Fibroid protuding into cavity of womb

Operative Hysteroscopy

An operative hysteroscopy is a minimally invasive operation which is usually undertaken as a day case ie. you go home on the day of the operation. The exact operation performed depends on the condition being treated but it is most commonly used to remove fibroids, polyps, a uterine septum or the lining of the womb (endometrium).

How is the operation performed?
A small telescope, called a hysteroscope, is passed through the neck of the womb (cervix) after the cervix has been dilated (opened up).  Fluid is then constantly circulated within the womb to open it up and allow space for the operation to take place. An electrical loop is then used to remove the fibroid / polyp etc in pieces. In some cases, where a fibroid is embedded too deeply in the wall of the womb, this may require the procedure to be undertaken in two stages ie two separate operations around three months apart.

Complications
Significant complications are uncommon during operative hysteroscopic surgery occurring in less than 1% of cases.

Inability to dilate the cervix
In some cases it is not possible to open the neck of the womb enough to allow the instruments to be passed into the womb. In this case the procedure will be abandoned and Mr Carpenter will discuss other options with you.

Uterine Perforation
When instruments are passed in and out of the womb, and when the electrical loop is activated, it is possible to accidentally make a hole in the wall of the womb (uterine perforation). If this happens with a dilator (a metal rod used to open the cervix) you will probably simply need to stay over night for observation and receive some antibiotics. If it occurs due to the loop, or if there is concern there may be excessive bleeding from the womb or damage to other organs, then a laparoscopy will be carried out. This involves the insertion of a small camera into your abdomen through your belly button to allow inspection of the womb and surrounding structures such as the bowel, blood vessels and bladder. Should any of these have been injured it would be necessary to repair these and this would require a larger incision in your abdomen (laparotomy).

Loop used to resect fibroid

Fluid Overload
As outlined above the womb is continuously flushed with fluid during the procedure to both open it up and wash any blood away. Occasionally, a significant amount of this can be absorbed into your system with the risk of it collecting on your lungs or brain. The amount of fluid absorbed during the procedure is monitored and if it starts to become excessive the procedure will be stopped. If the total absorbed is more than 1.5-2 litres then you will be kept in over night for observation and possibly given drugs to help you pass the fluid out (diuretics).

Bleeding
If there is significant bleeding, a balloon may be inflated inside the womb to squeeze on the bleeding area. This will be left in over night and removed in the morning once the area has clotted off. In the most extreme circumstance, where bleeding cannot be controlled it may be necessary to undertake a hysterectomy.

Infection
The risk of infection from this procedure is very low, and you will usually be given one dose of antibiotics at the time of surgery to try and reduce this risk further.

General Surgical Risks
As with all surgery there is a risk of deep vein thrombosis and pulmonary embolism (blood clot on the lung). Hysteroscopic surgery however, allows early discharge and rapid return to normal activity with the aim to minimise these risks.

Normal cavity of womb after fibroid removed

Specific post-operative care

• From theatre you will be taken to the recovery room where staff will monitor your pulse, blood pressure, pain, sickness and wound sites.
• You will have an intravenous drip in your arm.
• If you experience some nausea (sickness) this can be controlled with medication.
• Around half an hour later you will return to the ward.
• On the ward you will receive any pain killers and anti sickness medication you require
• You will be able to drink and eat as you feel able..
• Initially you may experience some period like discomfort that can usually be managed with simple pain killers. You should continue to take these at home if you require
• You will have some vaginal bleeding which will gradually lessen over the following days. This will gradually change to a discharge and then stop altogether. Bleeding / discharge will normally have stopped by two weeks. If it has not please inform Mr Carpenter’s secretary.
• Once you have passed urine, are drinking and are able to move about you will be able to go home.
• Some one will need to collect you and you will need someone with you at home over night

Specific discharge information

Pain Killers – you may need to take pain killers so it is best to ensure you have a good supply of paracetamol and ibuprofen (if you can take these) at home.

Bleeding – as above, you will have some vaginal bleeding which will gradually lessen over the following days. This will gradually change to a discharge and then stop altogether. Bleeding / discharge will normally have stopped by two weeks. If it has not, please inform Mr Carpenter’s secretary.

Activity – you can resume normal activity any time after 24hrs after the operation.

Hygiene – you may shower but do not soak in a bath until your bleeding / discharge has stopped.

Driving – you must not drive for 24hrs after your anaesthetic.

Sexual activity – you may resume sexual activity when any bleeding / discharge has stopped.

Work – you can usually return to work 24hrs after your operation

Follow Up
Follow up will be arranged by Mr Carpenter as appropriate.