When a woman has problems with conception, menstrual malfunctions or intermenstrual bleeding, a comprehensive diagnosis is performed to identify the causes of such conditions.
If the cause of the violation of women's health is the formation of the uterus like polyps or fibroids, then patients are assigned hysteroresectoscopy.
The concept of
The surgical operation, for which a hysteroresectoscope is applied, capable of producing the most accurate manipulations within the uterus, is called hysteresisectoscopy.
All actions of the surgeon are controlled by video equipment, so errors and complications are excluded.
Indications for
If the operation is performed competently and an experienced surgeon, then there will be no complications.
Completely preserved the integrity of the uterine wall, so that in the future the woman retains the ability to become pregnant, bear and safely give birth to children.
Hysteroresectoscopic surgery is indicated:
- With frequent miscarriages and no fetal bearing or infertility;
- With menstrual irregularities;
- If there is a suspected abnormality of intrauterine location, postpartum or abortive complications, intrauterine device scars, etc.;
- For the removal of intrauterine polyps, submucous myomatous nodes and pathologically altered areas of the intrauterine layer;
- For dissection of the formed adhesions, due to which the structure of the uterus is restored.
Contraindications
Hysteroresectoscopy can not be performed to all patients, because the procedure has a number of contraindications such as:
- Acute general pathologies, for example, angina, pneumonia or thrombophlebitis;
- Severe concomitant diseases( cardiovascular, renal or hepatic lesions, acute respiratory viral infection, nephritis, etc.);
- Pathologies of the genital system of infectious and inflammatory origin( Trichomonas, chlamydia, etc.);
- Pregnancy;
- Uterine oncology;
- Stenosis of the cervical canal( pathological narrowing of the cervical lumen).
Advantages of operation
Hysteroresectoscopic surgery has many advantages.
- Firstly, , this intervention is characterized by low traumatism and is well tolerated by patients. After such an operation, long rehabilitation is not required.
- Secondly, , after it there are no scars and post-operative scars that occur during an open surgery. Therefore, the risks of complications associated with open surgical operations are excluded.
In the process of hysteroscopy, the patient receives a whole complex of therapeutic and corrective procedures with complete sanation of the organs of the reproductive system.
After the operation, the woman returns to normal life and professional activity in a fairly short time. And reproductive functions are fully preserved, so after a certain time a woman again can become pregnant and give birth.
Visualization of the operational process ensures maximum accuracy of the manipulations.
Preparation for hysteroresectoscopy
The preparatory process includes a traditional examination and the delivery of the necessary tests. This is necessary to identify contraindications to hysteroresectoscopy, if any, to be.
Preoperative preparation also includes the following diagnostic tests:
- Fluorographic examination;
- ECG;
- General tests of blood, urine;
- Samples for hepatitis, AIDS and syphilis;
- Smear on the flora of the vagina, etc.
On the eve of the hysteroscopic operation it is recommended to clean the intestines, for which the enema is performed. And before the operation itself, it is necessary to empty the bladder. Since the operation is performed with anesthesia, it is forbidden to drink or eat anything on the day of its carrying out.
The operation is performed on the 5th-7th day of the cycle, when the menstrual period ends. If the woman is in peri- or postmenopause, the operation is performed without orientation to the phase of the cycle. Also, before the operation, you must necessarily go to the shower and thoroughly wash yourself, shave the hairline in the perineum and pubic area.
How is the procedure performed?
The patient is placed on a special chair and anesthesia is given. Then the specialized equipment is introduced through the vagina and the uterine neck - a hysteroresectoscope, which is equipped with microinstruments and an optical system that visualizes all the doctor's actions and the operated area.
A special solution is then pumped into the uterus, which expands the cavity of the organ and conducts the light rays. As a result, the surgeon sees the operated zone in detail, which ensures high accuracy of the operation. Hysteroresectoscopy lasts no more than an hour and a half, although it often takes 40-60 minutes.
Removal of polyp
Hysteroresectoscopic polypectomy uses traditional instruments.
- Preliminary into the uterus lead fluid to expand the area of activity and simplify the differentiation of the affected tissue from normal.
- The microvideo chamber is then introduced into the uterus through the cervical canal, which visualizes the entire course of the operation.
- Then there is a hysteroresectoscope. The polyp is removed using a hook or loop.
- After removal of the bed the polyp is coagulated.
- Then the liquid is withdrawn from the uterus and the woman is transferred to the ward.
Biomaterials obtained during the operation are necessarily examined histologically to identify malignant cells.
Treatment of the myoma node
Hysteresisectoscopic myomectomy is performed to remove the uterine nodes.
Submucous fibroids are dangerous because they cause bleeding and affect the female body, similar to the intrauterine device.
As a result, a woman can not get pregnant. Carrying out hysteroresectoscopy of submucous myoma allows to save the uterus after the operation, and later it gives the opportunity to become a mother.
During operation, the myomatous nodes are removed by dissecting with a cutting loop-electrode. Complete the operation by coagulation of the site on which the myoma was located, with a special electrode having a wide surface.
Fragments of the tumor can be removed after each electrode cut or after removal of the entire tumor by curettage or vacuum.
