In recent years, representatives of the weaker sex increasingly have to deal with various pathologies. The reason for this may be promiscuous sex life, lack of childbirth at a certain age, hormonal abnormalities, improper lifestyle, and so on. Many diseases have to be treated operatively. Of course, every woman is afraid to get on the surgeon's table. Especially when it comes to the future of its reproductive function. This article will discuss the procedure called hysteroresectoscopy. What it is will be described below. It is also worth mentioning the conditions and methods of such an operation.
Minimally invasive treatment of gynecological diseases
In recent decades, minimally invasive surgical interventions have become very popular. These include hysteroresectoscopy. The operation allows to reduce the time of treatment in the hospital and recover faster after all procedures. When using a minimally invasive treatment method, microscopic instruments are used. Most often, the surgeon controls them autonomously. This control is carried out using special optical devices.
Minimally invasive treatment is not always used. Before this, the doctor should carefully evaluate all the risks. Sometimes it is impossible to carry out such a manipulation. In this case, conventional laparotomy is prescribed.
Advantages of the procedure
The minimally invasive treatment method avoids many complications. So, during abdominal surgery, the patient always has a adhesive process in the pelvic area. Some women feel the pronounced symptoms of this pathology, while others more easily tolerate the presence of adhesions.
Using tools in an autonomous way allows you to avoid large injuries. Women no longer need to worry that their bodies will remain ugly and big scars. The use of this technology leaves only small and inconspicuous scars.
The main advantage of the minimally invasive method of treatment is that a woman should remain in the hospital for a minimum amount of time. After some interventions, the patient can go home in a few hours. However, the time of the procedure itself may increase slightly. All because of the fact that the doctor does not have direct access to the diseased area and works "blindly."
Cons of the procedure (possible complications)
The minimally invasive method of treating gynecological diseases has several disadvantages. However, they are insignificant compared with the described advantages. Among them are:
- the risk of damage to neighboring organs with the introduction of instruments and optics,
- bleeding that lead to the need for laparotomy,
- the ability to remove the pathology is not completely,
- joining infections and so on.
It must be remembered that abdominal surgery can have the same consequences. That is why when choosing a method of treatment, it is necessary to take into account all the risks and advantages.
Hysteroresectoscopy: what is it?
This manipulation is one of the minimally invasive procedures. It is performed in the walls of the hospital. However, in some cases, a woman can go home in a few hours.
In most cases, prior anesthesia of the body is necessary during the procedure called hysteroresectoscopy. What it is? Anesthesia is the use of anesthesia. It can be local, general or epidural. It all depends on the complexity of the pathology, the desire of the patient and the capabilities of the clinic.
Hysteroresectoscopy today makes it possible to treat many diseases that several decades ago required the complete removal of the genital organ or the dissection of its walls. This manipulation is increasingly used by modern clinics and young professionals. Perhaps within a few years, a hysteroresectoscopy of the uterus will become one of the most common manipulations and will take precedence over laparotomy and laparoscopy.
Indications for manipulation
So, you got acquainted with the concept of hysteroresectoscopy (what is it). Now it is necessary to find out who is assigned such a manipulation. The main indications for intervention are the following states:
- fusion of the walls of the reproductive organ, caused by genetic abnormalities or inflammatory diseases,
- the formation of adhesions inside the uterus for various reasons
- treatment of fibroids,
- neoplasms that appear on the walls of the uterus (papillomas, cysts, tumors),
- some pathologies of the cervical canal and so on.
Before manipulation, the doctor always assesses the risks. In some cases, the advantage is still given to laparoscopy or laparotomy.
Contraindications for manipulation
Not all patients can be hysteroresectoscopy uterus. The following situations may be considered as contraindications for the operation:
- infectious diseases of the pelvic organs, in particular the genital organ,
- bleeding of unknown etiology,
- severe abdominal pain associated with pathology,
- some diseases of the heart, liver and kidneys,
- catarrhal diseases and so on.
All of the above contraindications can be divided into absolute and conditional. Some of them categorically prohibit the use of this method of treatment. Others allow the use of a resectoscope after some correction.
How is the procedure?
During the manipulation of high-tech methods used to monitor the operation of devices. At the very beginning of the procedure, the woman is injected with an anesthetic. After that, the patient falls asleep (with general anesthesia) or stops feeling pain (with local or epidural anesthesia). Next, the doctor proceeds to the introduction of devices.
First, the cervical canal and cervix dilates. The resectoscope is inserted into the cavity of the reproductive organ. This device is equipped with a special camera that displays the image on a large monitor and the necessary tools for the operation. The doctor controls the entire process that occurs in the cavity of the reproductive organ.
Immediately after the introduction of the device is fed a small amount of solution. This fluid improves visibility and allows you to slightly stretch the walls of the uterus. Thanks to this treatment will be carried out more qualitatively.
Removal of the polyp in the uterus
This operation is performed in the following way. After the introduction of the device, the doctor detects a pathological formation. All available tools are sent to it and work begins. With the help of the device, which looks like a curette, a polyp is cut with the leg. After this, the base is coagulated. Most often used for this laser or drugs.
Removal of the polyp in the uterus occurs quickly and without any consequences. Many clinics guarantee no relapse with proper therapeutic correction after the procedure.
