Advanced Hysteroscopic Surgery

Hysteroscopic (keyhole) surgery combines the benefits of simplicity and short hospital stay (mostly day case) with absence of abdominal scarring and faster recovery.

What is hysteroscopy?

Hysteroscopy is the technique of inspecting or operating on the inside of the womb by passing a telescope through the cervix, thereby avoiding abdominal cuts. This is safely achieved by instilling fluid inside the womb to distend it at the beginning of the operation. Hysteroscopy has major advantages over other abdominal operations, including shorter hospital admission, faster recovery and return to normal functioning, reduced post-operative pain, reduced risk of post-operative adhesion formation (fibrous tissue that forms between different abdominal organs), and absence of abdominal scarring.

What to expect following hysteroscopic surgery

Anti-adhesion agents: we take active measures to reduce the risk of forming adhesions from hysteroscopic surgery. We do this by instilling 10mls a special gel (called Hyalobarrier) into the womb at the end of the operation. This gel gets absorbed by the body in about a week’s time. Women might pass some of the gel through the vagina causing an increased amount of discharge.

Pain: the first 24 hours after hysteroscopic surgery is associated with mild-moderate abdominal and pelvic pain for which we provide appropriate painkillers. We recommend you use the painkillers to keep on top of the pain so it remains manageable. The pain usually becomes much less troubling by the second day and thereafter resolves gradually.

Hospital stay: this depends on the procedure performed. The vast majority of hysteroscopic surgery is performed as day case. Operations needing inpatient hospital stay usually involve an overnight stay for observation.

Return to normal routine: we recommend staying off work for 1 week after a mild procedure and for 2 weeks after an intermediate/major procedure.

Hospital follow-up: this might not be necessary for some women but where indicated is arranged about 4-6 weeks after surgery.

Benefits of hysteroscopic surgery

Risks of hysteroscopic surgery

Our current state of knowledge indicates that hysteroscopic surgery is relatively very safe compared to abdominal surgery. Having said that, no operation is completely risk free and so we’ve listed below common and serious risks of hysteroscopy.

Bleeding: the risk of bleeding from hysteroscopic surgery depends on the type and complexity of the operation. Bleeding can occur during the operation or afterwards and this could necessitates a blood transfusion.

Uterine perforation: there is a small risk of perforating the womb during hysteroscopic surgery. This risk increases with the complexity of the operation and with bleeding.

Injury to pelvic/abdominal organs: this is very rare and only occurs if there has been a uterine perforation.

Adhesion formation: there is a small risk of intrauterine adhesion formation and this is further reduced with use of anti-adhesions agents.

Infection: these can complicate this type of surgery and so we use prophylactic antibiotics during surgery to reduce the risk. Offensive vaginal discharge especially if coupled with worsening pelvic pain suggest infection.

Our scope of advanced hysteroscopic procedures include:

Hysteroscopic myomectomy

This involves removing uterine fibroids from the womb. This procedure is particularly beneficial for women with infertility and repeated miscarriage.

Hysteroscopic metroplasty

This involves repairing the cavity of the womb to restore its natural contour. This procedure is particularly beneficial for women born with a particular type of abnormality of the womb or with scarring in the lining of the womb.

Hysteroscopic endometrial resection/ablation

This involves removing or destroying the lining of the womb. This procedure is particularly beneficial for women with heavy or troublesome menstrual periods.

Hysteroscopic myomectomy

Hysteroscopic myomectomy is a procedure whereby fibroids are removed from the womb (uterus) through keyhole or minimal access surgery through the neck of the womb (hysteroscopy). The popularity of this operation as recognised treatment of fibroids has increased recently and this patient information sheet is designed to help women better understand the procedures involved. Hysteroscopic myomectomy is only suitable for fibroids located predominantly on or protruding into the lining of the womb (endometrium). The procedure can be used to treat women with no more than three fibroids, the largest of which should be less than 5cm in size. This operation is not designed to remove every single fibroid from a woman’s womb, but to cut away those fibroids around the lining of the womb that the doctor believes might be responsible for a woman’s symptoms. It is, therefore, not uncommon for women treated in this way to still have fibroids in other parts of the womb after the treatment is completed. Ultimately, the doctor recommending the operation will provide a fuller explanation of what it entails and what women should expect from the treatment.

What is hysteroscopy?

Hysteroscopy is the technique of inspecting or operating on the inside of the womb through a small telescope that is passed through the neck of the womb. It does not involve making any cuts on the womb or abdomen. A sterile fluid solution is continously instilled into the womb to keep it distended during the procedure. Hysteroscopy has major advantages over abdominal surgery (laparotomy), including shorter hospital admission, faster recovery and return to normal fuctioning, reduced post-operative pain, reduced risk of post-operative adhesion formation, and avoidance of an abdominal scar.

Preparation for hysteroscopic myomectomy

Hysteroscopic myomectomy involves some preparation before the operation, to increase the likelihood of a successful outcome and reduce the risks of complications. This involves the use of an injection called Zoladex (taken four-weekly) as well as tablets called Livial (one tablet taken daily).

Depending on the number and size of the fibroids, these medicines are administered for 1-3 months before the operation. It is common for women on this treatment to stop having menstrual periods and a few might experience transient hot flushes. These should not give rise to any anxiety.

Details of the operation

Hysteroscopic myomectomy is performed in several stages, involving:

The duration of the entire procedure depends very much on the number, size and position of the fibroids to be removed. The average duration of hysteroscopic myomectomy is about 60 minutes.

Associated procedures

Hysteroscopic myomectomy might, very occasionally, be combined with an associated procedure, tubal cannulation. This is performed to re-open fallopian tubes that are blocked around the opening of the tube into the womb. It involves passing a small cannula (tube) through the hysteroscope into the blocked fallopian tube and flushing it with fluid. This procedure is not performed automatically but only very occasionally when indicated, and the doctor will normally discuss the need for it with the patient.

What to expect following the operation

Advantages of hysteroscopic myomectomy

Risks of hysteroscopic myomectomy

Hysteroscopic myomectomy is the safest way to excise fibroids from the womb, safer than both laparoscopic and abdominal myomectomy. However, every operation (irrespective of its simplicity or complexity) has a risk of complications. Those associated with hysteroscopic myomectomy are detailed below.