What is Hysteroscopic Myomectomy?

Fibroids, also known as uterine myomas, fibromas or leiomyomas are the most common tumors of the female reproductive system. About 30-40% of all women above 35 years of age are affected with this condition.

When non-invasive methods such as hormonal therapy and pain-killers don't seem to work, surgery is considered the final option. This is where hysteroscopic myomectomy comes to the rescue. It is particularly helpful when the fibroids are bulging into the uterine cavity.

An instrument called the resectoscope (similar to a telescope) is inserted into the uterus. A small camera attached to the hysteroscope allows the surgeon to see what's inside and remove the fibroids easily with the help of special surgical instruments.

Why is Hysteroscopic Myomectomy Required?

Following are the reasons why a hysteroscopic myomectomy is a preferred approach:

• Hysteroscopic myomectomy is done on an outpatient (OPD) basis. The patient can return home on the same day after surgery.
• There are lesser chances of scarring after hysteroscopic myomectomy.
• The patient may require lesser time to recover in comparison to other techniques.
• Low chances of risks and complications.

Fibroids and its associated symptoms are the only reason why the patient may need to undergo a hysteroscopic myomectomy. The fibroids should be well projecting inside the uterine cavity to be considered for this procedure.

Symptoms of fibroids include -

• Unsuccessful pregnancies
• Excessive bleeding from the uterus
• Infertility

Other uncommon causes to be considered before hysteroscopic myomectomy include:

• Leukorrhea: Abnormal whitish/yellowish discharge from the vagina
• Dysmenorrhea: Painful menstrual cycles with cramps
• Necrotic leiomyoma: following uterine fibroid embolization
• When the tissue structure seems uncertain in pelvic imaging.

However, hysteroscopic myomectomy is contraindicated in the following situations:

• In the presence of an acute pelvic infection
• During pregnancy
• Uterine or cervical cancer
• If you are suffering from any other medical condition - heart disease, bleeding disorders, etc.

Diagnosis

The gynecologist will evaluate the condition of the uterus and then go ahead with the surgery after confirming her suspicions:

• Blood Test: A common finding in women suffering with fibroids is heavy bleeding. The doctor would check the patient's hemoglobin levels (HB) to look for anemia because of this.
• Transvaginal Ultrasound (Sonography): A transducer like instrument is placed on the patient's vagina and sound waves are used to see the images on a monitor.
• Hysteroscopy: The cervical region is examined with the help of a hysteroscope. The camera on its head helps study the cervix visually.
• Hysterosalpingography: A dye is introduced inside the uterus and fallopian tubes and an X-ray is taken. Any tubal obstruction is ruled out with the help of this test.
• Magnetic Resonance Imaging (MRI): A 2-D view of soft tissues is produced with the help of magnetic and radiation waves.

  Once surgeon confirms the need for surgery, the anesthesiologist will order a general pre-operative workup to evaluate the patient's fitness before the surgery:

• Blood Test: This includes blood sugar, blood urea, blood pressure (BP), hemoglobin (HB), bleeding time, clotting time (BT, CT) and blood grouping.
• Urinalysis: Color and specific gravity of urine is checked. Along with this, presence of blood, proteins, pus cells etc are looked for to rule out any pre-existing pathology.
• Electrocardiogram: To study the electrical activity of heart plotted on a graph paper.
• Renal Functional Test: Blood Urea Nitrogen (BUN) and creatinine levels are seen.
• Liver Function Tests: AST (aspartate transaminase) and ALT (alanine transaminase) levels are calculated.
• Skin Test: To rule out allergies.
• Imaging Tests: Ultrasound, CT and MRI scans are repeated to get the latest condition of the uterus.
• Clinical examination: is repeated.
• Airway: The airway (beginning of your respiratory tract) is checked for suitability of intubation.

Risks and Complications related to Hysteroscopic myomectomy

The complications of hysteroscopic myomectomy can be categorized into:

• General complications
• Complications specific to hysteroscopic myomectomy