Hysteroresectoscopy fibroids has become one of the salutary procedures for women who want to give birth to a child. If earlier laparotomic and laparoscopic methods were used for the treatment of pathology, which required dissection of the walls of the reproductive organ, then with the development of technology everything has changed. This manipulation avoids incisions in the uterus that lead to scar formation. The majority of the weaker sex after the manipulation successfully bear children and give birth on their own.
During the procedure, the myoma node is cut with a small depression. After that, the damaged surface is processed. Also during work, the doctor has the opportunity to carefully examine the remaining cavity of the reproductive organ. It may be that small nodules are found that are immediately removed. This avoids re-operation.
Treatment of pathologies of the uterus
If there is a septum in the organ cavity or adhesions formed, the device detects them and makes a dissection. Such a manipulation allows one to assess the state of the walls of the organ and, if necessary, to correct other pathologies.
A few decades ago, the partition in the uterus could not be removed. Women with such an education, carrying a child, were at risk. Now everything has changed. With the development of medicine, the weaker sex can not only eliminate the disease, but also prevent its recurrence.
Like any other operation, it causes a hysteroresectoscopy selection. However, they do not last long. If, after a laparotomy, which requires dissection of the uterine wall, the bleeding can last up to two weeks, then after hysteroresectoscopy, discharge is observed for only a few days. This avoids massive bleeding and wound infection.
After the procedure, the woman goes to the ward, where she comes to herself. The effect of anesthesia is brief, and after a couple of hours the patient can go home. Only in some (more severe) cases the representative of the weaker sex remains in the hospital for several days.
After hysteroresectoscopy, treatment must be carried out. Depending on the pathology, it can be antibacterial, antimicrobial, immunomodulatory and hormonal. If the patient wants to conceive a child, then it is necessary to inform the doctor. In this case, a milder therapy is selected, which does not exclude the possibility of pregnancy.
Opinions of patients
Hysteroresectoscopy reviews have only positive. Women say that manipulation allows not only to remove the pathology, but also to conduct additional research. All materials obtained during the operation are sent to histology. According to the results of the diagnosis, a more accurate diagnosis is made, allowing to prescribe the correct treatment.
Also, patients note that the procedure called hysteroresectoscopy is a rather expensive treat. The price of manipulation in a private clinic can vary from 10 to 50 thousand rubles. In public medical institutions, treatment is free of charge, but at present not all hospitals have the necessary equipment and qualified specialists in this field.
Summing up and a small conclusion
You now know what a hysteroresectoscopy is. If you want to bring your health back to normal and avoid a long hospital stay, rehabilitation period and scarring in the abdominal area, this manipulation will help you. Contact your doctor and ask about the possibility of the procedure in the walls of your hospital. Cheers and do not get sick!
What is hysteroresectoscopy
This is a minimally invasive method, with the help of which not only a detailed examination of the inner surface of the uterus is performed, but also a safe transcervical access operation. After such a surgical procedure, recovery of the body occurs in the shortest possible time. This is a relatively new direction in gynecological surgery, which has become possible thanks to the improvement of technical support.
In the course of diagnosis and surgical manipulations, electric tools are involved - a hysteroresectoscope (endoscopic tube and LED, another light source), a microscopic video camera. Modern optical system helps to control the process, minimize the risk of postoperative complications. Therefore, this modern method is distinguished by its low-impact.
Indications for hysteroresectoscopy
Before prescribing the procedure, the doctor assesses the potential risks and relevance of the surgical intervention, conducts a detailed diagnosis of the whole body, determines the patient's response to anesthesia. Conducting hysteroresectoscopy appropriately strictly prescribed by a specialist in such clinical cases:
- adhesions of the pelvic organs,
- benign neoplasms on the walls of the uterus (papillomas, tumors, cysts),
- diagnosed uterine fibroids,
- the formation of the septum of the uterine cavity,
- polyposis of the cervix and the inner uterine layer,
- chronic endometriosis and endometritis,
- menstrual disorders of different etiology,
- "Cleaning" after an abortion, miscarriage, ectopic pregnancy,
- relief of intrauterine device from the uterus,
- physiological pathologies of the development of the uterus.
It is appropriate to have such surgical intervention in case of complicated hyperplasia of the organ of the reproductive system of a woman, in case of suspicion of the formation and development of malignant neoplasms. In the latter case, conducting a hysteroresectoscopy is permitted only for the purpose of reliable diagnosis and visual examination of a presumptive focus of pathology.
Hysteroresectoscopy of the submucous site is a topic that deserves special attention, since the presence of fibroids and polyps in the uterus becomes a frequent cause of menstrual failures, the occurrence of non-cyclic bleeding, and particular pain in critical days. After a comprehensive diagnosis and a hysteroresectoscopy, the general condition of the woman returns to normal, and after the planned rehabilitation the menstrual cycle is restored.
Contraindications for hysteroresectoscopy
Doctors report that not all patients undergo hysteroresectoscopy of the uterus, even for medical reasons. There are those weighty restrictions, the violation of which only aggravates the clinical picture, causes serious health complications. Medical contraindications are as follows:
- infectious diseases of the pelvic organs,
- abundant hemorrhages of unexplained nature,
- impaired blood clotting,
- selected diseases of the heart, liver, lungs and kidneys,
- progressive pregnancy
- inflammation of the cervix,
- uterine fibroids from 7 cm in diameter,
- sexually transmitted or parasitic diseases of the reproductive system,
- cervical stenosis,
- malignant tumors of the uterus.
