Hysteroscopic myomectomy

Hysteroscopic myomectomy is a minimally invasive gynecological procedure used to remove uterine fibroids (myomas) located inside the uterine cavity. The procedure is performed with a hysteroscope, an optical instrument that allows the doctor to visualize the uterine cavity directly, without external incisions or scars.

Role / Purpose

The procedure aims to remove submucosal fibroids that may cause abnormal bleeding, pelvic pain, or fertility issues, restore the normal uterine anatomy, and improve the patient’s overall quality of life.

Indications

• Abnormal or heavy menstrual bleeding
• Submucosal fibroids confirmed by imaging
• Infertility associated with uterine fibroids
• Recurrent miscarriages
• Pelvic pain
• Anemia due to excessive menstrual bleeding

Contraindications / Limitations

• Pregnancy
• Active genital infections
• Suspicion of uterine malignancy
• Fibroids unsuitable for hysteroscopic removal due to size or location
• Medical conditions contraindicating anesthesia

Procedure

The procedure is performed under local, regional, or general anesthesia, depending on each patient’s needs. The hysteroscope is inserted through the vagina and cervix into the uterine cavity, allowing the doctor to identify and remove the fibroids with precision. The intervention typically lasts 20 to 60 minutes and usually does not require prolonged hospitalization.

Advantages / Benefits

• Minimally invasive, no cuts or scars
• Fast recovery with minimal discomfort
• Preservation of the uterus and reproductive function
• Low risk of complications
• Quick return to daily activities
• Significant improvement of symptoms

Results

Most patients notice a reduction or disappearance of abnormal bleeding, relief from pelvic pain, and in selected cases, improved chances of conceiving.

 

Sources:

https://pmc.ncbi.nlm.nih.gov/articles/PMC9692806/
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/03/the-use-of-hysteroscopy-for-the-diagnosis-and-treatment-of-intrauterine-pathology
https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/outpatient-hysteroscopy-green-top-guideline-no-59/
https://www.ncbi.nlm.nih.gov/books/NBK564345/
https://gpm.amegroups.org/article/view/9731/html
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-023-02707-3
https://www.mdpi.com/2227-9032/13/14/1651
https://hologiced.com/library/aagl-practice-guidelines-for-the-management-of-hysteroscopic-distending-media/
https://www.fertstert.org/article/S0015-0282%2822%2901161-X/fulltext