Hysteroscopic Myomectomy

What is a hysteroscopic myomectomy?

This is a procedure where a doctor uses a thin tube with a tiny camera to look inside the uterus. There are no incisions. Saline solution is used to expand the uterus in order to look at the inside of the uterus. Small instruments are used to cut out the fibroid, sometimes using electrical energy.

When is this surgery used?

This procedure is performed when there is a fibroid inside of the uterus causing symptoms.  Only certain fibroids are able to be removed through hysteroscopic myomectomy.  

How do I prepare for surgery?

• Before surgery, a pre-op appointment will be scheduled with your doctor at his or her office or with a nurse practitioner or physician assistant at Domino Farms.

• Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy for surgery.
• The lab work for your surgery must be done at least 3 days before surgery.
• Some medications need to be stopped before the surgery. A list of medications will be provided at your pre-operative appointment.
• Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery. If you are a smoker, it is best to quit 6-8 weeks before surgery. If you are unable to stop smoking before surgery, your doctor can order a nicotine patch while you are in the hospital.
• Plan for your care and recovery before surgery. Most women recover and are back to most activities in 1-2 days.

What can I expect during the surgery?

• In the operating room, you will be given either a general anesthesia, a spinal anesthesia, or a local anesthesia. The choice of anesthesia is a decision that will be made by the anesthesiologist based upon your history and your wishes.

What are possible risks from this surgery?

Although there can be problems that result from surgery, we work very hard to make sure it is as safe as possible. However, problems can occur, even when things go as planned. You should be aware of these possible risks, how often they happen, and what will be done to correct them.

Possible risks during surgery include:

• Incomplete removal of the fibroid, which may require additional surgery in the future.
• Uterine perforation: Instruments used to dilate (or open) the cervical canal or instruments used to perform the hysteroscopy may cause an accidental puncture of the uterus. If this were to occur, the procedure may not be completed.
• Absorption of excess fluid through the uterus during the surgery, which can cause electrolyte abnormalities and may require additional monitoring after the surgery.
• Bleeding: If there is excessive bleeding, you will be given a blood transfusion unless you have personal or religious reasons for not wanting blood. This should be discussed with your doctor prior to the surgery.
• Damage to the bladder, ureters (the tubes that drain the kidneys into the bladder), uterus, and to the bowel: Damage occurs in less than 1% of surgeries. If there is damage to the bladder, ureters, uterus, or to the bowel they will be repaired while you are in surgery.

• Conversion to a laparoscopic surgery or to an open surgery requiring an up and down or Bikini incision: If a bigger open incision is needed during your surgery, you may need to stay in the hospital for one or two nights.
• Death: All surgeries have a risk of death. Some surgeries have a higher risk than others.

Possible risks that can occur days to weeks after surgery:

• A blood clot in the legs or lung: Swelling or pain, shortness of breath, or chest pain are signs of blood clots. Call you doctor immediately if any of these occur.
• Infection: Fever, pain or abnormal vaginal discharge.
• Scar tissue: Abnormal tissue connections that can form at the cervix or uterus. Scar tissue may decrease fertility or increase the risk of miscarriage.

• Recurrence of uterine fibroids. Persistent or recurrent heavy and/or irregular vaginal bleeding, even if there are no recurrent uterine fibroids.

Follow-up with your doctor:

You should have a post-operative appointment scheduled with your doctor for 4-6 weeks after surgery.

If you have any further questions or concerns about getting ready for surgery, the surgery itself, or after the surgery, please talk with your doctor.