Hysteroscopic Myomectomy

Surgical Advancements

Just a few short years ago, treatment for fibroid tumors in the uterus or pelvic cavity required major surgery - an incision in the abdomen and either cutting the uterus open to remove the fibroid or performing a hysterectomy. A major advance in treating submucous fibroids is the development of hysteroscopic myomectomy.

Submucous fibroids, the type that develop just under the lining of the uterine cavity, tend to have the most effect on heavy menstrual bleeding and they are the type of fibroid that can cause fertility problems and miscarriage. The submucous fibroids can change the shape of the uterine cavity causing decreased pregnancy rates of up to 70%. These fibroids can be removed with a hysteroscope and the results indicate that there is as much as a 70% increase in pregnancy rates with this method of treatment.

How Hysteroscopic Myomectomy is Performed

Hysteroscopic myomectomy is used only if fibroids are inside the uterus or bulging into the uterine cavity (submucosal). The surgery is performed as outpatient surgery with no incisions and practically no post-operative discomfort or pain. Since the surgery can take up to two hours, anesthetic is used to reduce the discomfort of the surgery. A hysteroscope, which is a small telescope, is passed through the cervix and into the uterus so the entire cavity is available for viewing. A small camera on the telescope projects the view to a video monitor that magnifies the picture enabling the physician to perform the surgery comfortably.

Rather than a knife, the hysteroscope is equipped with a thin wire attachment through which electricity passes, allowing it to cut through the fibroid without difficulty. As the fibroid is shaved away, blood vessels are seared by the heat of the instrument so blood loss is minimal. A woman can often return to work within a couple of days of the surgery, recovering very quickly.

Outstanding Results with this Surgery

When fibroids have been the reason for infertility, pregnancy rates as a result of this type of surgery are about 50%. If the hysteroscopic surgery was performed to combat heavy bleeding, the response rate indicates that nearly 90% of women end up with a normal menstrual flow.

While hysteroscopic myomectomy is not appropriate for all types of fibroid tumors, the success rate for submuscosal fibroids has been excellent. The fibroids are removed, bleeding stops or slows down and life becomes normal. If the fibroids had been a hindrance to pregnancy, the indications are positive that a successful pregnancy is very possible.