Benefits of the procedure
During abdominal surgery, an adhesions process may occur, which further requires repeated surgical intervention, a long rehabilitation period. As for hysteroresectoscopy, such potential complications are not expected. Doctors point out the additional advantages of this minimally invasive method:
- low trauma surgical method - the lack of postoperative scars, scars,
- short rehabilitation,
- minimal risk of developing infectious processes in the postoperative period,
- full preservation of the reproductive functions of women.
Disadvantages of the procedure
The advantages of hysteroresectoscopy are greater, but there are also drawbacks to such a progressive method of surgical intervention. The main disadvantages of the procedure are the possibility of such complications:
- traumatic damage to neighboring organs,
- the accession of secondary infections
- heavy bleeding with the need to resort to laparoscopy,
- incomplete removal of the pathology,
- complications of the main diseases of the body.
Preparation for hysteroresectoscopy
The preparatory process begins with a complete clinical examination of the female body and a series of laboratory tests of biological fluids. In the latter case, we are talking about general blood and urine tests, a smear on the flora of the vagina, tests for hepatitis, HIV and syphilis. It is also necessary to pass a biochemical blood test. Other diagnostic methods are:
- fluorographic examination,
- Ultrasound of the pelvic organs,
Hysteroresectoscopy involves thorough preoperative preparation: it is necessary to clean the intestinal cavity, for this, doctors perform a cleansing enema. After that you need to eat nothing, considering the impending performance of anesthesia. Before surgery, it is necessary to completely empty the bladder, thoroughly rinse, be sure to shave the hairs in the perineum and pubic area. The procedure of hysteroresectoscopy should be carried out on the 5-7 day of the cycle, when the patient ends critical days.
Methods of conducting hysteroresectoscopy
First of all, the patient is placed on a special chair and perform general anesthesia. When the anesthetic has worked, a hysteroresectoscope is inserted through the vagina and cervix into the uterine cavity. Then a special solution is pumped through the instrument, which expands the walls of the reproductive organ and conducts light rays. So much better visible pathology, while reducing the risk of complications. The duration of hysteroresectoscopy is 40-60 minutes. When the procedure ends, after a while the patient moves away from the anesthesia.
Hysteroresectoscopy of the endometrial polyp
The surgeon uses special tools, and the operation is carried out under the control of a modern optical system. The sequence of actions is as follows:
- Introduction to the uterine cavity of a special fluid for the forced expansion of the uterine walls, "highlighting" the focus of pathology.
- Introduction through the cervical canal of the uterus directly into the reproductive organ microvideo chamber, which visualizes the course of the operation.
- Introduction of a special hysteroresectoscope with further removal of the polyp using a hook or loop.
- Coagulation (cauterization) of a polyp.
- Differentiation of a benign neoplasm by the histological method.
Hysteroresectoscopy of uterine fibroids
Since the disease is accompanied by heavy bleeding and difficulty in conceiving, doctors prescribe a hysteroresectoscopic myomectomy, which further helps a woman of reproductive age to feel the joy of motherhood. The sequence of surgical procedures for uterine myoma is as follows:
- Dissection by cutting loop electrode.
- Removal of tumor fragments after each cut-off with an electrode or vacuum, curettage after complete removal of the tumor.
- Coagulation of the affected area to prevent extremely undesirable inflammation, complications.
The patient is discharged on the second day after hysteroresectoscopy, and the recovery period continues for another 2 weeks. You should not be surprised if, during the specified period, there is pain in the area of the uterus, scanty bleeding from the vagina. It is important to give up sex for a month. The remaining restrictions are presented below:
- It is important to avoid excessive physical exertion.
- It is necessary to exclude hypothermia,
- do not take hot baths, go to the sauna, bath (avoid overheating),
- no douching allowed
- banned from visiting the pool, open water.
The patient is advised to follow the rules of personal hygiene, replace the bath with a shower, and if necessary, complete a full course of drug therapy to accelerate the recovery of injured uterine tissues. Not taking hormonal drugs. The recommendations of specialists regarding the recovery period are presented below:
- it is required to apply cold on the uterus area for 20 minutes three times per day,
- take a shower once a day, perform toilet of the genitals twice a day,
- use drugs prescribed by a doctor.
If you have completed hysteroresectoscopy, it is important to avoid the occurrence of acute infections, otherwise the general condition of the woman deteriorates dramatically. Among the potential complications, doctors distinguish such dangerous diseases:
- gas embolism of uterine vessels,
- hematometers (uterine cramps with bleeding),
- perforation of the uterine wall, which is in dire need of timely resuscitation,
- diagnosed infertility
- infectious diseases.
Medication after hysteroresectoscopy
Two weeks after the operation, the patient is observed by the attending physician, and the use of drug methods is not excluded. Representatives of the following pharmacological groups are involved in the scheme of complex therapy:
- Oral contraceptives. In 3-4 months of the course, the endometrial tissues are restored, the disturbed menstrual cycle is normalized, they are protected from unwanted pregnancy until the complete restoration of the reproductive organ (Yarin, Danazol, Regulon, Premarin).
- Antibiotics. Provide prevention of bacterial infections in the postoperative period. Representatives of the pharmacological group of cephalosporins in a full course of 5-7 days, for example, Ceftriaxone, Cefuroxime, Cephalexim, are especially effective in a given direction.
