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Features of hysteroresectoscopy endometrial polyp

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Uterus - The main organ of the female reproductive system. The uterus of a non-pregnant woman does not exceed 7 cm in length and 6 cm in width. It is located in the pelvis, behind the bladder. The shape of the uterus resembles a triangle, facing the top down. In the upper corners of the uterus there are mouths of the fallopian (fallopian) tubes, through which an egg cell enters the uterus.

The lower part of the uterus narrows, turning into cervix. This is a muscle tube 2-3 cm long. It pierces cervical canal or cervical channel. The lower end opens into the vagina, and the upper end into the uterine cavity.
The wall of the uterus consists of three layers:

  • Mesometry - the outer layer of the uterus, which is a sheath of connective tissue. Longitudinal and circular connective tissue fibers cover the uterus outside, protecting it from damage. They also form ligaments that ensure the attachment of the organ to the walls of the pelvis.
  • Myometrium - muscle layer. It consists of multidirectional smooth muscle beams. They form three layers: outer - subperitoneal, middle and inner - submucosal, on which the mucous membrane is located. Such a structure allows the uterus to contract intensively during childbirth and ensures the strength of its walls necessary during pregnancy.
  • Endometrium - mucous membrane lining the internal cavity of the uterus. Its thickness and structure largely depend on the phase of the menstrual cycle. Endometrium includes two layers: the basal and functional.

  • Basal or sprout the layer is adjacent to the myometrium. It contains a large number of blood capillaries and the basics of the uterine glands. Here are the light cells, which during the menstrual cycle are transformed into cylindrical cells of the functional layer. The task of the basal layer is to ensure the restoration (regeneration) of the mucous after delivery, menstruation and other injuries.
  • Functional layer lines the surface of the endometrium. It consists of uterine glands, blood capillaries and stroma - loosely located cells of the connective tissue, which separates the ducts of the glands. The surface of the functional layer is covered with cylindrical epithelium. The task of the functional layer is to prepare the uterus for the attachment of a fertilized egg and the onset of pregnancy. If this does not happen, then the functional layer is rejected during menstruation, and with a new cycle is restored. These processes are controlled by female sex hormones - estrogen and progesterone.

How to prepare for hysteroresectoscopy?

  1. Instrumental research methods
Studies aimed at identifying diseases that may go unnoticed during a medical examination.
  • Colposcopy - examination of the mucous membrane of the cervix and vagina,
  • Transvaginal ultrasound,
  • ECG or ultrasound of the heart (if indicated),
  • X-ray of the chest.
  1. Drug training
  • Hormonal drugs appointed to block sex hormones, which leads to a decrease in the size of fibroids. Also, under the influence of hormonal preparations, the endometrium acquires a thin, even structure, which facilitates the review during hysteroresectoscopy and allows to reduce bleeding and reduce the risk of postoperative complications. For these purposes, prescribe:
  • Progestogens block receptors of cells that are sensitive to estrogen and progesterone, reducing the rate of growth of the endometrium - Didrogesterone, Norethisterone,
  • Antiprogestins make endometrial cells less sensitive to the effects of estrogen - Gestrinone,
  • Gonadotropin inhibitors cause artificial menopause, inhibit the growth and secretory ability of the endometrium - Danazol,
  • Gonadoliberin agonists reduce the level of sex hormones, temporarily suspend the ovaries and endometrium growth - Goserelin, Triptorelin, Nafarelin, Buserelin.
The dosage of drugs is established only by the doctor, since low doses do not have the desired effect, and high doses can cause side effects.

As an alternative to the hormonal preparation of the endometrium, mechanical or vacuum curettage of the endometrium can be performed. This procedure is cheaper, takes less time and avoids the side effects of hormones. Scraping (curettage) is recommended before the treatment of endometrial hyperplasia and polyposis.

  • Antibiotic prophylaxis. Immunocompromised women (diabetes, obesity, anemia, smoking) are prescribed antibiotics to prevent bacterial complications:
  • Ampicillin, Ampioks, Ticarcillin. Assign inside a short course of 3-5 days.
  • Cefuroxime. The first dose of shock 1.5 g is administered intravenously. The following and 2-3 standard single doses of 0.75 g intramuscularly with an interval of 6-8 hours,
  • Sedatives prescribed to reduce emotional stress. Once, in the dosage set by the doctor, tranquilizers are taken - Sibazon, Ketarol. They improve sleep before surgery and promote muscle relaxation.

  1. Sanitary activities
Starting 6 days before the intended operation, prescribe vaginal suppositories for the rehabilitation of the genital tract. Mostly these are combined agents that act simultaneously on fungi, protozoa and bacteria. For example: Terzhinan 1 time per day for the night for 6 days. Miconazole 1 time per day at night for 5-6 days.

What pathologies are treated with hysteroresectoscopy?

The required set of tools: loop electrode in the "cut" mode, electrocautery, cylindrical electrode, laser conductor.

Growth on the leg cut off a loop, hook or electrocautery. The body of the polyp is removed with forceps and sent for histological examination. The polyp bed is coagulated (cauterized) with a cylindrical electrode or a laser to prevent bleeding and prevent polyp re-growth.
Polyps on a wide base are removed with a loop, removing layer by layer until the entire formation has been removed. This bed is treated with a spherical electrode or laser. Tissue samples are sent for examination to the laboratory.

Small polyps can be completely destroyed using a laser conductor using a contact or contactless technique. The laser beam evaporates moisture from the polyp, drying it out.

Required tools: laser conductor or loop electrode, spherical or cylindrical electrode.

The purpose of the operation is to remove the entire uterine lining. Treatment of the uterus begins from the mouth of the fallopian tubes, leading the electrode towards the cervix. Sequentially process the front and side walls, then the back.

For the destruction of the upper layer of the mucous membrane, the doctor can use a laser, by contact (pressing the electrode to the mucous membrane) or by the contactless technique, when the electrode is at the minimum distance. After exposure to the laser remains a thin groove.
Using a loop electrode, cut off the top layer of the mucous membrane. The removed tissue accumulates at the external pharynx of the cervix, from where it must be periodically removed. This method is used when it is necessary to send tissue for histological examination.

A spherical or cylindrical electrode coagulates (cauterizes) the upper mucous membrane layer. The electrode head makes stroking movements, treating the mucous membrane in the same manner as with a laser. Subsequently, it is rejected and removed from the uterus.

Deep destruction of the endometrium - ablation, leads to disruption of menstruation and infertility. After such a procedure, the uterus mucosa is not restored, but is replaced by connective tissue.

