About Hysteroscopic Myomectomy

A hysteroscopic myomectomy is a minimally invasive surgical procedure used to remove submucosal fibroids (uterine growths) that bulge into the uterine cavity. It is performed using a hysteroscope (a thin, lighted tube with a camera) inserted through the vagina and cervix into the uterus. This procedure can be both diagnostic (to evaluate fibroids and other abnormalities) and therapeutic (to remove fibroids).

Hysteroscopic Myomectomy Procedure

Preparation

• The procedure is performed under local, spinal, or general anesthesia, depending on the patient's condition and the surgeon’s recommendation.
• The cervix is gently dilated using special instruments to allow the smooth insertion of the hysteroscope into the uterus.
• A sterile fluid, such as saline or glycine, is introduced into the uterus to expand the uterine cavity, which improves visibility and provides space for surgical instruments.

Procedure Steps

1. Insertion of the Hysteroscope: A thin, lighted instrument called a hysteroscope is inserted through the vagina and cervix into the uterine cavity. This device is equipped with a camera that displays real-time images on a monitor, guiding the surgeon throughout the procedure.

2. Fibroid Detection: The surgeon visually inspects the uterus to identify the location, size, and number of fibroids. Submucosal fibroids (those protruding into the uterine cavity) are usually targeted in this procedure.

3. Removal of Fibroids: Specialized instruments such as a resectoscope (with an electric loop), mechanical morcellator, or laser fiber are passed through the hysteroscope to:

• Shave, cut, or vaporize the fibroid tissue
• Carefully remove fibroids without damaging the surrounding uterine wall

4. Tissue Collection: The removed tissue is often retrieved through suction or instrument graspers and may be sent for biopsy to rule out any abnormal or cancerous changes.

Duration & Completion

• The entire procedure typically takes 30 minutes to 1 hour, depending on the size, number, and location of fibroids being treated.
• Since it is a minimally invasive, uterus-preserving technique, many patients are discharged the same day and recover quickly with minimal discomfort.

Before the Procedure

1. Diagnostic Imaging: Your doctor may recommend a pelvic ultrasound or MRI scan to get a detailed view of the fibroids — including their size, number, and exact location within the uterus. This helps in surgical planning and ensures the best possible outcome.

2. Hormonal Therapy: In some cases, you may be prescribed gonadotropin-releasing hormone (GnRH) agonists or similar hormonal medications for a few weeks before surgery. These drugs help to shrink the fibroids and reduce bleeding during the procedure, making the removal process easier and more efficient.

3. Pre-Operative Fasting: If the procedure is being done under general anesthesia, you will be asked to avoid eating or drinking for 6–8 hours before surgery. This reduces the risk of complications related to anesthesia.

4. Medication Review: Inform your doctor about any medications, supplements, or allergies. Certain medications (like blood thinners) may need to be paused before surgery.

5. Logistics & Planning: Arrange for a family member or friend to accompany you on the day of the procedure, especially if you're receiving sedation or general anesthesia. You may need a day off to rest and recover post-procedure.

Recovery after Hysteroscopic Myomectomy

• Same-day discharge in most cases.
• Mild cramping, spotting, or discharge for 1–2 weeks.
• Resume light activities in 1–2 days; avoid heavy work/exercise for a week.
• No sexual intercourse for about 2 weeks or until bleeding stops.
• Periods may be irregular for 1–2 months, then improve.
• Follow-up visit within 1–2 weeks.
• Seek care if heavy bleeding, severe pain, fever, or foul-smelling discharge occurs.

Advantages of Hysteroscopic Myomectomy

✔ Minimally Invasive – No abdominal incisions.

✔ Short Recovery Time – Return to normal activities quickly.

✔ Preserves Fertility – Unlike a hysterectomy, the uterus remains intact.

✔ Low complication rates compared to open surgery.

✔ Outpatient procedure – Usually no overnight hospital stay.