- Nonsteroidal anti-inflammatory drugs. The drugs provide anti-inflammatory, analgesic and antipyretic effects in the body, act systemically. Doctors recommend Diclofenac, Ibuprofen, which is supposed to take a course of 7-14 days.
- Anti-inflammatory drugs for use externally prescribed for the complete destruction of pathogenic microorganisms in the vagina. For example, for 5 days at night you can use Terzhinan, Betadin.
- Multivitamins. Representatives of such a pharmacological group restore disturbed hormonal balance, restore injured uterus tissues, strengthen local immunity. It is desirable to focus on multivitamin complexes containing vitamins A, E and group B.
Positive dynamics is observed at the very beginning of the treatment course. Special emphasis is recommended on such medications:
- Diclofenac. This is a representative of the pharmacological group of NSAIDs, which is available in the form of tablets. Prescribe the drug from the first day of rehabilitation in the recommended dosage of 1 tablet no more than 3 times per day. From 3 days it is supposed to reduce the dose to 1 tablet at night. The duration of treatment is negotiated individually by the attending physician. do not exclude the "addictive effect" to the drug.
- Ibuprofen Another representative of NSAIDs, which relieves pain, inflammation, high fever in a state of fever. Recommended dosages - up to 3-5 tablets up to 4 daily approaches. Individual course of treatment. The instructions indicate contraindications, doctors do not exclude side effects, in the absence of positive dynamics after 2 days it is supposed to replace the drug with an analogue.
- Regulon. These are oral contraceptives for replacing the missing female hormones, as an important component of replacement therapy. It is required to accept tablets from 3 to 6 months, at the same time the daily dose is defined according to the special scheme. It is necessary to drink 1 tablet per day every day at the same time without interruptions. If side effects occur, this oral contraceptive is replaced by Yarina, Zhanin.
- Danazol. These are antigonadotropins that prevent the growth of the endometrium. The drug is available in the form of capsules, intended for ingestion of the course for several weeks without a break. The maximum daily dose for adult patients is 800 mg, for more detailed information you need to contact a specialist for consultation. The systemic action in the body, the drug is prescribed for many female diseases.
- Premarin. This is a medical drug that increases the concentration of estrogen in the body. It is necessary to take pills for 4 weeks, since they contribute to the rapid healing of the wound after surgery. The recommended dosage - 625 mg - 1.25 mg per day, alternating oral administration for 3 weeks with a break of 7 days. The doctor may increase the daily dose. The course of treatment is a few weeks.
Pregnancy after hysteroresectoscopy does not occur immediately, but with the passage of a full medical course and compliance with all medical recommendations, the patient's chances of feeling the joy of motherhood increase significantly. When conservative treatment ends, re-diagnosis is necessary. Only after that the doctor makes valuable recommendations for further planning of pregnancy.
Hysteroresectoscopy - technique of
The patient is placed on a gynecological chair, under general or intravenous, or other type of anesthesia, they begin the operation. Before the procedure, an internal examination is performed, then the external genital organs, the vagina and the cervix are treated with a disinfectant (betadine for example), after which the cervix is fixed with a special tool and the cervical canal is expanded to introduce a hysteroscope into it and further introduce the uterine-expanding medium (0, 9% sodium chlorine or gas). After the introduction of the hysteroresectoscope under the control of the image on the monitor, it is advanced into the uterine cavity for the purpose of inspection. When the uterine cavity and the mouth of the fallopian tubes are examined and the pathological area is found, proceed with resection (removal). For this purpose, a bipolar or monopolar electrode can be applied, depending on the equipment of the clinic.
In this case, one electrode is used in the form of a cutting loop. The basal electrode is placed before the operation, directly under the patient, in order to contact the skin. With this arrangement of electrodes, an electric current passes through the patient's body, which may be a risk of burns due to the use of high voltage.
Bipolar hysteroresectoscopy - how is it going
This technique is more modern and does not have the disadvantages of its predecessor. It uses two electrodes, which are both parts of the same cutting tool. This method allowed the use of a liquid medium. And the procedure itself for removing the pathological part of the cutting loop is more productive, since the conditions for dissection or cutting are better that it is many times more efficient than using a monopolar electrode.
When a hysteroresectoscopy is performed, anesthesia can be applied in a variety of ways, depending on the patient’s concomitant diseases, her current condition, the duration and volume of the operation, and even the patient’s personal wishes. It is intravenous, general (rarely used), endotracheal anesthesia (in the case of a long operation), spinal anesthesia (if the duration of the operation is no more than thirty to forty minutes). Therefore, it depends directly on how long a hysteroresectoscopy lasts, how anesthesia is performed. Usually, this question is previously discussed between a gynecologist and an anesthesiologist, after which they can provide a choice to the patient, in any case, without any written permission, no manipulation will be carried out. And she will be offered the best option for anesthesia in this particular case.
Preparation for surgery
Before surgery, hysteroresectoscopy, how to prepare, excites each patient. To do this, it is necessary on the eve of the operation a light supper, emptying of the intestines, and on the day of the operation exclude food intake and sharply restrict fluid intake. Preparing the patient a few weeks before the intervention includes an extensive clinical and laboratory examination and consultation of other specialists, which are described in detail by the attending physician.
