Hysteroscopic Myomectomy

Fibroids are non-cancerous tumors that grow in and around the uterus and are made of the same smooth muscle tissue and the middle layer of the uterus. (myometrium) They are most often referred to as uterine fibroids but are also called leiomyomas or myomas and are the most commonly found pelvic tumor in women.

Uterine fibroids vary in size, and location within the uterus and can be numerous. Fibroids are generally classified by their location and can affect the available treatment options. Fibroids that are located inside the uterine cavity are called submucosal fibroids and often cause severe and heavy menstrual bleeding.

What Is a Hysteroscopic Myomectomy?

A myomectomy is a surgical procedure that is used to remove fibroids from the uterus and can be performed using different techniques. When a doctor uses hysteroscopy to remove fibroids it means they are using a surgical instrument called a hysteroscope to perform the procedure. Only one type of fibroid can be removed using this technique because they are located inside the uterus and can be accessed through the vagina.

A hysteroscopic myomectomy is considered a minimally invasive type of myomectomy surgery performed to remove submucosal fibroids from the uterine wall through the vagina. Unlike an open myomectomy, the surgery is performed through the vagina via the cervix, so there are no external incisions making recovery times much shorter. However, after the surgery, more fibroids may occur, and those not fully removed may continue to grow, especially in women of child-bearing age.

Why Would a Hysteroscopic Myomectomy Be Performed?

Submucosal fibroids grow inside the uterus and can be located on the surface of the uterine lining, embedded, or partially embedded into the uterine wall. A hysteroscopic myomectomy may be performed to remove smaller submucosal fibroids, that are not deeply embedded, to alleviate symptoms such as:

• Abnormal uterine bleeding;
• Chronic pelvic pain and pressure;
• Discomfort or pain during intercourse;
• Fertility issues.

Who Is a Candidate For a Hysteroscopic Myomectomy?

Only women who are diagnosed with submucosal fibroids are candidates for a hysteroscopic myomectomy. Submucosal fibroids make up approximately 10% of all fibroids diagnosed and are the least common. Submucosal fibroids can cause heavy and prolonged menstrual bleeding, pelvic pain and pressure, and are a common cause of infertility. A hysteroscopic myomectomy can be used to remove smaller submucosal fibroids that are growing on the inside of the uterus and are easily accessible. If the fibroids are large or deeply embedded within the uterine wall, a hysteroscopic myomectomy may not be effective in eliminating them.

What to Expect From Hysteroscopic Myomectomy?

A hysteroscopic myomectomy is normally performed as outpatient surgery under local, regional, or general anesthesia. During a hysteroscopic myomectomy, the surgeon uses an instrument called a resectoscope, which is a hysteroscope that has a wire-like loop, powered by high-frequency electrical energy to cut through the fibroids. The resectoscope is inserted into the uterine cavity through the vagina and cervical canal to remove the fibroids without an external incision.

Recovery From Hysteroscopic Myomectomy Surgery

The recovery from a hysteroscopic myomectomy is much faster and often less painful when compared to the recovery time for a myomectomy (abdominal).

After a hysteroscopic myomectomy, most patients can return home after only a few hours of observation, but in rare cases, may have to stay in the hospital overnight. Upon discharge, the patient may be given a prescription for pain medicine and instructions for aftercare and any activity restrictions.

Patients who have a hysteroscopic myomectomy generally experience fewer complications as it does not require an abdominal incision. Hysteroscopy recovery time is shorter than that of any other type of myomectomy; however, patients still need a few weeks to fully heal. Most patients can go home within a few hours unless unexpected medical concerns arise. During their hysteroscopy recovery patients can expect:

• A small amount of vaginal bleeding or staining from a few days to six weeks after the procedure.
• Mild to moderate uterine cramping and discomfort that may be alleviated through over-the-counter pain relievers.
• Sleepiness and fatigue or other symptoms related to the use of general anesthesia if used during surgery.
• Patients can usually resume their normal work and activity level within a couple of days.

Risks and Side Effects of Hysteroscopic Myomectomy:

Although the risks of hysteroscopic myomectomy are less than those associated with an open myomectomy or hysterectomy, some risks include:

• Adverse reaction to general anesthesia if used;
• Damage or abrasions to the cervix;
• Uterine puncture;
• Inability to completely remove the fibroid with one surgery;
• Development of scar tissue inside the uterine cavity that could cause fertility issues.

Uterine Fibroid Embolization Vs. Hysteroscopic Myomectomy

If you have been diagnosed with uterine fibroids, you may be a candidate for a non-invasive procedure that does not involve risks of damaging your cervix or uterus. Uterine Fibroid Embolization (UFE) is a non-surgical procedure that is 90% effective in eliminating fibroid symptoms, including heavy bleeding, with a very low-risk factor. It shrinks and destroys all the fibroids by blocking the blood flow that is feeding them and making them grow.

When using hysteroscopy to remove fibroids, the surgeon is limited by the type of fibroids they can remove as well as how easy they are to access.

Unlike hysteroscopic myomectomy, UFE addresses and eliminates all types of uterine fibroids and allows a woman to keep her uterus fully functional, without risks and complications from fibroid surgery. UFE has a recovery time of about a week allowing a woman to quickly return to normal life.

Contact Atlanta Fibroid Center at (770) 953-2600 or make an appointment online to see if you are a candidate for UFE.