What Is Hysteroscopy?
Hysteroscopy literally means “placing a scope in the uterus”. The same technology that allows doctors to see in the colon (colonoscopy), is used to see inside the cavity of the uterus. With this technology, the lining of the uterus can be evaluated by directly looking at it. Biopsies can be performed and tissue can be removed if present, e.g. a polyp or a fibroid. The hysteroscopic removal of a fibroid is called hysteroscopic myomectomy which is advertised right now under the brand name MyoSure®.
When Is Hysteroscopy Used for Fibroids?
Less than 5% of uterine fibroids are located in the uterine cavity. This type of fibroid is an uncommon type and called submucosal fibroids. These fibroids are a common cause of abnormally heavy bleeding.
If the submucosal fibroid is smaller than 3.5-4 cm (1 1/2 inches) it can be removed hysteroscopically. However, as with any procedure, experience is very important. Most Gynecologists do not have the sufficient skill to perform these procedures, particularly the bigger the fibroid is. In some patients, the Gynecologist will tell that multiple hysteroscopic procedures will be necessary to remove the fibroid. No patient should be subjected to more than one hysteroscopic procedure if there is an experienced Interventional Radiologist available. We’ll discuss more this later in the article.
Why Would Multiple Hysteroscopic Procedures Be Needed?
To allow visualization and potential removal of a fibroid that is located within the uterine cavity, fluid needs to be rapidly instilled to keep the walls of the cavity separated. This fluid will be absorbed by the patient and must be very accurately recorded. When there is more than 1000 ml (1 liter) difference between what is absorbed by the patient, i.e. input, and the amount of urine produced, i.e output, the procedure must be stopped.
Severe injury, e.g. permanent neurologic injury, heart failure, pulmonary edema, and deaths have occurred when this measurement was not kept accurately and paid attention to. This is in addition to the risks of performing hysteroscopic fibroid removal which include:
- bleeding (hemorrhage),
- uterine puncture and injury, and
- uterine scar tissue formation.
Multiple hysteroscopic procedures for fibroids are completely unnecessary when there is an outstanding procedure that can ensure that no more than one hysteroscopy would be necessary. Uterine Fibroid Embolization (UFE) can treat all of the fibroids that are present, even those in the uterine cavity. If the fibroid that is in the uterine cavity is 3.5 cm or less, only the UFE procedure is needed. If there is a fibroid greater than 3.5 cm, a combined nonsurgical option can be offered to patients. This consists of a UFE procedure which is followed 2-3 weeks later by a hysteroscopic myomectomy to remove the fibroid within the cavity.
After the UFE, all of the fibroids, including the one in the cavity, are treated. The 2-3 week delay between procedures is necessary to soften up the intracavitary fibroid to make it easy for the Gynecologist to remove hysteroscopically. If there is too much time between procedures (>4 weeks), the patient is likely to try to pass this large fibroid which should be avoided due to the pain it would cause the patient, particularly if the patient has not had a previous vaginal delivery.
Is Hysteroscopic Fibroid Removal A Permanent Solution For Heavy Bleeding?
As mentioned earlier, hysteroscopic fibroid removal can only address a very small fraction of uterine fibroids. Even those patients that are candidates for this procedure, a number of them only get a portion of the fibroid removed. This may be due to a fluid deficit (see earlier) or the fact that there is a portion of the fibroid located outside of the uterine cavity which cannot be removed by this approach.
Is Hysteroscopic Myomectomy A Treatment Option For Adenomyosis?
No, hysteroscopy is not a treatment option that can be used for adenomyosis.
Can Hysteroscopic Myomectomy Remove All Types of Fibroids?
No, hysteroscopic fibroid removal can only be performed for a certain type of fibroids that are located inside the uterine cavity – submucosal fibroids. To address all types and sizes of fibroids, a procedure like Uterine Fibroid Embolization (UFE) should be considered.
Hysteroscopic Fibroid Removal vs. Uterine Fibroid Embolization (UFE)
Uterine Fibroid Embolization (UFE) is an outpatient, non-surgical procedure which can treat all types and sizes of uterine fibroids in one session.
Both hysteroscopic fibroid removal and UFE can be performed in an outpatient facility and patients do not require an overnight stay. The hysteroscopic myomectomy procedure is performed by an OB-GYN, and UFE is performed by an Interventional Radiologist like Dr. John Lipman of the Atlanta Fibroid Center®, with over 25 years of experience and over 9,000 UFE procedures to his credit.
If you have been diagnosed with fibroids and are suffering from heavy bleeding or other painful symptoms, and are seeking relief, contact the leaders in fibroid care, Atlanta Fibroid Center® for a consultation at (770) 953-2600.