Indications for hysteroresectoscopy
Surgical intervention with the help of a hysteroresectoscope is performed in cases when it is necessary to examine the uterine cavity and eliminate the identified pathologies in a single session. Gisteroresektoskopiya is appointed in the presence of the following indications:
- The need to remove remnants of an intrauterine contraceptive device (IUD), placenta, or ovum after an abortion or delivery.
- Polyps uterine cavity.
- Miscarriage of pregnancy (spontaneous miscarriage).
- Therapy of uterine hyperplasia with ineffective hormone therapy.
- Bleeding in the postmenopausal period, intermenstrual bleeding.
- Treatment of adenomyosis (internal endometriosis).
- Pathologies of development of the uterine cavity (intrauterine septum).
- Suspected endometrial cancer.
- The presence of synechiae - fusion of the uterine walls.
- Fibroids with a diameter of 4-5 cm.
Also, surgery can be prescribed to monitor the results of hormone replacement therapy in hyperplastic processes of endometrial tissues.
Contraindications to hysteroresectoscopy
As with any operation, the treatment of pathological processes in the uterus using a hysteroresectoscope has several limitations:
- infectious, inflammatory diseases of the reproductive organs,
- bleeding disorders,
- uterine myoma more than 6 cm (according to ultrasound),
- pregnancy (ectopic, uterine),
- severe diseases of the heart, lungs, kidneys, liver,
- cancer pathology of the genital organs,
- common chronic acute illness.
Also carrying out hysteroresectoscopy is contraindicated when detecting trichomonads, chlamydia or excessive white blood cell count in a vaginal smear.
For most women, hysteroresectoscopy causes a lot of unfounded fears and various questions. The main task of the doctor is to give exhaustive answers to all the questions of interest: what is the procedure for, what are its advantages as compared with radical therapeutic methods, what happens during the intervention, possible consequences of the operation, features of the rehabilitation period, the need to follow the doctor’s recommendations, etc.
Conducting hardware and laboratory studies
7-10 days before the upcoming surgery, the patient undergoes a preliminary examination, which allows to detect possible contraindications to the procedure, as well as to diagnose and treat diseases that may cause complications after hysteroresectoscopy.
Laboratory tests include:
- general, biochemical analysis of blood, urine,
- determination of the Rh factor, blood group,
- blood test for syphilis (Wasserman reaction),
- coagulogram (detection of blood clotting level),
- blood tests for hepatitis, HIV,
- microbiological analysis of detachable vagina (smear check on flora),
- pregnancy test (blood for hCG).
Among the instrumental studies are the following:
- transvaginal ultrasound,
- Ultrasound of the heart or ECG (if necessary).
To achieve maximum and lasting therapeutic effects, prior to the procedure, preliminary hormonal therapy is carried out, aimed at suppressing the production of sex hormones and reducing the size of fibroids. Under the influence of hormonal agents, the endometrium becomes even and thin, which makes inspection with hysteroresectoscopy easier and reduces the likelihood of postoperative complications. As part of hormonal training, progestogens, antiprogestins, gonadotropin inhibitors and gonadoliberin agonists can be prescribed. The drug, the regimen and its dosage is determined by the doctor. Improper use of hormones can lead to the development of side effects.
An alternative to hormonal preparation can be vacuum or mechanical curettage of the endometrium. Such manipulation is faster, cheaper and avoids the complications associated with taking hormones. Curettage can be performed before removal of the polyp and surgical treatment of endometrial hyperplasia.
To prevent bacterial complications, immunocompromised women are prescribed antibacterial agents. To reduce emotional stress, sedation drugs (tranquilizers) are indicated.
How is hysteroresectoscopy performed?
If preliminary preparation by hormones was not carried out, removal of polyps is prescribed for 5-7 days after the end of menstruation (in this period the endometrium is the thinnest). If antigonadoptron preparations were used as part of the hormonal preparation, the procedure is performed after the end of their use. If Gonadoliberin agonists were used for the preparation, hysteroresectoscopy is performed 5-6 weeks after the end of therapy.
High quality anesthesia is necessary to remove myoma or another neoplasm in the uterine cavity. Considering the anticipated volume of manipulation and the nature of the disease, general anesthesia, intravenous anesthesia, epidural anesthesia or endotracheal anesthesia (the introduction of anesthetic into the respiratory system) can be used.
After the anesthesia has worked, the doctor proceeds with the operation. Surgical treatment of pathological processes in the uterus using a hysteroresectoscope is carried out in several stages:
- Determining the location and size of the uterus by probing (bimanual examination) of the organ.
- Treatment of genitalia antiseptic preparations.
- Vaginal dilatation to provide access to the uterine cervix.
- Treatment of the neck with an antiseptic and fixation with forceps.
- Expansion of the uterine canal with Gegara dilators so that the lumen of the channel corresponds to the diameter of the outer housing of the endoscopic system.
- Filling the uterine cavity with sterile saline, which improves visibility and facilitates the work with tools.
- Examination of the uterus, followed by drawing up a plan of the procedure. Preparation of appropriate electrodes, the choice of which depends on the location, size and nature of the identified pathological focus.
- Removal of the diagnostic part of the resectoscope. In this case, the control over the course of manipulation is carried out using laparoscopy or ultrasound.
- Excision of tumors. Polyps can be removed in several ways: laser treatment, freezing (cryodestruction), cauterization with electric current, as well as with the help of a surgical loop or a radio wave knife. The most effective technique is selected based on the size, location and number of formations.