Required tools: laser conductor, spherical or cylindrical electrode.

Carry out coagulation (cauterization) according to the method described for the treatment of endometrial hyperplasia. At the same time, the endometrium (functional and basal layers) and myometrium are destroyed to a depth of 3 mm. A side effect of this treatment is infertility. It is recommended for women who do not plan to have children.

Necessary tools: laser conductor or loop electrode, spherical electrode for coagulation of blood vessels.

A laser or a surgical loop destroys the functional and basal layer of the endometrium, and then the upper layer of the myometrium which contains the foci of adenomyosis. A side effect is infertility.

Necessary tools: endoscopic scissors, forceps, electropneumatic laser.
Gentle weak synechias cut through the body of the hysteroscope. More dense cut gradually with scissors. Dense fibrous adhesions are dissected using electrocautery. When this procedure begins at the exit of the cervical canal, moving up to the mouth of the fallopian tubes.

With common uterine synechia, the procedure is carried out carefully, controlling the vacated cavity. In order to avoid damage to the walls of the uterus, ultrasound or laparoscopy may additionally be involved.

Required tools: electrocautery, straight loop, spherical electrode to stop bleeding.

Carry out the dissection of the septum in the middle line using a loop through which electric current passes. A more dense partition is cut by an electrocautery. An incision is made in the midline, starting at the bottom edge.

When the septum is dissected to the bottom of the uterus, bleeding begins, which is a sign of the end of the operation.

The specifics of the procedure

Hysteroresectoscopy is performed using a special camera (hysteroscope), which moves from the vagina into the uterine cavity. Due to this, the doctor can get the most accurate clinical picture of the state of the tissues and the location of the polyposis lesions. This makes it possible to adjust their actions in the process of surgical intervention.

The polyp is removed with tools and requires careful scraping of the affected area of ​​the endometrium. Then the walls of the uterus are treated with special means to prevent recurrence and the appearance of the inflammatory process.

The method has a lot of positives. It passes without pain, does not require long-term recovery, does not threaten the reproductive function of the patient.

Better than other methods

Hysteroresectoscopy is a modern method of combating formations that significantly reduces the possibility of recurrent growths and the development of infected foci. The use of the device allows the doctor during the operation to closely monitor their actions performed on the site of the emerging formations. The ability to see everything clearly, facilitates the work on the complete removal of pathological particles and eliminates the likelihood of their growth resuming.

The peculiarity of the technique is the simultaneous removal of a polyp and cauterization of the center of its growth. This minimizes the risk of infection spreading on the existing scar and around the endometrial layer. Especially the method is valuable in eliminating numerous entities. This allows you to get rid of pathologies without injuring or damaging the remaining areas on the walls of the uterus. Hysteroresectoscopy is also prescribed for single formations. It is most effective when removing a leg polyp.

The operation is not abdominal, does not require a traditional incision in the peritoneum. This allows you to reduce the injury to the body, reduce the painfulness of the procedure and shorten the rehabilitation period. The postoperative stage passes without additional therapeutic measures. It is enough to prescribe supporting measures to the patient.

Using the method is excluded:

  • the appearance of adhesions
  • manifestations of severe postoperative pain,
  • difficulties in conceiving a child,
  • infertility development.

The method is the most gentle, preserving all reproductive functions and painless. Some painful sensations arise, discomfort is possible, but all phenomena are short-lived.

disadvantages

In order to understand what it is, what possibilities a hysteroresectoscopy has, in what cases it is recommended for patients, it is better to know the effects and possible complications after its use.

The postoperative period may be characterized by the following deviations from the norm:

  • the development of infections in the uterus (can be brought with tools),
  • injury to organs near the uterus,
  • unsuccessful elimination of polypous formations
  • bleeding, to eliminate which used abdominal surgery.

According to experts, almost all deviations are not associated with a violation of the methodology, but are the result of involuntary intervention in the body and the processes of its vital activity. Even despite the possible adverse effects, hysteroresectoscopy is considered the safest and most harmless method of removing polyps and has a lot of significant advantages. However, in each case there are some nuances and, therefore, the need to perform the procedure is determined only by a specialist. He is responsible for the qualified and safe course of the operation and the postoperative period.

Indications for use

Before operating a patient, a set of measures, tests and examinations are required, which the doctor will need to familiarize themselves with the clinical picture and the patient's condition, in each particular case.

Polyps can cause severe pain and heavy bleeding in a woman. In cases where pain is significantly exacerbated when they are detected, then there is a possibility that the patient has an additional and serious gynecological pathology. The operation is carried out only after a serious examination. You will need to use all possible research methods and identify the cause of this symptom, and based on the final data to decide on the implementation of hysteroresectoscopy.

Contraindications

The hysteroresectoscopy method is not recommended for everyone. The operation should be postponed if diagnosed:

  • inflammations caused by infections of the reproductive organs,
  • inflammations found in the uterus, ovaries, tubes or vagina,
  • infections not related to the reproductive system (influenza, ARVI, pneumonia),
  • strong pain,
  • unreasonable, at first glance, intense bleeding.

The exacerbation of certain chronic diseases of the cardiovascular system, liver or kidneys can be a serious obstacle to the operation. The aggravation of existing pathologies is considered individually and in each case the decision is made by the doctor.

Polyps cause excretions, but if they are excessive, removal will not solve the problem. Do not recommend it in the presence of adenomatous neoplasms during menopause. In this case, it is advised to amputate the uterus, since this type of polyp is a precursor of cancer and is fraught with recurrence. The expediency of the operation is determined by the gynecologist.

What equipment is used

Surgery is performed using a hysteroresectoscope (mono or bipolar). This is a complex electronic device consisting of several systems:

  • optics allows you to monitor and monitor the progress of the operation. This is possible because a microscopic video camera moves through the cavity and is connected to the monitor. It displays an image that helps the doctor as accurately as possible to examine the mucous membrane of the uterus, identify pathologies, monitor the process of eliminating polyps,
  • medical instrument - a set of electrosurgical electrodes, with the help of which the removal, dissection, grinding, cauterization, elimination of fragments of polyps from the walls of the uterus. There are special tips for laser, cryo and microwave surgery.

Methods of anesthesia with hysteroresectoscopy

Hysteroresectoscopy is a complete surgery that requires high-quality anesthesia. Only after the diagnosis of the disease and the scope of the expected work is determined by one of the types of anesthesia:

  • epidural (the patient is conscious, but there is no sensitivity of the lower limbs),
  • general - deep sleep caused by drugs
  • intravenous (provides for anesthesia within 1 hour),
  • endotracheal - drugs are injected into the respiratory system. This allows the patient to provide deep sleep. It is used in cases when long operation is required.

