy and it is advisable that you do not drive or operate machine.
You are given antibiotics to prevent infection.
You may experience cramping symptoms. You can take paracetamol (e.g. Panadol) or ibuprofen such as Nurofen (only if you are not allergic to it, or asthmatic or have history of ulcer). If you are in doubt, talk to your pharmacist.
Rest for a couple of days then gradually resume your normal activities.
It is normal to bleed for a few days and as long as 2-4 weeks. Do not use tampons, use sanitary towels. For a few weeks (2 - 4 weeks), you may still see a pinkish/brown/yellow or clear vaginal discharge which is common as the womb heals.
Use shower instead of bath in the first 2 weeks.
If you experience any of the following symptoms, please, contact gynaecology emergency department immediately:
Symptoms to call for immediate medical attention
Fever/chills.
Headache/dizziness.
Increased abdominal pain and not relieved by pain medications.
Increased/prolonged bleeding.
Unusual vaginal smelling.
Difficulty in passing urine or unable to pass urine.
Frequent urination or burning sensation when passing urine.
Don’t use tampons until the blood stained discharge has stopped as this could introduce infection.
You can have sex again as soon as the discharge stops. Do continue contraception as before, unless you are wanting to get pregnant.
Depending on your speed of recovery, you can go back to work and continue with normal activities within about one week.
What can I expect from the procedure?
If your reason for the operation is heavy periods or irregular menstrual bleeding, then your periods will be likely lighter and more regular afterwards. You will see improvements over the next 2-3 months.
If you received Endometrial Ablation at the same time of your hysteroscopic resection, reduction in bleeding will be even more pronounced.
If your fibroids had made conceiving difficult then your chance of getting pregnant is improved after hysteroscopic resection. Please remember that the ability to conceive depends on may factors and therefore it is difficult to predict who will be successful.
Author:Dr Nicki On, PhD, MRPharmS. The information on this page has been peer-reviewed by Dr Rajesh Varma, MA, PhD, MRCOG. Dept of Obstetrics and Gynaecology, Guy's and St. Thomas' NHS Foundation Trust, London SE1 7EH, UK.
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This page was last modified on Tuesday 23 March 2010 10:21 pm.
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