A hysteroscopic myomectomy is a minimally invasive fibroid surgery in which the fibroids are taken out through the vagina, and there is no need to make any cut on the abdomen. This procedure is done as a day case – this means you are able to go home on the same day.
Hysteroscopic Myomectomy can only be done if the fibroids are located completely, or mostly on the inside of the uterus. Also the fibroids have to be less than 5cm to be removed. Sometimes, medications are given for a few months to shrink the fibroids before the surgery can be done. In some other cases, the procedure will need to be done more than once to get all the fibroids out.
Before the Hysteroscopic Myomectomy surgery, some tests will be done to check your blood level, heart and kidney functions, and blood group. If an abnormality is detected or if you have been known to have a previous illness, you might need to be seen by another doctor to be cleared for surgery. If your blood level is low, you will be placed some tablets or injections to raise the blood level, or to prevent you from having another period, so that your blood level doesn’t drop. Once everything is satisfactory, a date can be fixed. This procedure is done within the first two weeks of your cycle, after the bleeding has stopped.
For Hysteroscopic Myomectomy surgery, you will have the choice of either being put to sleep (general anaesthesia), or being numbed from the waist down (spinal anaesthesia), as long as there are no other medical contraindications involved.
A fluid is passed into the cavity of the uterus, to enable insertion of a thin camera which has some cutting instruments attached to it. The images are projected on a screen, and the surgeon cuts the fibroid out in small pieces under direct visualization. The surgery lasts for an average of 30 minutes to one hour. After the procedure, there might be a need to insert something into the uterus (either a Copper IUCD or a uterine balloon) to prevent scar tissue from forming inside the uterus. This will be removed at a clinic visit, a few weeks after the surgery.
Two to three hours after the procedure, you will be able to go home. Most people are able to go back to their regular activities by the next day; recovery takes a maximum of about one week.
If you intend to get pregnant, you will be asked to wait for about three months before you start trying again, in order to enable the uterus heal completely.