Dates

The procedure is prescribed in a planned manner or according to urgent indicators. Date planned is determined by taking into account female physiology. In the period of menstruation, endometrium rejection occurs, which resumes with time. In the follicular phase, the layer is thin, so the uterine cavity is perfectly visible. It occurs on days 7-9 from the onset of menstruation.

Emergency surgery is necessary if there are serious indicators that are determined by the attending physician and are appointed on any day of the cycle. Menstruation is a reason for delay, since excessive bleeding distorts information.

Training

Before the operation, measures are assigned to assess the condition and exclude the development of complications in the patient. The operation is carried out strictly on an empty stomach. The patient put an enema and eliminate urine.A list of diagnostic procedures that need to go through a week or 10 days before the operation is proposed and done:

  • general blood and urine analysis
  • vaginal smear to determine the level of purity,
  • blood test for clotting,
  • fluorography,
  • biochemistry analysis
  • blood per group and Rh factor
  • sugar analysis,
  • analysis for sexually transmitted diseases,
  • antibody and HIV test,
  • colposcopy
  • Ultrasound examination of the abdominal cavity and pelvic organs,
  • ECG.

The diagnostic results will help eliminate the likelihood of complications and determine the presence of contraindications for surgery. It will require strict fulfillment of medical prescriptions, providing for blocking of sex hormones with the help of hormonal preparations.

It is necessary to perform hygiene measures one week before the operation. In this regard, appointed vaginal candles for the rehabilitation of the genital tract. These are combined drugs that eliminate fungi, protozoa and bacteria.

How is the - stages

The procedure is simple for a woman, because the patient is subject to minimal risks. The doctor will need experience, knowledge and qualifications to work on complex equipment. As a rule, hysteroresectoscopy takes place within 20-40 minutes and involves the following steps:

  • the introduction of anesthesia
  • dilation of the cervical canal with liquid or gas
  • insertion of a flexible tube with a video camera into the uterine cavity,
  • insertion of the resectoscope - a tool for the separation of the polyp and healthy tissues,
  • with the help of a surgical loop or hook, the removed polyp is brought out,
  • liquid or gas is removed from the uterus,
  • the patient is sent to the ward
  • remote education needs histological analysis, in a special laboratory for the likely detection of malignant changes.

What to expect

Despite the seeming simplicity of the operation, devices that fall into the uterine cavity can cause minor damage. During the first day, blood discharge may occur after hysteroresectoscopy, which differ in quantity, depending on the purpose of the procedure. So with the diagnosis, the blood is less, and with the surgical intervention the excretions are more abundant and prolonged. After surgery, hemostatic drugs are prescribed.

When diagnosing the menstrual cycle is not disturbed, whereas during the operation the first day of the month is considered the date of its operation. To eliminate the negative effects and complications of hysteroscopy will require careful monitoring of the processes occurring in the body. If the discharge does not stop and does not cease to be intense, accompanied by pain, then you should consult a doctor. After surgery to remove a polyp, a temporary rest from sex is required. Attention should be paid to sensations during menstruation, the first after hysteroscopy.

Rehabilitation

The postoperative period with hysteroresectoscopy can be divided into two stages:

  • primary recovery involves the healing of wounds, injuries and cuts from surgical intervention and lasts about 3 weeks,
  • full normalization of the structure and function of damaged tissues is characterized by the restoration of the endometrium on the walls of the uterus and the full restoration of the reproductive function of a woman and lasts for 2-3 months.

Definition

What it is? Hysteroresectoscopy of the uterus is a method equally effective for both therapy and for diagnosing diseases in the uterus, including tumors, to which the polyp refers.

The method has several advantages, since it is not only a little invasive, but also safe, non-traumatic and modern. In addition, it allows for a single procedure to carry out both diagnosis and treatment. Most often prescribed for processes associated with endometrial hyperplasia — myomas, polyps, endometriosis, etc.

Such manipulation is carried out with the help of special equipment of the hysteroscope. It is placed in the uterine cavity through the vagina and the cervical canal. It is equipped with a camera, the image from which is displayed on the monitor of this device. Thus, after entering the remaining instruments, the doctor performs manipulations based on the received image.

Only the hysteroscope and the camera are used for diagnosis, when it is possible to make a diagnosis based on the results of a visual inspection. With the introduction of additional tools, the doctor may also perform manipulations.

Despite the minimal trauma, the intervention is still considered surgical, albeit minimal. It is carried out on an outpatient basis, but in conditions of a gynecological operating room and in sterility. Pain relief can be either general (anesthesia) or epidural (anesthesia). When choosing the method of anesthesia, a lot depends on the volume of work and the psychological mood of the patient, how nervous she is.

Usually, a woman can leave a medical institution within 3-4 hours after the intervention.

Equipment

A hysteroscope is a rather complicated apparatus that allows performing painstaking surgical interventions in very small areas with minimal trauma. Hysteroscopes are monopolar and bipolar, but regardless of this, they consist of two parts.

  • The optical system is represented by a miniature camera, the image of which is transmitted to the monitor of the device. And it is based on it, the doctor conducts all the necessary medical surgical procedures (or examination for diagnosis),
  • The second system is represented by surgical instruments. It is activated only if necessary for surgery. In the general case, during diagnostic examination, such equipment is not introduced into the uterine cavity at all.

Such equipment is considered functional and convenient, and the method itself is modern and safe.

Anesthesia

The anesthesia of several types is applied. It is selected on the basis of both the psychological mood of the patient and her contraindications. The following methods are used:

  1. Epidural anesthesia is injected into the lumbar region, the woman remains conscious, but the sensitivity of the lower body is completely lost,
  2. General anesthesia or anesthesia is given with the help of a mask, with this type of patient completely loses consciousness,
  3. Intravenous general anesthesia is similar in effect to the previous type, but is injected, into a vein (as it does not last long, it is suitable for short operations of less than 30 minutes in duration),
  4. Endotracheal anesthesia is characterized by the introduction of anesthetic substances into the respiratory system, with the result that the patient is placed in a medication sleep (suitable for long-term interventions).

Hysteroresectoscopy of the endometrial polyp lasts an average of 30-40 minutes, because masked anesthesia is not often given. Although it may be suitable for complex long-term operations with a large number or complex arrangement of polyps.

