Hysteroscopic resection is also known as Transcervical Resection of Fibroids (TCRF). It is a procedure for removing fibroids that occur in the inside of the uterus using an instrument called a resectoscope.
Submucosal fibroids that are beneath the endometrium (the lining of the uterus) which grow into the inner cavity of the uterus can be removed hysteroscopically.
TCRF is usually performed under a general anaesthetic as a day-case procedure. No external cut is required, as all the surgery is performed through the canal. The cervix (the neck of the uterus) is gently stretched and a hysteroscope (small telescope) is then inserted through the cervix into the uterus. The hysteroscope gives a view of the uterine cavity and has a surgical loop at its end that is used to remove (or ‘resect’) the fibroids.
There is a 2–3% incidence of one of the following complications during TCRF:
- Injury to the cervix
- Perforation of the uterus: In this case the procedure will have to be stopped and a laparoscopy (telescope through the umbilicus) will be carried out to see the damage. The surgery may have to be carried out after a few months. You will be kept overnight for observation.
- Fluid overload: This is a result of absorption of the fluid used to distend the uterus, leading to a fluid overload in the body. If this occurs may need admission for observation and further treatments.
- Bleeding: A balloon may be placed in the uterus to stop bleeding. Sometimes transfusion may be required.
- Infection: A course of antibiotics will be given to prevent infection. You may need another course if you have a very smelly discharge a few days after the operation.
The patient goes home on the same day as the operation. There may be some period-like cramps and bleeding for a few hours after the procedure, but otherwise the procedure is completely pain free. There will be some light bleeding, or blood-stained discharge that usually settles within seven days although some discharge may persist for up to four weeks. During this time the cavity of the uterus is healing. Most women return to driving and work within 48–72 hours.
This procedure can only remove fibroids in the cavity. Fibroids that are deep within the wall of the uterus may need to be removed using open or laparoscopic techniques.