58563 Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)

Name of the Procedure:

Hysteroscopy with Endometrial Ablation

Summary

Hysteroscopy with endometrial ablation is a minimally invasive surgical procedure used to treat abnormal uterine bleeding. During the procedure, a thin, lighted tube called a hysteroscope is inserted into the uterus through the vagina to visualize the uterine lining. Endometrial ablation involves removing or destroying the lining of the uterus to reduce or stop bleeding.

Purpose

The purpose of this procedure is to address abnormal uterine bleeding, which can be caused by conditions such as heavy menstrual periods, uterine fibroids, polyps, or endometrial hyperplasia. The goal is to reduce or eliminate excessive menstrual bleeding, thereby improving the patient's quality of life and preventing anemia or other complications related to heavy bleeding.

Indications

• Heavy menstrual bleeding (menorrhagia)
• Uterine fibroids or polyps
• Endometrial hyperplasia
• Failed medical management of abnormal uterine bleeding
• Patient preference for a non-hormonal treatment option

Preparation

• Pre-procedure instructions may include fasting for several hours prior to the procedure.
• Medication adjustments may be necessary, particularly if the patient is taking blood thinners.
• A pre-procedure ultrasound or endometrial biopsy may be performed to assess the condition of the uterus.

Procedure Description

1. The patient is positioned and given anesthesia or sedation as needed.
2. The hysteroscope is gently inserted through the vagina and cervix into the uterus.
3. The uterine cavity is inspected, and any polyps or fibroids may be removed.
4. Endometrial ablation is performed using techniques such as electrosurgical ablation, endometrial resection, or thermoablation.
5. The hysteroscope is removed, and the patient is monitored during recovery.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Gynecologist or surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurse or technician

Risks and Complications

• Infection
• Bleeding
• Uterine perforation
• Complications related to anesthesia
• Incomplete ablation requiring further treatment

Benefits

• Reduction or elimination of abnormal uterine bleeding
• Minimally invasive with a relatively quick recovery
• Can be an alternative to hysterectomy (removal of the uterus)

Recovery

• Post-procedure care includes monitoring for pain, bleeding, or signs of infection.
• Most patients can resume normal activities within a few days.
• Follow-up appointments may be needed to ensure proper healing.
• Patients are usually advised to avoid inserting anything into the vagina, such as tampons or having intercourse, for a specified period.

Alternatives

• Medical management with hormonal therapies or medications.
• Dilation and curettage (D&C).
• Uterine artery embolization.
• Hysterectomy.

Pros and cons of alternatives:

• Medical management can be less invasive but may not be effective for all patients.
• D&C is a shorter procedure but may not provide lasting results.
• Uterine artery embolization is less invasive but has its own risks.
• Hysterectomy is definitive but involves more extensive surgery and longer recovery.

Patient Experience

During the procedure, the patient will be under anesthesia or sedation, so they should not feel pain. Post-procedure, some cramping, spotting, and mild discomfort are common. Pain management typically includes over-the-counter or prescribed pain relievers. Most patients report significant improvement in symptoms within a few weeks.

Comfort measures may include resting, using heating pads for cramps, and following specific post-operative care instructions provided by the healthcare team.