The patient is placed on the surgical table. Then anesthesia is administered. After that, there are several stages of intervention:

  1. Feeling the uterus, determining its position,
  2. Disinfection of the genital organs with antiseptic,
  3. Vaginal disclosure and antiseptic disinfection,
  4. The expansion of the cervical canal to 9 mm,
  5. Filling an organ cavity with sterile saline,
  6. Examination of the uterus,
  7. Removal of a neoplasm
  8. Removing from the cavity residues of tissue curette
  9. Coagulation of vessels in the intervention area,
  10. Removal from the body of saline and equipment,
  11. Disinfection of the vagina, cervical canal and external genitalia with an antiseptic.

After that, the patient comes out of anesthesia. Within several hours she is under the control of a specialist and on the same day is able to leave the medical facility.

Recovery and Rehabilitation

The rehabilitation period lasts one month. Throughout its length is necessary:

  1. On the first day after the intervention, apply ice to the abdomen every 8 hours for 20 minutes,
  2. Carefully observe personal hygiene.
  3. Restriction of sexual intercourse,
  4. Keep your feet warm, do not freeze,
  5. Avoid baths, saunas, tanning beds,
  6. Do not swim in the pools and open water,
  7. Avoid physical exertion
  8. Take a shower, but not a bath,
  9. Take hormonal and antibacterial agents prescribed by a doctor.

You can return to sedentary work after a week, to physical work - after 6 weeks.

Prices for manipulation vary depending on where it is held.

What to do after hysteroresectoscopy?

Gisteroresektoskopiya is a minimally invasive operation and is transferred fairly easily. The woman has no wound on the abdominal wall, the uterus wall is minimally injured and there is almost no bleeding. Patients are concerned only with moderate pain in the lower abdomen and in the sacrum. Yet the procedure is stressful for the body, therefore, to prevent complications, it is necessary to take preventive measures.
Restrictions apply for 4 weeks:

  • Apply cold on the uterus area for 20 minutes 3 times a day,
  • Follow the rules of personal hygiene. Shower 1 time a day, toilet genitals 2 times a day,
  • Refuse sexual intercourse,
  • Avoid hypothermia, especially the legs and pelvis,
  • Avoid overheating - saunas, baths,
  • Avoid physical exertion, weight lifting, gym visits,
  • Replace the bath with a shower
  • Avoid swimming in the pool and open water.
Medication after hysteroresectoscopy:
  • Oral contraceptives contribute to the normal functioning of the endometrium and the restoration of the menstrual cycle. Also OK protect a woman from unwanted pregnancy, until the restoration of the uterus is not fully completed.
  • Yarin, Regulon to replace the missing female hormones. They are applied as prescribed by the doctor for a course of 3 to 6 months.
  • Premarin 4 weeks. Estrogen preparations after the treatment of fibroids are prescribed for wound healing.
  • Antigonadotropins - Danazol and hypophysis releasing hormone agonists - Buserelin, Zoladex course 3-4 months. Recommended after curettage of the endometrium for the prevention of re-growth.
  • Antibiotics. They are used to prevent bacterial infections that may result from the ingress of bacteria into a postoperative wound in the uterus. The first dose of antibiotic is recommended to take 2 hours before surgery. This allows you to neutralize bacteria that enter the bloodstream during the procedure. Next, take a broad-spectrum antibiotic, preferably a group of cephalosporins: Ceftriaxone, Cefuroxime, Cephalexim. The course is 5-7 days.
  • Nonsteroidalanti-inflammatoryfacilities They have analgesic and anti-inflammatory effects. Recommended: Meloxicam, Diclofenac, Ibuprofen, Nimesulide 1 tablet no more than 3 times a day. Starting from the 3rd day, you need to reduce the dose to 1 tablet at night.
  • Localanti-inflammatoryfacilities. Designed to destroy pathogens in the vagina. Terzhinan, Betadine at night 5 days.
  • Multivitamins to restore hormonal balance, speedy tissue regeneration and immunity. It is necessary to choose complexes containing vitamins A, E and group B.
A woman engaged in intellectual work can return to work in 7-10 days. Return to the usual physical activity and sports is possible after 6 weeks.

Blood and blood discharge from the genital tract normally lasts 2-4 weeks. If during this period the volume of discharge has increased dramatically (you have to change the gasket every 1-2 hours), then you should consult a doctor. Medical attention is also required if the following symptoms appear:

  • Temperature rise above 37.5,
  • Foul smelling
  • Blood clots
  • Sharp pain in the lower abdomen, extending to the genitals and lower back,
  • Sharp weakness.

What is endometrial hysteroresectoscopy?

Endometrial hysteroresectoscopy or endometrial ablation is a minimally invasive surgery, during which the surgeon performs the destruction of the functional and basal layers of the endometrium, as well as the underlying muscle layer. The procedure is performed using endoscopic equipment, which is inserted through the vagina and cervical canal.

Endometrial hysteroresectoscopy makes it possible to cure endometrial hyperplasia, various uterine bleeding and foci of endometriosis inside the uterine muscle layer.

The operation takes place under visual control - the image of what is happening inside the uterus is displayed on the screen, which allows the surgeon to avoid mistakes. During ablation, bleeding is minimized due to coagulation and sealing of the blood vessels. Electric surgical instruments, a laser and a radonozh prevent the development of postoperative infections.

Endometrial ablation is indicated for women who do not plan to have children.Since the destruction of the endometrium often leads to the absence of menstruation and infertility.

Why produce hysteroresectoscopy for uterine polyps?

Hysteroresectoscopy for uterine polyps allows you to identify and remove the smallest formations. Thereby, the risk of endometrial re-polyposis is significantly reduced.

During the procedure, the doctor examines the surface of the endometrium. Large polyps on the legs are cut using a surgical loop or hook. Small polyps that do not rise above the surface of the mucous are removed with a laser or with a small portion of the mucosa with a loop electrode. With numerous polyps, the doctor performs curettage of the endometrium.

To prevent the recurrence of a polyp, the place from which it was removed is burned with a laser or liquid nitrogen (cryodestruction).

Why produce hysteroresectoscopy for uterine myoma?

Hysteroresectoscopy for uterine myoma allows you to estimate the size and location of myoma node and remove it in one procedure. The surgeon gains access to the tumor through the genital tract. There is no need to cut the abdominal wall and the uterus itself, which allows the woman to recover much faster after the operation.
Not all fibroids can be removed with the help of hysteroresectoscopy. The site must be less than 5 cm and located under the endometrium in the upper layer of the myometrium.

In the event that the tumor bulges into the uterus, the node can be removed with a surgical loop. By removing the chips, the surgeon removes the myoma from the uterine wall, layer by layer.