Video shows hysteroresectoscopic operation to remove submucous node:
Postoperative period
Usually, postoperative recovery from hysteroresectoscopy takes only a couple of weeks, although the patient is discharged on the second day after the operation.
During the recovery period, the patient can clearly feel painful discomfort in the uterine region, which is accompanied by brownish bloody discharge of scanty character.
For a month, a woman is prohibited from:
- Lifting or carrying weights;
- To be cooled;
- Take a hot bath;
- Douche;
- Physically overloaded.
Sexual rest must be observed for a month. If the doctor has made any medicinal purposes, then they must necessarily follow.
If a myomatous node or cyst of the uterus has been removed during hysteroresectoscopy, a woman can be prescribed hormone therapy and taking medicines to speed up the recovery of the uterus.
Possible complications of
Among the possible complications that occur quite rarely, experts call:
- Gas embolism of the uterine vessels. It happens like this in a single clinical situation when using gas for expanding the uterus;
- Perforation of the uterine wall, which is usually accompanied by fainting and high blood loss, therefore requires additional resuscitation;
- Infectious complications caused by penetration of the pathogenic microflora into the uterus and necroticisation of unnoticed myomatous tissues;
- A hematoma is a uterine spasm that causes copious uterine bleeding;
- Due to serious damage to the endometrium during the operation, infertility may occur.
These complications are rare, usually due to insufficient experience of the doctor. In general, hysteroresectoscopy refers to safe and maximally gentle procedures.
What is the difference between hysteroscopy and hysteroresectoscopy?
Hysteroresectoscopy is a modern organ-preserving surgical technology that allows transcervical surgery without damaging the uterine walls.
Hysteroresectoscopy is somewhat different from conventional hysteroscopy.
For hysteroresectoscopy, it is necessary:
- Preliminary histological examination of scraping taken from the endometrial layer;
- Use of anesthesia;
- Laparoscopic control;
- Specialized non-electrolyte solutions for filling the uterine cavity;
- Strictly monitor the deficiency of fluid in the uterus.
Reviews
Catherine:
Somehow I started bleeding incomprehensible, in the middle of the cycle. And the blood did not smear, but flowed. I underwent ultrasound, found a uterine polyp 2.5 cm. He was the cause of bleeding. Hysteroresectoscopy was prescribed as the most gentle method of polypectomy. The operation went perfectly, but the pains and excretions disturbed another month and a half. I was additionally prescribed hemostatic and antibiotics, and for six months I was prescribed Novinet to rule out the recurrence of the polyp. It took 2,5 years after the operation, I safely became pregnant and gave birth to a little son. The polyp has not yet appeared.
Elena:
When I found a myoma knot, I just fell into a stupor. I did not understand anything, why, why, why, etc. But I have to be treated, I agreed to a hysteroresectoscopy. As in a fog, I went to a chair. I remember how the anesthesia was injected into the vein, then the start was strong in it, as if they had injected boiling water. And then she woke up already in the ward. Hysteroresectoscopy is not necessary to be afraid, because you do not feel anything. After surgery, the lower abdomen hurts 2-3 weeks and discharge. Monthly after operation began to pour, as from a bucket. But over time, everything is restored. The main thing is that there are no nodes. They are dangerous because they can be reborn in cancer. A hysteroresectoscopy works well with them.
Price
Hysteroresectoscopy procedure is relatively expensive:
- In Moscow clinics it will cost 28000-46000 rubles.
- In St. Petersburg clinics, hysteroresectoscopy is slightly cheaper - 18,000-34,000 rubles.
Answers to Frequent Questions
When patients are prescribed hysteroresectoscopy, then they have a lot of questions.
- What day of the cycle is hysteroresectoscopy done? - Hysteroresectoscopic myomectomy or polypectomy is performed on the 5th-10th day of the cycle, after the end of the menstrual period.
- Monthly after hysteroresectoscopy. - Usually the first menstruation after the operation comes about a month later. An important point is the nature of menstruation. If the consistency has changed, the amount and color of menstrual flow, then a consultation of the gynecologist is necessary.
- Temperature after hysteroresectoscopy. - Normally the morning and evening temperatures should not rise above 37 ° C.But in the presence of blood and bloody discharge for about 2 weeks, the temperature can rise to 37.2-37.4 ° C.If the hyperthermia is more pronounced, then it is necessary to undergo examination in order to exclude postoperative inflammation.
- Pregnancy after hysteroresectoscopy. - The question of pregnancy should be dealt with by a doctor, based on the data of the control ultrasound diagnosis and the results of hormone therapy. Usually, pregnancy planning can begin one month after stopping hormonal drugs, which are prescribed for about six months. If hormone therapy is not prescribed, then with favorable prognosis it is possible to plan pregnancy approximately 3-4 months after the operation.
Hysteroresectoscopy is not to be feared. This is an organ-preserving, sparing and minimally invasive operation. After the procedure, it is necessary to observe the gynecologist and periodically make control ultrasound examinations( 3 and 6 months after the operation).
In the future, with a favorable picture of treatment, a woman needs to visit a gynecologist every year for preventive purposes.