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Big Fibroid operation refused in U.K & Was done successfully laparoscopically in India
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Hysteroscopic Surgeries >Submucus Fibroid
  Submucus Fibroid resection :  
 

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Indication:
Commonly found with:

  1. Primary/Secondary Infertility
  2. Investigating & treating a case of B.O.H.
  3. Investigating & treating Abnormal bleeding P/V
  4. Investigating & treating case of mass(SOL) inside the uterine cavity

Diagnosis:

Confirmed by TVUSG as typical shadow towards endometrial linings. Sono-salpingography helps in detecting intra cavitary portion of submucus fibroid and helps in understanding detail fibroid mapping pre-operatively to counsel our patient before operation.

Objective:

Hysteroscopy is the commonest type of work up in the entire Infertility & BOH patient along with Diagnostic Laparoscopy. Only diagnostic hysteroscopy is the commonest work up recommended before IVF. We record Hysteroscopy diagnostic & operative procedure for future important record in Infertility patient, for second opinion & for deciding future treatment protocol. Selection of patient is very important. Multiple fibroids and big fibroids resection are likely with TUR syndrome and should be selected very carefully. Glycine deficit and S.Na level should be monitored during resection vigilantly to prevent complication.
Benefits of Hysteroscopy Surgery:

  1. Shorter Hospital stay.
  2. Earlier return to your routine work.
  3. Cosmetically no scar on abdomen.
  4. Less pain after operation.
  5. Best fertility enhancement & Fertility results following hysteroscopy
  6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
  7. Patient discharged within 4-6 hours after procedure.
  8. Patient can resume to her normal routine work within 12-24 hours after the procedure.

Pre-operative Check Lists:

  1. Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.Etc.); Pelvic Trance vaginal USG report & Serum Electrolytes.
  2. Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc. If The couple is infertile) and repeated pregnancy loss (BOH)
  3. Operation planned from 4th to 10th day of Menstrual Cycle.
  4. Preparation of local parts.




No. Of Cuts on Abdomen: Nil

Average Stay in Hospital:
6 to 8 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
2 to 10 minutes

Average Blood loss during Surgery:
10-50cc

Average time after operation to resume normal activities/work:
Within 12-24 hours.

Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)

Procedure:

Patient is given general anesthesia. Patient is put on lithotomy position. Local parts cleaning & paintings with antiseptic solution & draping are done. After P/V examination cervix is checked with uterine sound.

Hysteroscopy requires distention of the uterine cavity with Normal saline to create working space inside the uterine cavity and flushes both fallopian tubes with high pressure fluid also helps in achieving very good fertility enhancing results following Hysteroscopy in infertility patients.

First Diagnostic hysteroscopy is done after removing the air from sheath & hysteroscope (varsascope/1.9 mm/ 2.9 mm) assembled. Hysteroscopy along with irrigation of Normal saline is introduced inside the cavity. Systemically both corneal openings, cavity, both lateral walls and anterior & posterior wall of the uterine wall and location pf submucus fibroids confirmed & is noticed for any lesions or normalcy.

For Submucus fibroid resection 10 mm dilatation done & loop resection started from above downwards with using Glycine 1.5% as distention medium. 100 watt cutting current is used and fibroid is shaved in small strips from the surface systemically till capsule is reached. Strict Byline input & output watch is mandatory to prevent complication for hyponatremia.
Post-operative Course:
Patient remains drowsy/sedated for 1-2 hours after hysteroscopy but conscious & pain free. Patient can take fluids 1-2 hours after hysteroscopy & light food after 2-4 hours. She may feel little discomfort after hysteroscopy for 6-8 hours but it can be relieved with pain killer tabs. Most of the patients can walk normally without support and can take normal diet 6-8 hours after the hysteroscopy. She can be discharged on the same day of the operation. Few patients may feel nausea & vomiting after hysteroscopy, which can be very well controlled with injection in post-operative room. Patient can do her normal activity within 12-24 hours after hysteroscopy. Patient is advised to take antibiotics & analgesic tabs for 5 days following hysteroscopy. Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately. Patient is advised to come for follow up 7 days after the next period or on the day for IVF protocol & preparation for IVF.

 

 

 

 

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