Sometimes after 2-3 months, repeated hysteroresectoscopy may be required to control the treatment. If for the first time the tumor was not removed completely, then during this period the wall of the uterus will level out, pushing the remains of the fibroids into the uterine cavity. This will enable the surgeon to completely remove the tumor without damaging the organ wall.

What is the difference from hysteroscopy?

For the common man, the abracadabra of the terms sometimes looks frightening. In fact, based on the translation from Latin, hysteroscopy should be understood as an examination of the uterus, that is, a diagnostic procedure.

Hysteroresectoscopy involves the removal of a certain formation or part of the patient’s organ under visual control. Another thing is that sometimes the first shorter term is simply used for convenience.

And after the discovery of a small polyp, they can immediately resort to removal, which automatically translates the procedure into a surgical operation. Therefore, in relation to such entities it is quite fair to refer both terms.

Hysteroresectoscopy is a longer and more complex exercise that was originally planned to remove a polyp inside the uterus. Therefore, it requires more serious training.

Attention! Often under hysteroscopy imply the diagnosis and elimination of minor elements in the outpatient setting.

Features of the operation

The only way to get rid of such a formation in the uterine cavity is to remove it surgically. Drug treatment has very low efficacy, which, coupled with the risk of oncological degeneration, forces us to resort to surgery.

But this does not mean that the presence of a polyp on the endometrial surface automatically directs the patient to hysteroresectoscopy.

Indications for removal:

  • Pronounced symptoms in the form of intermenstrual and contact bleeding, as well as an increase in the volume and duration of menstruation,
  • Sites of polyposis in the uterus with a diameter of more than 4-5 cm
  • Education size from 10 mm,
  • Rapid growth
  • Patient planning for pregnancy, including IVF,
  • If a histological analysis is performed, then the glandular-fibrous, placental, fibrous, adenomatous type of polyp.

Expert Opinion Olga Y. Kovalchuk Vrach, expert In most cases, gynecologists offer to eliminate education, without waiting for symptoms and consequences, to be safe.

This is justified by the fact that when removing small growths the risk of complications is much lower and the recovery is more rapid. Sometimes small polyps are removed during diagnostic hysteroscopy, that is, when detected.

Hysteroresectoscopy prescribed for 1-3 days after menstruation. This is due to the fact that the uterus has the least amount of endometrium, which came out with menstruation and did not have time to grow again. Otherwise, the loose intrauterine layer will close small polyps and prevent the manipulation of surgical instruments.

Attention! In emergency cases, the operation is carried out at any time, except for menstruation.

The sequence of actions for hysteroresectoscopy:

  1. Prepare the patient: placed in a chair, treated external genitals with antiseptics, anesthesia is served.
  2. On the neck set expander.
  3. A hollow tube is inserted through which all other equipment will be supplied.
  4. The uterus is filled with fluid. For this purpose, special solutions are used that allow electrodes to work. The peculiarity of the process is to maintain a constant pressure, therefore, circulation with a certain pressure is ensured, the volume of lost fluid is taken into account. As a result of such actions, the folds of the uterus are cracked, providing space for manipulation and visibility. Previously used gas, but the risk of embolism, and, consequently, death, forced to abandon this method. When hysteroscopy use sodium chloride, which is unacceptable to remove the electrocoagulator.
  5. With the help of a video camera examine the endometrium of the uterus in a clockwise direction. On the detected suspicious areas make tissue scrapings for histology.
  6. The polyp is removed using a laser, radio wave scalpel or electrical loop. Often use the method of classical polypectomy, when the formation of unscrewed, cleaned the base and cauterize it with a point electrode.
  7. With the flow of circulating fluid, the polyp flows out, and it is sent for histology.
  8. Empty the uterus from the instruments and rinse with antiseptic solutions.
  9. Sometimes a cervical canal biopsy is done if necessary.
  10. The patient is taken to the intensive care unit until awakening. It is monitored by an anesthesiologist.

After surgery, hysteroresectoscopy rehabilitation continues for six months. In this period of time, it is also possible to distinguish two stages of recovery congruent with the postoperative periods: early and late.

In the early period, the woman has bleeding, pulling pain in the lower abdomen. Meanwhile, early regenerative processes are carried out in the uterine cavity and the cervical canal: the healing of microdamages, the partial restoration of the mucous membrane of the uterus and the mucous membrane of the cervical canal.

Full scarring of the tissues of the damaged epithelium, as a consequence of hysteroresectoscopy, occurs by the end of the third - fourth week. As a result, the woman recovers her own menstrual cycle and begins menstruation.

The late recovery period is characterized by a complete functional and structural restoration of the endometrium and cervical canal, while the woman has a clear yellow color for some time. These secretions are evidence of the healing process of the cervical canal.

During this period of rehabilitation in order to prevent complications and speedy recovery, the patient is advised on which lifestyle to lead.

Since this is a full-fledged operation - hysteroresectoscopy, the postoperative period presupposes the conditions for its management, primarily from the patient.

In these first four weeks, you should stop using tampons and refrain from sexual intercourse in order to avoid infectious complications such as endometritis.

Indications for

Resectoscopy is assigned in the following cases:

  • large size of the formation, overlapping the entrance to the uterine cavity,
  • intense symptomatic picture of the disease,
  • the presence of heavy uterine bleeding,
  • lack of positive dynamics from the conducted drug therapy,
  • high risks of polyp degeneration into the formation of a malignant character.

Removal of a polyp in the uterus using hysteroresectoscopy is a more complex surgical procedure than conventional curettage. Therefore, it requires careful preparation to minimize the risks of adverse effects after the procedure.

Features of preparation

Before performing hysteroresectoscopy, a woman needs to undergo a thorough medical examination to identify possible contraindications to the procedure. Diagnosis of the patient's condition includes the delivery of a number of laboratory tests and the passage of instrumental diagnostic methods. These include the following:

  • blood test - general clinical and detailed
  • sugar analysis, hormones,
  • blood chemistry,
  • colposcopy
  • ultrasound examination of organs located in the pelvis,
  • electrocardiogram.

Preparation for surgery requires careful vaginal hygiene. For this purpose, within 7 days before the operation, it is necessary to use vaginal suppositories, which include components that destroy pathogens, fungi and pathogenic bacteria.

Tools used

The technique of removal of polyps - hysteroresectoscopy, is carried out using a special optical device hysteroscope. Removal tools are electrical electrodes that dissect a polyp and burn blood vessels.