- Removing tissue fragments from the uterine cavity using forceps or a surgical spoon (curette).
- Coagulation of vessels (according to indications).
- Removal of fluid and electrodes of the hysteroresectoscope from the uterus.
- Treatment of external and internal genital organs with antiseptic preparations.
After the end of the procedure, the patient is followed by postoperative observation (monitoring of pressure, general well-being, quantity and nature of vaginal secretions, etc.).
Recovery period after hysteroresectoscopy
This manipulation refers to minimally invasive operations and is transferred fairly easily. Стенка матки минимально травмирована, рана на брюшной полости отсутствует, кровотечения практически не наблюдаются.The only thing that can bother women is moderate pain in the sacrum and lower abdomen.
Since any surgical intervention is a certain stress for the body, to prevent the development of possible consequences for 3-4 weeks after the operation, it is recommended to adhere to a number of preventive measures:
- Follow the rules of hygiene (washing 2-3 times a day, common shower - once a day).
- Refrain from intimacy.
- Apply cold on the uterus area 2-3 times a day for 20 minutes. This will help reduce pain.
- Avoid overheating (bath, sauna), hypothermia and physical exertion.
- Do not swim in open ponds, pools.
- Do not go to the gym, do not lift weights.
In addition, during the rehabilitation period, the following medicines are prescribed:
- Oral contraceptives. Used to restore the menstruation cycle and the normal functioning of the endometrium. Also, these drugs protect against unplanned pregnancy until the uterus is fully restored.
- Antibiotics. Used to prevent bacterial infections that can develop as a result of the entry of pathogens into a postoperative wound. The first dose of antibacterial agents is taken 2-3 hours before surgery. Further preparations of a wide range are prescribed. Mostly these are antibiotics of the cephalosporin group,
- Anti-inflammatory nonsteroidal drugs. They have anti-inflammatory and analgesic effects.
- Local anti-inflammatory drugs. Appointed to combat pathogenic bacteria in the vagina.
- Multivitamin complexes. Used to normalize the balance of hormones, strengthen the immune system and rapid tissue regeneration.
Intellectual work patients may return to work several weeks later. Return to sports activities and usual physical activity is possible in 6-8 weeks.
What are the consequences of hysteroresectoscopy?
Normally, after examining and treating diseases of the uterus with a hysteroresectoscope from the genital tract, blood and spotting may be observed for 3–4 weeks. If after this time the discharge has not stopped or their number has increased - you should consult with the doctor. This may be a sign of an inflammatory or infectious process in the uterus.
In addition, the assistance of a specialist will be required when the following abnormalities and symptoms are detected:
- appearance of vaginal discharge with an unpleasant smell,
- the occurrence of blood clots
- severe weakness, malaise,
- temperature above 37.5 degrees
- pain in the abdomen, radiating to the lumbar or perianal region.
To determine the cause and severity of the pathological process, the doctor will prescribe a series of studies and then develop an individual program of therapeutic effects.
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How is the intervention?
Hysteroresectoscopy is considered a fairly simple operation: it is well tolerated by patients and extremely rarely causes complications. The operation belongs to the category of minimally invasive interventions, in recent years widely used both in gynecology and in other areas of medicine. The main difference of such an operation from open interventions is that the doctor does not need to make an incision in the skin: it is enough to insert a thin endoscope tube equipped with a diode into the organ cavity and miniature tools for removing tumors.
To perform the operation, the doctor requires a fairly high level of qualification and considerable experience.
In total, the operation takes about half an hour. It proceeds in several stages:
- a woman gets general anesthesia. It is usually used fairly light drugs, as long-term pain relief is not required. Therefore, the state after waking up quickly returns to normal. The choice of anesthesia method (mask, epidural, intravenous) depends on the patient's condition,
- The cervical canal passing through the cervix expands, through which either a gas or a special fluid is injected. This allows you to increase the organ cavity and better visualize the pathological foci,
- through the cervical canal a tube is inserted into the uterus, at one end of which a chamber is located. The picture from the camera is transmitted to the monitor, so that the doctor can see all the pathological changes in the organ mucosa,
- if necessary, a resectoscope is inserted into the organ: a device that allows the removal of tumors. Removal is performed by visual inspection by a physician. For example, hysteroresectoscopy of uterine fibroids is performed using a special electrocautery,
- on the site of the eliminated neoplasms, the tissues are cauterized, which helps prevent inflammation,
- fluid is removed from the organ, after which the patient is sent to the ward.
If a polyp was detected during hysteroresectoscopy, after removal, it is sent for histological examination. This allows you to determine whether the malignant process is developing in the uterus.
Does hysteroresectoscopy have any contraindications?
It may seem that hysteroresectoscopy is simple. However, it can not hold every woman. For example, such an intervention is contraindicated in the following cases:
- exacerbation of chronic disease
- the patient has ARVI or ARI,
- blood clotting disorder: in this case, serious bleeding may develop during surgery,
- there are infectious diseases of the urogenital system, for example, the patient is infected with chlamydia,
- hysteroresectoscopy is contraindicated in the case of pathological stenosis of the cervical canal, that is, when its lumen is narrowed.
Absolute contraindication to surgery is pregnancy. For women in position, resectoscopy is recommended only if there is no need to maintain pregnancy.
Before surgery, you should inform the doctor about the presence of chronic diseases: many of them are considered a contraindication for hysteroresectoscopy.
