Fibroid Removal Hysteroscopy

Overview

Fibroids may not always create symptoms, but when they do, they can cause heavy menstrual flow, back pain, frequent urination, and pain during sex. Small fibroids may not require treatment, while bigger fibroids may require medication or surgery.

Submucous fibroids in the uterine cavity can be removed by a hysteroscopic myomectomy. Fibroids are removed using this operation utilizing a hysteroscopic resectoscope, which is passed up into the uterine cavity through the vagina and cervical canal. The fibroid is surgically removed using an electrosurgical wire loop in standard resection. Only women with submucosal fibroids are eligible for this type of myomectomy.

This procedure cannot remove fibroids lying within the uterine wall. Outpatient hysteroscopic myomectomy is a surgical treatment. Patients are discharged from the recovery room after several hours of monitoring. In most cases, recovery takes only a few days. The technique leaves no scars on the skin. Fibroids may reappear, particularly in premenopausal women.

Cold loop hysteroscopic myomectomy has recently been reported as a safe and successful method for removing submucous myomas with intramural development while preserving the anatomical and functional integrity of the myometrium.

What are Uterine Fibroids?

Uterine fibroids (also known as leiomyomas) are uterine growths composed of muscle and connective tissue. These growths are not generally malignant (benign). In your pelvis, the uterus is an upside down pear-shaped organ. Your uterus is around the size of a lemon. It's also known as the womb, and it's where a kid grows and develops during pregnancy.

Fibroids can form as a single nodule or as a cluster. Fibroid clusters can be as small as 1 mm in diameter or as big as 20 cm (8 inches) in diameter. In contrast, they may grow to be the size of a watermelon. These tumors can form within the uterine wall, within the organ's main cavity, or even on its surface. The size, number, and location of fibroids within and on your uterus can all vary.

With uterine fibroids, you may suffer a number of symptoms that are not the same as those experienced by another woman with fibroids. Because fibroids are so unique, your treatment approach will be designed for the specific situation.

Are Fibroids Common?

Fibroids are a somewhat frequent form of pelvis tumor. Fibroids affect between 40 and 80 percent of women. However, because many women do not suffer any symptoms from their fibroids, they are unaware that they have them. This can happen if you have little fibroids, which are known as asymptomatic since they don't create any symptoms.

Who is at Risk For Uterine Fibroids?

There are a number of risk factors that might increase your chances of getting fibroids. These are some examples:

Obesity and higher body weight (a person is considered obese if they are more than 20% above their healthy body weight).
History of fibroids in the family.
Recurrent pregnancy loss.
Menstruation begins too soon (getting your period at a young age).
Menopause occurs at an advanced age.

Where Do Fibroids Grow?

Fibroids can develop in a variety of locations both within and outside of your uterus. The size and location of your fibroids are crucial factors in your treatment. The location of your fibroids, their size, and the number of them you have will influence which sort of therapy is best for you if treatment is even necessary.

The locations of your fibroids in and on the uterus are known by many names. These names reflect not only the location of the fibroid but also how it is attached. Uterine fibroids can occur in the following locations:

Submucosal fibroids: they are the most frequent form of fibroids; they are found in the muscle under the lining of the uterus and distort the uterine cavity; even tiny lesions in this area can cause bleeding and infertility. An intracavitary fibroid is a pedunculated lesion within the cavity that can migrate through the cervix.

Intramural fibroids: Intramural fibroids are found within the uterine muscular wall. They may be asymptomatic unless they are large. Intramural fibroids originate as tiny nodules in the uterine muscle wall. Intramural fibroids can develop inwards over time, producing uterine cavity deformation and elongation.

Subserosal fibroids: These fibroids are located on the exterior of the uterus this time and are closely attached to the outer wall of the uterus.

Pedunculated fibroids: The least common type, these fibroids are also located on the outside of the uterus. However, pedunculated fibroids are connected to the uterus with a thin stem. They’re often described as mushroom-like because they have a stalk and then a much wider top.

Fibroids Symptoms

The majority of fibroids do not produce symptoms and do not require treatment other than frequent monitoring by your healthcare physician. These are usually little fibroids. Asymptomatic fibroid refers to a fibroid that does not cause symptoms. Larger fibroids can produce a number of symptoms, including:

Abnormal or uncomfortable bleeding during your period (menstruation).
Bleeding in between periods.
A sense of fullness/bloating in your lower abdomen.
Urine frequency (this can happen when a fibroid puts pressure on your bladder).
Chronic vaginal discharge.
Pain when having sex.
Pain in the lower back.
Constipation.
Inability to pee or empty your bladder entirely.
Increased abdominal distention, giving your abdomen the appearance of being pregnant.
Because hormone levels in your body decrease after menopause, symptoms of uterine fibroids normally stabilize or disappear.

Can Fibroids Change Over Time?

Fibroids can decrease or increase in size over time. They can grow or shrink suddenly or gradually over time. This can happen for a variety of reasons, but in most situations, the amount of hormones in your body is connected to the size of your fibroid. Fibroids can grow in size when your body's hormone levels are high. This can happen at certain points in your life, such as during pregnancy. During pregnancy, your body produces a lot of hormones to help your baby grow.