Course of operation

The duration of the procedure is from half an hour to 90 minutes. The patient is given anesthesia. For the subsequent removal of a polyp of the cervical canal, a liquid or gas is introduced through a special device, this helps to widen the passage. A hysteroscope is inserted through the vagina, then a resectoscope is inserted - a device with which the polyp will be removed by detaching it from the healthy structures of the uterine cavity.

To scrape polypous formation, a technique is used as in curettage - a benign growth is captured with a special hook and pulled out. At the end of the procedure, the expanding gas or liquid is removed from the uterus.

The removed polyp is poisoned to a laboratory for histological examination, which is necessary to determine the nature of the formation.

Advantages of the technique

Hysteroresectoscopy is the primary treatment for benign polyps in the uterine cavity. This is the least traumatic type of surgery, with minimal risks of complications.

The advantage of the method is that after the removal of the polyp, the location of its localization is cauterized. This means that the likelihood of a relapse, although it remains, but in percentage terms, it is negligible in comparison with other methods of curettage.

For the operation there is no need to make a cavity incision, due to which the rehabilitation period is significantly shortened. Hysteroresectoscopy is preferred because after the operation there are no risks of complications characteristic of other methods of removing the pathology:

  • there is no risk of scarring tissue and soft structures,
  • there is no pain symptom after surgical manipulation,
  • the procedure does not affect the reproductive function of women and the possibility of conception,
  • the probability of developing infertility due to trauma to the organs of the reproductive system is absent.

Hysteroresectoscopy is a gentle and safe method, one of the few techniques for removing polyps in the uterine cavity, which can be used in non-deliverable women. Pain and other discomfort during the operation are absent.

Possible complications

Although hysteroresectoscopy is the safest surgical method, the likelihood of complications, although small, is present. During rehabilitation after the intervention, the following negative effects may occur:

  • infection infection - this complication may be caused by insufficient treatment of a surgical instrument, the lack of proper preparation for surgery, when a woman does not use vaginal suppositories for rehabilitation, or does not observe careful hygiene during the rehabilitation period,
  • injury to the tissues of internal organslocated near the uterine cavity - this complication occurs due to the careless work of the doctor,
  • opening bleeding - may be associated with the individual characteristics of the organism, if the operation was carried out in the presence of contraindications for the patient.

Despite the likelihood of these complications, resecting a uterine polyp is considered the safest method of treatment of uterine polyposis. It is possible to prevent the development of complications, for this it is necessary to carefully follow the doctor’s instructions during preparation for and after the operation, and also to entrust the removal of a polyp to a doctor with work experience.

If we analyze the reviews of women who have gone through this procedure, it becomes obvious that hysteroresectoscopy is tolerated easily, and serious consequences after it occur in extremely rare cases.

Angela, 31 years old

When they found a polyp on my endometrium, I didn’t waste time with medication, but I immediately decided to remove it. The operation was normal, the polyp would not be very large, but not small, the operation was performed under general anesthesia. She came to in the ward, nothing hurt. 2-3 days after the removal of a little cover, but just a little more like a daub. She felt good, there were no complications. So my opinion - it is better to delete immediately. The only minus of hysteroresectoscopy is when the doctor said after 3 weeks that you can have sex, for the first time it was a bit sick.

Maria, 37 years old

The worst thing I can say about hysteroresectoscopy is the moment of recovery from anesthesia. Either so my body reacted, or the anesthesiologist went too far with the dose, but the sensations were not very good. I felt sick and vomited, my head ached wildly. And the operation itself went well, there were no complications during recovery.

Ksenia, 28 years old

When I heard my diagnosis of polyposis, I panicked, but the doctor said that everything would be fine after the operation. Operation was terribly afraid, so nervous, and in vain. It lasted about 30 minutes, not more. She went away from the anesthesia easily, then there was a few days later a light smear with blood and that was all. A little stomach, but the doctor explained that this is a reduction in the uterus and is quite normal. Already a year has passed after the operation, routine inspection shows that everything is clean, there is no recurrence.

What is a hysteroresectoscopy?

Hysteroresectoscopy of the endometrial polyp, what is it? This is the surgical removal of polyps from the uterus by means of instruments and instruments equipped with the latest technical innovations.

The device for conducting hysteroresectoscopy has a complex structure.

The main equipment systems are:

  • Optical equipment - micro video camera for displaying images on a computer monitor,
  • Surgical instruments with electrodes for excision, cutting, dissection and cauterization of polyposis foci (there are nozzles for cryo, microwave and laser surgery).

The main advantage of hysteroresectoscopy is the possibility of further histological examination of the removed sample.

Thanks to technical equipment, the surgeon constantly monitors the ongoing process on the computer monitor. Optics virtually eliminates the risk of leaving fragments in the uterus, trauma.

Hysteroresectoscopy is a modern method of removing uterine polyps. After manipulation, the risk of recurrence is reduced by 35%, and rehabilitation is reduced to 14 days.

Indications and contraindications

Indications for surgery are the following symptoms and conditions:

  • The spread of growths in the uterus:
  • Big sizes of neoplasms,
  • Uterine bleeding,
  • The ineffectiveness of drug treatment,
  • Potential risks of cancer cell transformation (there is a suspicion of an endometrial adenomatous polyp).

Another indication for the removal of endometrial polyps is miscarriage or lack of pregnancy. Polyps violate the morphological structure of the endometrium, lead to the rejection of the ovum, cause uterine tumors.

Limitations to

Considering that hysteroresectoscopy is much more complicated than traditional curettage of the uterus, bases are required for manipulation. All contraindications are relative and can be reviewed by a doctor individually.

General restrictions are:

  • active inflammation in the organs of the genitourinary system,
  • infections of female reproductive organs,
  • respiratory diseases, infections, acute inflammations of other localization,
  • bleeding
  • exacerbation of chronic pathologies of the liver, heart, kidneys.

Removal of polyps in the uterus is not performed with adenomatosis during menopause. Older women with multiple polyps in the uterus (including the risks of malignancy) are removed by the uterus along with the appendages.

How is hysteroresectoscopy of the uterus and cervix performed?

Hysteroresectoscopy is carried out by means of a hysteroscope - endoscopic equipment with a tip in the form of a camera for better visualization of the uterine cavity. At the same time, a surgical instrument is supplied through the hysteroscope, with the help of which the necessary manipulations are carried out.

After removal of the polyp, the stroma is necessarily scraped - the base of the growth for maximum cleansing of the uterus from the remnants of the removed material. The method has many advantages over other surgical methods. The price of hysteroresectoscopy in metropolitan clinics starts from 20,000 rubles.