How to prepare for the operation?
Usually, before such an intervention a woman undergoes a full clinical examination. This allows you to determine whether the patient has any contraindications to hysteroresectoscopy.
It is important to pass the following tests:
- urine and blood tests
- analysis for various infections (AIDS, syphilis, hepatitis B),
- smear vaginal microflora.
Depending on the patient’s history, additional tests may be indicated. In the event of any abnormalities, their prior treatment may be required.
Immediately before the operation, the nurse should give the patient an enema. It is also very important to empty the bladder. Before hysteroresectoscopy can not eat and drink, so usually the operation is performed in the morning. And you also need to thoroughly wash and remove hair in the crotch area.
Hysteroresectoscopy is performed on about the sixth day of the cycle. If the patient has already reached menopause, the intervention can be done on any given day.
Hysteroresectoscopy is performed quite often. This is due to the indisputable advantages of this treatment method:
- the operation belongs to the category of minimally invasive. It is well tolerated by ladies of all ages and does not require a long rehabilitation period,
- after the procedure, the woman can quickly return to her normal activities,
- hysteroresectoscopy does not affect reproductive functions: pregnancy is possible after surgery,
- after the intervention, there will be no scars on the body. This is important not only from an aesthetic point of view: any open surgery is fraught with serious complications, for example, inflammation of a postoperative suture. Naturally, by virtue of its specificity, hysteroresectoscopy does not have this deficiency. This refers to the main differences in minimally invasive interventions.
Recovery after surgery
As a rule, a woman can go home on the second day after such an intervention. However, the full rehabilitation period is about 14 days. At this time, there may be quite unpleasant sensations in the lower abdomen, bloody discharge. This should not frighten: similar symptoms suggest the restoration of the mucous membrane of the uterus. Treatment in this case is not required: after the postoperative period is over, they will disappear on their own.
To avoid various infections for some time, a woman needs to take antibiotics prescribed by a doctor. If the pain after hysteroresectoscopy worries strongly enough, you can drink analgesics.
For about three to four weeks after the intervention, the woman is required to follow simple rules:
- do not lift heavy things
- do not engage in power sports and do not overload
- bathe only under a cool shower, giving up the hot tubs,
- shy away from douching
- do not supercool
During the month should not live sex life. If you are planning a pregnancy, ask your doctor when you can begin to attempt to conceive a baby.
If the purpose of hysteroresectoscopy was to remove a polyp or myoma node, hormonal preparations are additionally required, which accelerate the process of postoperative recovery of the body. To refuse their admission is not worth it. There are many prejudices that relate to this group of drugs, however, it should be remembered that the doctor prescribes medications in a certain dosage, which is not capable of causing harm to the patient. If, after taking hormonal pills, you feel unwell, contact a specialist to correct the treatment regimen. You can not change it yourself or replace drugs!
Hysteroresectoscopy is relatively rarely the cause of the development of complications. However, in some cases, patients have:
- gas embolism of uterus vessels. This happens extremely rarely and is due to the fact that the gases used to expand the uterus enter the bloodstream,
- perforation of the uterus wall. Such a complication may develop in the case of inaccurate performing surgical intervention is not enough qualified specialists. If the doctor has damaged the uterine wall, massive bleeding develops, which leads to fainting. In this case, immediate restoration of the circulating blood volume and other resuscitation measures are required.
- hematometer, that is, spasm of the uterine walls. This causes profuse bleeding, in some cases life-threatening patient,
- with severe lesions of the uterine mucosa, infertility may develop.
However, do not be afraid. Reviews indicate that serious complications are extremely rare after surgery. To protect yourself, you should find a good specialist who has considerable experience in carrying out such an operation, and also not hide the presence of chronic diseases from your doctor.
What signs indicate the development of postoperative complications?
After the hysteroresectoscope procedure, the woman should be especially attentive to the state of her body. As a rule, a medical examination is required one month after surgery. Visit a specialist before you need the following symptoms:
- copious periods with blood and clots
- delay of menstruation. Typically, menstruation is restored within a month after surgery. If the menstrual cycle has not recovered, it is necessary to conduct an additional examination of the body,
- the appearance of an unpleasant smell from the genitals,
- severe pain in the lower abdomen and lower back, which are not controlled by pain medication,
Ignore these symptoms, if they develop in the postoperative period, in any case it is impossible: they may indicate the beginning of serious complications.
The sooner the necessary treatment is prescribed, the better! The complex of medical measures can be prescribed only by a doctor. Self-treatment in this case is unacceptable.
Hysteroresectoscopy is an operation that is performed for many gynecological diseases. Modern minimally invasive treatment methods are characterized by a short recovery period and high efficiency. To better prepare for the operation, get rid of the tension that is natural in this situation, ask your doctor all the troubling questions and watch the videos taken during the intervention (the latter can only be done if you are not overly impressionable).
Advantages of the operation
There are many advantages to hysteroresectoscopic surgery.
- First of allSuch an intervention is distinguished by low injury and is well tolerated by patients. After such an operation, long-term rehabilitation is not required.
- Secondlyafter it there are no scars and postoperative scars that occur during an open surgery. Therefore, the risks of complications associated with open surgery are also excluded.
In the process of hysteroscopy, the patient receives a whole range of therapeutic and remedial procedures with the complete reorganization of the reproductive organs.