The fibroid grows as a result of the surge of hormones. Discuss with your healthcare practitioner if you know you have fibroids prior to becoming pregnant. You may need to be watched during the pregnancy to see how the fibroid grows. When your hormone levels decline, your fibroids may shrink as well. This is frequent following menopause. The level of hormones in a woman's body is substantially lower once she has gone through menopause. The fibroids may shrink as a result of this. Often, your symptoms will improve following menopause.

How are Uterine Fibroids Diagnosed?

Fibroids are most commonly discovered during a physical examination. During an abdominal or pelvic exam, your doctor may feel a solid, irregular (often painless) lump.

These tests are the two main options:

Ultrasound: The most often utilized scan for fibroids is ultrasound. It diagnoses fibroids using sound waves at frequencies significantly higher than the human ear can hear. To scan the uterus and ovaries, a doctor or technician puts an ultrasound probe on the abdomen or into the vagina. It is quick, easy, and typically correct. However, successful outcomes are dependent on the doctor's or technician's experience and skill. Other tests, such as MRI, may be more effective for some disorders, such as adenomyosis.
MRI: Magnets and radio waves are used to generate images in this imaging test. It provides your physician with a map of the size, quantity, and location of the fibroids. We can also tell the difference between fibroids and adenomyosis, which is commonly misdiagnosed. MRI is used to confirm a diagnosis and to help us decide which therapies are best for you. MRI may also be a better option for other disorders including adenomyosis.

Other tests for uterine fibroids:

In special circumstances or if doctors can’t identify the source of your pain, you may need additional testing:

Hysterosalpingogram (HSG): An HSG is often used by doctors for women who are having fertility problems. It examines the uterus (uterine cavity) and fallopian tubes. After inserting a catheter (small tube) into the uterus, the doctor gently injects a specific contrast dye and obtains X-rays.
Hysterosonogram: A hysterosonogram is used by doctors to examine the interior of the uterus. They inject water into the uterus after inserting a tiny catheter and collecting a series of ultrasound photos. The test can detect uterine polyps or intracavitary fibroids, which can cause severe bleeding.
Laparoscopy: A doctor makes small incisions in or around the navel for laparoscopy. A long, thin tool (laparoscope) is then inserted into the belly and pelvis by the doctor. The laparoscope features a camera and a powerful light. It enables your doctor to examine the uterus and associated tissues. The image can help your doctor identify if you have a disease that causes pelvic pain, such as endometriosis.
Hysteroscopy: A doctor uses a long, thin tool with a camera and light to examine possible anomalies inside the uterus. The tool is passed via the vagina and cervix into the uterus by the doctor. No incision is required. Using this method, the doctor can examine for fibroids or endometrial polyps within the uterine cavity. During this procedure, your doctor may also remove some forms of fibroids.

Indications for Fibroid Removal Hysteroscopy

The choice to do surgery for uterine leiomyomata is difficult and differs from patient to patient based on medical comorbidities, surgical history, clinical circumstance, and patient choice. In general, hysterectomy is considered in patients who have:

Excessive uterine bleeding:

Profuse bleeding causing lifestyle problems that is resistant to medical treatment.
Anemia caused by uterine hemorrhage.

Pelvic discomfort:

Acute and severe
Chronic lower abdomen discomfort, low back pain, or pelvic pressure with imaging evidence of a large leiomyoma

Leiomyoma that is palpable abdominally.

Myomectomy indications are similar, and this treatment is explored when the patient has a desire for future fertility or feels strongly about maintaining their uterus. Whether considering hysterectomy or myomectomy, these factors are aimed at treating symptoms or enhancing quality of life by reducing the patient's anxieties. There are no indications for the removal of asymptomatic fibroids.

How Do You Prepare For Surgery?

Your doctor may prescribe medication prior to surgery to lessen the size of your fibroids and make them easier to remove.

Gonadotropin-releasing hormone agonists, such as leuprolide (Lupron), are medications that inhibit estrogen and progesterone production. They will induce transient menopause in you. Your menstrual cycle will resume once you stop using these drugs, and conception should be feasible.

Make sure to ask your doctor any questions you have regarding preparation and what to expect during your surgery when you meet with him or her to go through the process.

You may require testing to ensure that you are in good enough health to have surgery. Based on your risk factors, your doctor will choose which tests you require. These are some examples:

blood tests.
electrocardiogram.
MRI scan.
pelvic ultrasound.

Certain drugs may need to be stopped prior to your myomectomy. Inform your doctor about all of your drugs, including vitamins, supplements, and over-the-counter medications. Ask your doctor about the medications you must discontinue before to surgery and how long you must do so.

Stop smoking six to eight weeks before your procedure. Smoking can both impede recovery and raise your risk of cardiovascular problems during surgery. Consult your doctor about quitting smoking.

The night before your operation, you must cease eating and drinking by midnight.

What is Hysteroscopic Myomectomy?