Preparatory stage

Despite the minimally invasive hysteroresectoscopy, preparation for manipulation is always carried out in full.

A few weeks before surgery, a woman undergoes a series of examinations.:

  • gynecological examination,
  • colposcopy
  • ultrasound of the reproductive organs (when doing an ultrasound with a polyp in the uterus is more detailed here),
  • ECG (sometimes ultrasound of the heart if necessary),
  • fluorography.

With a complicated medical history, women must perform the following laboratory tests.:

  • urine tests (sterility, total, according to Nechyporenko),
  • blood test (biochemical developed, general, on electrolytes, on the work of functions and liver),
  • blood test for HIV, viral hepatitis,
  • scraping the vaginal microflora to determine sterility (the operation is carried out only when the sterility of the first degree).

In the presence of inflammation, an obligatory antibacterial treatment is performed, then tests are again performed and, with negative results, the date of surgery is prescribed.

On the eve of a hysteroresectoscopy, the patient is shown to clean the intestines by means of an enema or medication (Fortrans, Picoprep, Lavacol).

What is hysteroscopy

Hysteroscopy and hysteroresectoscopy are used in practice as equivalent concepts, but if you delve into the essence of the terms, the differences are definitely there. Hysteroscopy means only the examination of the uterus, that is, it has diagnostic value.

With hysteroresectoscopy, in addition to visualization of the endometrium and nearby structures, the removal of pathological structures, polyps, myomas, and areas of endometrial hyperplasia. To do this, the hysteroscope device must be able to connect special conductors подключ scissors, scalpels, etc. to it.

Advantages over other methods

Hysteroresectoscopy is a modern method for the diagnosis and treatment of many gynecological diseases, which helps to conduct quite complex manipulations with minimal consequences for the body. The advantages of the operation are as follows:

  • everything that is happening can be seen on the monitor, while with the usual curettage of the uterus, the doctor will do everything blindly, guided only by his own feelings,
  • hysteroresectoscopy allows you to remove polyps, submucous fibroids, without making a single incision on the skin,
  • short recovery period
  • targeted removal of formations, while there is an extremely low probability that the “leg” of the polyp will remain and thus there will be a rapid relapse of the pathology,
  • the probability of complications is minimal if all the recommendations of the doctor are followed,
  • visual inspection allows not to miss a single pathological formation, even the smallest size and insidious location, which increases the diagnostic value of the procedure.

And here more about the consequences of hysteroscopy when removing the endometrial polyp.

Indications for the procedure

Hysteroresectoscopy is performed in the following cases:

  • ultrasound or other signs indicating endometrial problems - polypous growths, submucous myoma, synechiae, abnormal growth of the endometrium,
  • unclear cause of bleeding from the genital tract,
  • in violation of the menstrual cycle and the lack of response to conservative treatment,
  • inability to get pregnant for an unclear reason
  • suspicion of the abnormal structure of the uterus,
  • if complications arise after childbirth.

A, B - uterine polyp

Ideally, hysteroscopy can replace all diagnostic curettage, as it has a higher information content. However, not all medical institutions are equipped with the necessary devices, so hysteroscopy is performed, as a rule, for certain indications.

How to do hysteroresectoscopy

Gisteroresektoskopiya performed in a hospital. But usually hospitalization takes no more than three to five days. Often with the recommendations of a woman can write out the next day, if the manipulation was without complications.

A woman arrives at the hospital, having a list of examinations on her hands.She talks with her doctor and then with the anesthesiologist, since hysteroresectoscopy is performed under intravenous anesthesia. On the day of admission or the next, the manipulation itself is carried out in the surgical building. A woman should not eat, be with an empty bladder and empty bowels.

Two types of hysteroresectoscopy are possible ̶ with filling the uterus with carbon dioxide or liquid.

Hysteroresectoscopy with uterine cavity filling

If gas hysteroscopy is performed, carbon dioxide is used as the medium, which is launched into the uterine cavity using a special hysteroflator apparatus. It is important to monitor the rate of incoming gas, pressure in the uterus, as excessive pressure can lead to emboli and serious, even fatal complications. Since all these parameters are quite variable and difficult to maintain, gas hysteroscopy is rarely used.

Liquid hysteroscopy is less safe, therefore, more popular. To expand the uterus and improve visualization, various solutions are used: physiological solutions, Ringer's solution, glucose or glycine.

Removal of uterine polyp

The sequence of actions is as follows:

  • a woman is laid on a gynecological chair. She is catheterized by a vein in the elbow,
  • the anesthesiologist performs intravenous anesthesia: a drug is injected, after which the patient falls asleep, does not feel pain,
  • the cervical canal is dilated with the help of Gegar extenders, it helps to control the fluid pressure in the uterus, as well as to enter other instruments without difficulty
  • then the gynecologist takes the hysteroscope, inserts it sequentially into the pre-treated vagina, then into the cervical canal and the uterine cavity. At this time on the monitor, which is connected to the camera inside the hysteroscope, you can see everything that happens. The doctor assesses the clinical situation by observing this picture
  • In order to visualize everything that happens inside, in addition to the hysteroscope, a light guide and a catheter are introduced into the uterine cavity, through which sterile saline (or, more rarely, a solution on glucose) comes in. The uterus cavity swells a little, which allows you to perform some kind of manipulation,
  • When pathology is detected, the doctor through the hysteroscope places various manipulators in the uterus and performs all the necessary: ​​removes polyps, submucous fibroids, disconnects adhesions, etc.,
  • at the end of the procedure, the hysteroscope is removed, and the woman is scraped all the walls of the uterus with a set of curettes to remove the functional layer of the endometrium. This is necessary for his subsequent research, as well as to reduce the likelihood of various violations of the cycle at first. With gentle hysteroscopy, this manipulation may not be carried out.

After the end of the procedure, the woman wakes up. She is transferred to the ward in the gynecological department. Within two hours, she is more frequently monitored by doctors and nurses so that complications can be suspected in time. After two hours of rest, you can try to get up. But you need to do this carefully, as dizziness may occur, you can fall.

See in this video about the indications and the order of hysteroresectoscopy:

Postoperative period

Immediately after surgery, the woman will mark the following:

  • pain in the lower abdomen pulling character due to manipulation inside the uterus,
  • bleeding may be thin or abundant, in the latter case, it is necessary to exclude uterine bleeding,
  • general weakness, headaches are also possible.

Within two to four hours a woman comes to her senses, can eat, stand up, serve herself.