After the operation, the woman returns to her usual life and professional activity in a fairly short time. Moreover, the reproductive functions are fully preserved, so after a certain time, the woman will again be able to get pregnant and give birth.
Visualization of the operational process ensures maximum accuracy of the manipulations.
Treatment of myoma node
A hysteroresectoscopic myomectomy is performed to remove uterine nodes.
Submucous fibroids are dangerous in that they cause bleeding and affect the female body, similar to the intrauterine device.
As a result, a woman can not get pregnant. Conducting hysteroresectoscopy of submucous fibroids allows you to save the uterus after surgery, and further provides an opportunity to become a mother.
During the operation, myoma nodes are removed by cutting with a cutting loop electrode. The operation is completed with coagulation of the area on which the fibroid was located, with a special electrode having a wide surface.
Fragments of the tumor can be removed after each cut-off by the electrode or after the entire tumor has been removed by curettage or vacuum.
The video shows a hysteroresectoscopic operation to remove a submucous node:
Among the likely complications that are quite rare, experts call:
- Gas embolism of uterine vessels. It happens like this in single clinical situations when using gas to expand the uterus,
- Perforation of the uterine wall, which is usually accompanied by fainting and large blood loss, therefore, requires additional reanimation,
- Infectious complications caused by the penetration into the uterus of pathogenic microflora and necrotization of unnoticed myoma tissues,
- Hematometers - uterine spasm, causing profuse uterine bleeding,
- Due to serious damage to the endometrium during the operation, infertility may occur.
These complications are quite rare, usually due to lack of experience of the doctor. In general, hysteroresectoscopy refers to safe and most gentle procedures.
What is the difference between hysteroscopy and hysteroresectoscopy?
Hysteroresectoscopy is a modern organ-preserving surgical technology that makes it possible to perform transcervical surgery without damaging the uterine walls.
Hysteroresectoscopy is somewhat different from conventional hysteroscopy.
To carry out hysteroresectoscopy you need:
- A preliminary histological examination of the scraping taken from the endometrial layer,
- Use of anesthesia
- Laparoscopic control,
- Specialized non-electrolyte solutions for filling the uterine cavity,
- Strictly control the lack of fluid in the uterus.
Somehow I began to have bleeding incomprehensible, in the middle of the cycle. And the blood is not smeared, but it flowed. I went through an ultrasound, found a uterine polyp 2.5 cm. It was he who caused the bleeding. Hysteroresectoscopy was prescribed as the most gentle method of polypectomy. The operation went well, but the pain and discharge bothered another six weeks. I was additionally prescribed hemostatic and antibiotics, and also appointed Novinet for half a year in order to exclude a relapse of the polyp. It has been 2.5 years after the operation, I got pregnant safely and gave birth to a little son. Polyp has not yet appeared.
When they discovered a myoma node, I just fell into a stupor. I didn’t understand anything, where, why, why, etc. But she needed treatment, she agreed to hysteroresectoscopy. As in the fog went to the chair. I remember how anesthesia was injected into a vein, then it was very hard to burn the beginning in it, as if boiling water was injected. And then I woke up in the ward. You do not need to be afraid of hysteroresectoscopy, because you do not feel anything. After surgery, the lower abdomen hurts for 2-3 weeks and discharge.Monthly after surgery began to pour like 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 copes with them.
The procedure of hysteroresectoscopy is relatively expensive:
- In Moscow clinics, it will cost 28000-46000 rubles.
- In St. Petersburg clinics, hysteroresectoscopy costs somewhat less - 18,000-34,000 rubles.
Frequently asked questions
When patients are prescribed hysteroresectoscopy, then they have a lot of questions.
- On which day of the cycle do they perform hysteroresectoscopy? - Hysteroresectoscopic myomectomy or polypectomy is carried out on the 5-10 day of the cycle, after the end of menstruation.
- Monthly after hysteroresectoscopy. - Usually, the first menstruation after surgery comes in about a month. The important point is the nature of menstruation. If the consistency, quantity and color of the menstrual flow has changed, then a gynecologist's consultation is necessary.
- Temperature after hysteroresectoscopy. - Normally, 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 hyperthermia is more pronounced, then it is necessary to undergo an 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 hormonal therapy. Typically, pregnancy planning can begin one month after discontinuing hormonal drugs, which are prescribed for about six months. If hormonal therapy was not prescribed, then with favorable prognoses, pregnancy can be planned approximately 3-4 months after the operation.
Histeroresectoscopy is not necessary to be afraid. It is an organ-sparing, sparing and minimally invasive surgery. After the procedure, it is imperative to be monitored by a gynecologist and periodically to do control ultrasound examinations (3 and 6 months after surgery).
In the future, with a favorable picture of treatment, a woman for preventive purposes should visit a gynecologist annually.
Description and characteristics
Hysteroresectoscopy is a minimally invasive method for the treatment and diagnosis of pathologies of the reproductive organ. It is carried out using a special device - a hysteroresectoscope, which is inserted into the cervical canal and penetrates into the uterine cavity. Thanks to this operation, it is possible to fully assess the condition of the mucous membranes and, if necessary, immediately perform all therapeutic measures.
The technique is effective in the treatment of such diseases of the uterus, such as:
- polyps of the cervical canal and genital organ,
- submucous nodes,
- formation of adhesions,
- benign neoplasms
- septum in the uterus.