A myomectomy is a procedure that removes fibroids without removing healthy uterine tissue. It is excellent for women who want to have children following fibroids therapy or who want to maintain their uterus for other reasons. After a myomectomy, you might become pregnant. This method of eliminating fibroids while keeping the uterus is considered the standard of care.

Myomectomy has typically been performed with a big abdominal incision, although technological improvements have enabled less invasive options such as hysteroscopic and laparoscopic myomectomies. Although this treatment is more intrusive and more consuming for the surgeon, it allows people to stay fertile. A hysteroscopic myomectomy removes fibroids via the vaginal canal.

How Fibroid is Removed?

A long, thin scope with a light is passed through the vagina and cervix into the uterus during this surgery. No incision is required. The doctor can examine the uterus for fibroids and other issues such as polyps. A camera can also be used in conjunction with the scope.

Submucous or intracavitary myomas are easily visible and can be resected or removed with the use of a wire loop or other similar instrument. Although submucous myomas can cause considerable bleeding and anemia, they are easily treated by hysteroscopic myomectomy.

Patients are frequently taken home after the procedure and require little recovery time. The hospital stay might range from 30 minutes to 2 hours, with a typical recovery duration of 1-2 days. Generally, only fibroids that are small and accessible through the cavity can be treated this way.

Fibroids Removal Surgery Results

Outcomes from hysteroscopic myomectomy may include:

Symptomatic relief. Most women report alleviation from troublesome signs and symptoms following myomectomy surgery, such as heavy menstrual bleeding and pelvic discomfort and pressure.
Fertility improvement. Within a year of surgery, women who have laparoscopic myomectomy with or without robotic assistance had favorable pregnancy outcomes. After a myomectomy, it is recommended that you wait three to six months before attempting to conceive to enable your uterus to recover.

Fibroids that your doctor does not find during surgery or fibroids that are not entirely removed may develop and cause problems in the future. New fibroids can form, which may or may not necessitate therapy. Women with a single fibroid have a reduced probability of acquiring new fibroids – known as the recurrence rate – than women with numerous tumors. Women who become pregnant following surgery are also less likely to develop new fibroids than women who do not become pregnant.

Women who have new or recurrent fibroids may have access to nonsurgical therapies in the future. These are some examples:

Embolization of the uterine artery (UAE). In order to reduce blood flow, microscopic particles are injected into one or both uterine arteries.
Radiofrequency volumetric thermal ablation (RVTA). Radiofrequency radiation is utilized to remove (ablate) fibroids using friction or heat, which is directed by an ultrasound probe.
Focused ultrasonic surgery with MRI guidance (MRgFUS). Magnetic resonance imaging is used to guide the use of a heat source to ablate fibroids (MRI).
Hysterectomy. If a woman is finished having children, she may choose for a hysterectomy if she has new or reoccurring fibroids.

Complications & Risks

Mechanical complications:

The most common cause of uterine perforation is cervical dilation. Cervical stenosis, a strongly retroverted or anteverted uterus, and nulliparous or postmenopausal women can all cause this. Perforation during electro-resection might result in harm to the intestine, bladder, or vessels. This consequence is infrequent, however, it is more likely in fibroids with an intramural component.

Infection:

Postoperative endometritis affects 1–5% of individuals. To reduce the number of infections, an intraoperative prophylactic antibiotic dose is indicated.

Bleeding:

In the event of heavy bleeding, a Foley catheter with 30 ml of isotonic saline can be placed into the uterine cavity.

Gas embolisms:

Gas embolisms can occur with either electrosurgery gas or room air gas. The risk was believed to be exceedingly low with bipolar energy. Air embolism is a potentially fatal consequence causing pulmonary embolism. Surgeons and anesthetists should be aware of this and should be prepared to deal with it.

Adhesions:

Post-operative adhesions were observed to be 35-45 percent with monopolar energy and 7.5 percent with bipolar energy. Many barrier approaches have been tried in order to prevent adhesion development. Some have limited efficacy (intrauterine device, hormonal treatment), while others show promising (Foley catheter balloon and hyaluronic gel).

Is Always Fertility Re-gained After Fibroid removal?

Submucosal fibroids have a negative impact on pregnancy rates. Surgical resection by hysterescopy improves pregnancy rates in submucosal fibroids while myomectomy for intramural myoma is still debated.

Conclusion

Fibroids are tumors composed of smooth muscle cells and fibrous connective tissue. They develop in the uterus. It is expected that 70 to 80 percent of women may acquire fibroids in their lifetime; however, not everyone will experience symptoms or require treatment.

The most essential feature of fibroids is that they are usually invariably benign, or noncancerous. However, some fibroids develop into cancer, but benign fibroids cannot.

A myomectomy is a procedure to remove one or more fibroids. It is frequently indicated when more conservative treatment options fail for women who desire fertility preservation surgery or to keep their uterus. In a hysteroscopic myomectomy (also known as transcervical resection), the fibroid is removed using a resectoscope, an endoscopic equipment introduced via the vagina and cervix that may employ high-frequency electrical energy to cut tissue or a similar device.