What is a hysteroscopic resection of the endometrium?
Hysteroscopic resection is also known as Transcervical Resection of Endometrium (TCRE). It is a procedure in which the lining of the womb (endometrium) is removed using a special instrument called a resectoscope.
A hysteroscopic resection is performed to treat very heavy periods (menorrhagia) in women who do not wish to have more children. It can be carried out in conjunction with a transcervical resection of fibroids.
What does the operation involve?
TCRF is usually performed under a general anaesthetic as a day-case procedure. No external cut is required; all the surgery is performed via the birth canal. The cervix (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 endometrium.
What specific complications can occur?
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 stay in 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.
- Bleeding: A balloon may be placed in the uterus to stem the flow of the blood. 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.
What is the recovery after surgery?
The patient goes home on the same day as the operation. There may be some period-like cramps and bleeding for few hours after the procedure, but otherwise the procedure is completely pain free. Any light bleeding or blood-stained discharge 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.
