Name of the Procedure:

Hysteroscopy, surgical; with removal of leiomyomata.

Summary

A hysteroscopy with removal of leiomyomata is a minimally invasive procedure where a surgeon removes fibroids (leiomyomas) from the uterus using a hysteroscope, a thin, lighted tube inserted through the vagina and cervix.

Purpose

The procedure is used to treat uterine fibroids, which are non-cancerous growths in the uterus that can cause heavy menstrual bleeding, pain, and fertility issues. The goal is to reduce symptoms, improve quality of life, and potentially enhance fertility.

Indications

• Heavy or prolonged menstrual periods
• Pelvic pain or pressure
• Recurrent miscarriages
• Infertility
• Uterine fibroids diagnosed via imaging studies (e.g., ultrasound, MRI)

Preparation

• Fasting for a certain period before the procedure (typically 6-8 hours if general anesthesia is used)
• Temporary discontinuation of certain medications (e.g., blood thinners, NSAIDs)
• Preoperative imaging (e.g., ultrasound) and blood work to evaluate overall health
• Follow specific instructions provided by the healthcare provider

Procedure Description

1. The patient is given anesthesia, either local, regional, or general, depending on the case.
2. The hysteroscope is gently inserted through the vagina and cervix into the uterine cavity.
3. Saline solution may be introduced to expand the uterus for better visualization.
4. Special instruments attached to the hysteroscope are used to cut and remove the fibroids.
5. The removed tissue may be sent for pathological examination.
6. The hysteroscope is withdrawn, and the procedure is completed.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

The procedure is usually performed in a hospital, outpatient surgical center, or clinic equipped for gynecological surgery.

Personnel

• Gynecologist or specialized surgeon performing the procedure
• Anesthesiologist or nurse anesthetist
• Surgical nurses and support staff

Risks and Complications

• Infection
• Heavy bleeding
• Perforation of the uterus
• Scar tissue formation (Asherman's syndrome)
• Reaction to anesthesia

Benefits

• Relief from symptoms like heavy bleeding and pain
• Improved chances of pregnancy
• Minimally invasive with shorter recovery time
• Less postoperative pain and discomfort

Recovery

• Monitoring in a recovery area until anesthesia wears off
• Mild cramping and light bleeding for a few days
• Avoidance of strenuous activity and intercourse for a specified period (usually 2-4 weeks)
• Follow-up appointment to ensure proper healing

Alternatives

• Medications (e.g., hormonal treatments)
• Uterine artery embolization
• Myomectomy (surgical removal of fibroids through abdominal or laparoscopic surgery)
• Hysterectomy (complete removal of the uterus)
• Each alternative has its pros and cons, such as differences in invasiveness, recovery time, effectiveness, and impact on fertility.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, some cramping and discomfort can be expected, which can usually be managed with over-the-counter pain relievers. Most patients are able to resume normal activities within a few days and should experience relief from symptoms shortly after recovery.