This refers to the removal of polyps or fibroids through the hysteroscope. The surgeon cuts the outgrowths into smaller pieces and removes them from the uterine cavity. Fibroids that are deep within the wall of the uterus or on the outermost surface can not be removed this way.
There are options for the type of anesthesia used, and this should be discussed with the anesthetist prior to the procedure.
- If a “general anesthetic” is used, patients will be asleep and continuously monitored by the anesthetist. This is not commonly required for this procedure.
- A “regional anesthetic”, such as a spinal or epidural anesthetic may also be used. This involves a needle into the patients back to deliver the pain-relieving medication to the nerves. With this technique, patients remain awake but will not feel pain. Patients will receive a mild sedative so that they feel very relaxed.
- Conscious sedation with intravenous drugs and local anesthesia to the cervix can also be used.
In most instances patients report feeling no pain and remembering very little about the procedure.
There are advantages and disadvantages for each type of anesthetic. Further details should be discussed with the anesthetist.
In some cases, a better result of the ablation is achieved if the endometrium is thinned out prior to surgery. There are various ways this can be achieved, either by medications or injections for six to eight weeks prior to the procedure. Some gynecologists may elect to do a D&C (dilatation and curettage) just prior to the procedure.
Any surgical procedure carries with it the possibility of complications. While none of these complications are common, it is important to be fully aware of them:
Any type of anesthetic carries with it some risk. Details are most appropriately discussed with the anesthetist involved.
Perforation of the uterus could occur. This could occur near the beginning of the procedure, when the cervix is being dilated (opened to allow passage of the hysteroscope). It could also occur during the procedure with the attachment tip being moved back and forth. Should this occur, it may be necessary to stop the procedure. If the perforation involved heavy bleeding, or damage to other organs, such as bowel or bladder, additional surgery may be required to correct the injury. Because of the known potential for this complication, specific techniques and precautions are used to minimize this risk.
As mentioned above, a sterile liquid is used to distend the interior of the uterus during the procedure. A certain amount of this liquid is absorbed into the blood circulation. If a large amount enters the circulation, the potential exists for “fluid overload” to occur, resulting in fluid accumulation in the lungs and other organs. Precautions to avoid this include using as low an amount and as low a pressure as possible. In addition, careful measuring of the fluid flowing in and fluid flushing back out the instrument is done during the procedure.
Because the surgical procedure occurs with the use of electrical energy, there is a risk of the electrical energy burning other organs, such as the bowel (if perforation of the uterus has occurred) or skin.
The amount of bleeding during and following this procedure varies from individual to individual. Usually, no particular treatment is needed but, should bleeding be excessive, further management may be necessary. In very rare circumstances, hysterectomy is required to stop excessive bleeding.
Infection is possible with most surgical procedures but is very uncommon with this operation.
These procedures should not be considered effective sterilization. Effective contraception should be used if needed. If appropriate and desired, laparoscopic tubal ligation can often be carried out or an intrauterine device could be inserted at the same time.
Several papers in medical journals have reported on the results of this operation. When women who have the procedure were asked whether or not they were satisfied with the outcome, overall satisfaction was reported in 80% or more of cases. It should be very clearly noted that “satisfaction” does not necessarily mean no bleeding but also includes a reduction in bleeding to the point where it is no longer a problem to the individual.
Because there is irritation of the uterus, it is not uncommon to have menstrual-like camping or pain. Medications such as Naproxen or Tylenol #3 will be prescribed to help control the pain will be prescribed.
There will be a variable amount of bleeding following the procedure. After a few days, this may become dark in color and thick, as the endometrium, which has been cauterized, comes away and discharges. This discharge may last up to a few weeks, but should normally steadily decrease in amount.
Post operative patients must report foul-smelling discharge, especially if associated with fever and/or chills. Increasing abdominal pain is not normal and should be reported immediately.
|
