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Hysteroscopic Surgeries >TCRE
  Trance cervical resection of Endometrium (TCRE)  
 

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Indication:
Commonly found with:

  1. Excessive bleeding P/V.
  2. Postmenopausal bleeding P/V.
  3. Investigating & treating Abnormal bleeding P/V.
  4. Investigating & treating case of mass(SOL) inside the uterine cavity

Diagnosis:

Endometrial thickness is confirmed by TVUSG as typical shadow towards endometrial linings. Sono-salpingography helps in detecting intra cavitary portion of SOL(submucus fibroid) and helps in understanding detail endometrial lining & any suspicious malignant tissue pre-operatively to counsel our patient before operation.

Objective:

Only diagnostic hysteroscopy is the commonest work up recommended for DUB (Abnormal bleeding P/V). We record Hysteroscopy diagnostic & operative procedure for future important record in bleeding P/v patient, for second opinion & for deciding future treatment protocol. Selection of patient is very important. Multiple fibroids and big fibroids resection are likely to be complicated 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 her routine work.
  3. Cosmetically no scar on abdomen.
  4. Less pain after operation.
  5. Best 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.
  9. Uterus preserved which helps in prevention of uterine prolapse and vault support. And uterine preservation also offers better sexual function to the patient compared to Hysterectomy.

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.
  5. Patient must be counseled for family planning operation if she had not done previously, as pregnancy after TCRE is likely to be complicated with placenta accrete/increta/precreta and PPH if she conceives after TCRE.

No. Of Cuts on Abdomen: Nil

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

Average Duration of Surgery:
12 to 20 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.

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 Trance cervical Resection of Endometrium(TCRE), 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 superficially from the surface systemically till basal layer is reached. Strict Glycine input & output measurement is mandatory to prevent complication of 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 to rule out the possibility of Hematrometra by TVUSG. (Collection of blood in uterine cavity because of cervical stenosis rarely found in few cases after TCRE)

 

 

 

 

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