Hysteroscopy and Endometrial Ablation

What is a hysteroscopy and endometrial ablation?

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.  The endometrial ablation device is then used to burn the lining of the uterus.

When is this surgery used?
To treat heavy vaginal bleeding.

How do I prepare for surgery?

• Before surgery, a pre-op appointment will be scheduled with your doctor at her office. During this appointment, specific instructions prior to and after your surgery will be reviewed with you.
• 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:

• 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.
• Uterine perforation: Instruments used to dilate (or open) the cervical canal or instruments used to perform the ablation may cause an accidental puncture of the uterus.
• 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. However, not all injuries are visible at the time of surgery and may not show up until days or weeks later. If this were to occur, this may require another hospitalization or another surgery to repair the injury.
• 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.
• Inability to complete the ablation procedure may sometimes occur due to the size or shape of the uterus, or if a uterine perforation occurs.

Possible risks that can occur days to weeks after surgery:

• Persistent pelvic pain, irregular and/or heavy menstrual bleeding.
• 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. This could delay diagnosis of abnormalities of the uterine lining if they develop after ablation. For example, may also mask postmenopausal bleeding which could be a sign of endometrial cancer and thus delay the diagnosis of uterine cancer.  Scarring from endometrial ablation may also make biopsy of the uterine lining painful or difficult and may also cause collection of blood within the endometrial lining, which may cause pelvic pain and/or swelling of the uterus.

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. 

New Topic:

Vulvar Biopsy: Patient after care instructions

Vulvar Biopsy: Care Instructions
After your procedure, you may have some pain, soreness, swelling, or bruising. Your

doctor may recommend over-the-counter medicines to help with any discomfort. Most people can return to their normal routine the same day of their procedure.

Most biopsy sites take 1-3 weeks to heal.
This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?
For the first few days avoid exercise that could irritate your biopsy site(s) and prolong your healing time.

Avoid sexual activity until healed.

Avoid hot tubs & swimming for 2 weeks or until healed.

Do not apply steroids or other topical medication to the vulva for 1 week. After 7 days, you may use topical medicine to the area unless instructed differently by your health care provider.

Your biopsy site may appear grey in color but this is normal. The cautery we use to control bleeding after we collect the biopsy will cause this appearance. You may also experience a discharge resembling “coffee grounds” for the first few days following the biopsy.

Sometimes stitches are necessary at times.  The majority of time they are dissolvable.  Your health care provider will tell you if they need to be removed.

Wound Care:
-Keep the area clean and dry.
-If the biopsy site bleeds, put direct pressure on it with gauze until the bleeding stops.

A small amount of bleeding and discomfort is normal. If you are soaking a pad in 1 to 2 hours, and bleeding does not stop call our office during business hours or use the after-hours phone number provided.  

You may cover the wound with a thin layer of petroleum jelly, such as Vaseline.

Skin infection can follow any surgical procedure.

Call your doctor now or seek immediate medical care if:

You have signs of infection, such as:

Increased pain, swelling, warmth, or redness.

Red streaks leading from the wound.

Pus draining from the wound.

A fever.

            You have pain that does not get better after you take pain medicine.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

Biopsy results:
Within two weeks you will be called with your biopsy results. We understand that you are anxious to receive your results. We will call you as soon as we have them. If you have not heard from us after two weeks, please call us during office hours.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

 

New Topic:

Treatment options for early pregnancy loss or miscarriage

You have several options to treat your early pregnancy loss or miscarriage. All of these options are safe and complications are rare, but some options are more likely than others to require more than one treatment. The treatment options differ in the length of time it takes to completely pass the pregnancy. Sometimes your provider will recommend or discourage treatments based on your medical or pregnancy history. However, most of the time you may choose which option you most prefer.

Waiting (“Expectant management”)

Often, you may wait for the pregnancy to pass on its own. Eventually, your uterus will begin to contract and will pass the pregnancy tissue. This can take several weeks or longer and is successful roughly 50% of the time.  Heavy bleeding and painful cramping is normal with this process. Your provider will give you guidelines to watch your bleeding during this process.  Risks include very heavy bleeding or incomplete passage of the pregnancy that can require surgery and infection.

Pills (treatment with the medication “misoprostol”)

You may use a medicine called misoprostol that will cause your uterus to contract and pass the pregnancy.   This is successful about 85% of the time within 1 week of taking it.  Heavy bleeding and painful cramping is normal with this process. If the pregnancy does not pass, additional doses of misoprostol or a surgical procedure may be needed.  Risks include very heavy bleeding or incomplete passage of the pregnancy that can require surgery and possible infection.  Neither of these risks is common. 

Surgical procedure (uterine aspiration, either in the operating room or in the office)

You may have a surgical procedure to remove the pregnancy from your uterus.  Your cervix (entrance to the uterus) is slowly stretched open to allow a small plastic tube to enter. Suction is applied to the tube as it is moved inside the uterus for 2-3 minutes.  You will feel cramping during and after this procedure.  The doctor will check to make sure that the pregnancy tissue appears completely removed.  This procedure can be done in the office or in the operating room. Your provider may recommend one location over the other because of your medical history, but most of the time you may choose.

Uterine aspiration in the office: You will be awake for the procedure.  You can have either pills, or medications through an IV line to assist you with pain or nervous feelings.  A support person can join you in the office for the procedure.  This is typically a short visit. (1 hour or less)

Uterine aspiration in the operating room:  You can choose to be completely asleep for the procedure.  A support person will not be able to join you in the operating room for the procedure.  You will spend several hours at the hospital for this procedure.  

Risks include infection (up to 3 out of 100 women), incomplete aspiration (up to 3 out of 100 women), serious bleeding (1 out of 1000 women), injury to uterus or cervix (1 out of 500 women) or injury to a nearby organ (very rare).