After a hysteroresectoscopy, the following manipulations are possible:

  • allergic reactions to drugs used for anesthesia, antibiotics, painkillers, etc.
  • bleeding which requires symptomatic treatment, extremely rarely ̶ surgery,
  • infectious complications are possible, since chronic foci may worsen, and new ones may arise if the doctor's prescriptions and rules of sterility are not observed, which happens very rarely,
  • Synechiae ̶ adhesions in the cervical canal and uterine cavity, which can prevent the outflow of menstrual contents and cause infertility, may occur.

See in this video about the complications after hysteroscopy:

What are the possible results?

All the material that doctors receive for hysteroscopy is sent for histological examination. According to the results of his lined up further tactics of treatment of women. The structure of the endometrium obtained during the study is studied separately. In the results there is one of the following:

  • endometrium in proliferation. This is a result that should be obtained in the first phase of the cycle, it indicates a normal hormonal level in a woman,
  • endometrial secretion. It is thickening, parts of the tissues are preparing for rejection. The vessels are fragile and easily injured,
  • menstrual tissue. At the same time, in the histological specimen there are scraps of the endometrium, which are of little informative,
  • endometrial postmenopausal, atrophic. The endometrium is thin, pale, and the material is scarce.

In addition, various pathological growths can be detected, namely:

  • polyps
  • areas of hyperplasia,
  • foreign bodies, for example, intrauterine device, synechiae.

During hysteroscopy, the doctor makes a conclusion about the following structures:

  • varicose veins of the pelvis,
  • rupture of blood vessels
  • abnormalities of the structure of the uterus ̶ septum, saddle,
  • areas with dystrophy, necrosis, inflammation,
  • petechial hemorrhages, which is characteristic of diabetes.

And here more about what can cause intermittent menstruation.

Hysteroscopy is a modern alternative to curettage of the uterus. It allows you not only to accurately determine the pathological processes, but also to remove them, and then histological examination and to establish the diagnosis accurately. The procedure is safe, subject to all contraindications. The hospitalization period is minimum ̶ from one day to three to five days.

What is a uterine polyp?

Pathological formations that rise above the surface of the endometrium (mucous membrane) of the smooth muscle of the sexual organ in which the fetus is bearing, in medicine are called uterine polyps. They have a different configuration, texture, narrow or wide base, smooth, fleecy or lobed surface. The sizes of neoplasias can be different: from sesame seeds to a golf ball. Polyps of the uterus mucosa are single and multiple. The term "polyposis" is used if the number of neoplasias is more than twenty.

According to its structure, a polyp consists of three components. The surface of the formation is covered with epithelial tissue, the leg consists of a fibrous base and thick vessels. Neoplasias can ulcerate, undergo infection, cellular metaplasia, necrotizing.

Polyps are classified most often by morphological structure. There are the following types of pathological formations:

  • Glandular polyps consist of endometrial tissue containing glands.
  • The glandular fibrosis is represented by a mucous layer lining the cavity of the internal reproductive organ and connective tissue (stroma).
  • Fibrous formed by dense connective tissue.
  • Adenomatous polyps are represented by glandular epithelium and are prone to transition to endometrial cancer.

Endometrial polyps rarely germinate beyond the uterus. They are detected both in young girls and in women of menopausal age. In gynecology, the condition is regarded as precancerous, and in most cases an operation is prescribed to remove an endometrial polyp.

Treatment methods

As the statistics show, abnormal formations of the uterus are most often formed on the background of a disorder of the hormonal function of the ovaries and an increase in estrogen levels. But hormone therapy as a primary method of treatment is rarely used.

The best method of treatment is hysteroscopy - resection of a uterine polyp using endoscopic equipment. Formations on the leg are “twisted off”, and the bed is cauterized by a cryogenic method or by electrocoagulation. Eliminated neoplasias are further sent for histological examination, the results of which determine the most effective treatment tactics.

Removal of the fibrous endometrial polyp is performed by polyurethomy with curettage (curettage) of the uterus. When resection of glandular pathological formations requires additional hormone therapy. Radical therapy methods (supravaginal amputation, panhysterectomy) are used to treat adenomatous uterine polyps.

Benefits of Hysteroscopy

The use of modern equipment during the operation improves its quality and reduces the risk of complications. In surgery, such treatment methods are quite common. The terminology of the operation, as a rule, comes from the name of the equipment with which it is performed.

Hysteroscopy of the endometrial polyp is the removal of focal hyperplasia of the uterus using a special endoscopic apparatus in the form of a tube with a fiber-optic system and illumination. Endovision surgery, i.e. it does not provide for opening of the cavity. But this is not the only plus hysteroscopy.

  • Surgical manipulation does not require special preparatory measures.
  • Resection of focal hyperplasia of the uterus, performed with the help of endoscopic equipment, is less traumatic than classical curettage.
  • The negative effects of hysteroscopy (removal of the endometrial polyp) are rarely detected.
  • Short rehabilitation period.
  • Due to visual inspection, the likelihood of incomplete removal of a polyp is minimal.
  • After hysteroresectoscopy, the neoplasia bed is cauterized, which reduces the number of relapses.
  • If the manipulation is carried out using a hard hysteroscope, it is allowed to use different channels for irrigation (long-term irrigation of the cavity) and aspiration. The operation using such equipment has a lower cost.

Removal of endometrial polyp (hysteroresectoscopy): indications

The operation, although minimally invasive, is still a surgical intervention. The decision to conduct it is made after numerous surveys. Pathologies, which are indications for hysteroresectoscopy, can only be established by a doctor. These include:

  • Multiple endometrial hyperplasia that are common (uterine polyposis).
  • Any single polyps that are asymptomatic.
  • Endometrial neoplasia of any size, accompanied by regular uterine bleeding.
  • The development of anemia caused by frequent blood secretion from the genitals.
  • Excessive vaginal discharge, accompanied by severe pain.
  • Violation of the menstrual cycle.
  • Inefficiency or complications after curettage.
  • Adenomatous (glandular) polyps. Such tumors have a high chance of rebirth from a benign to a malignant tumor.
  • The threat of spontaneous abortion.
  • Hormonal disbalance. Violations of the hormonal background can trigger the growth of tumors.

Removal of the endometrial polyp in the uterus during pregnancy planning is carried out to create good conditions for the implantation of the embryo.

Technique of performing hysteroscopy

Surgical manipulation is performed using a mono-or bipolar hysteroresectoscope. It is a sophisticated instrument consisting of optics, allowing visual control of the process and surgical device.

Removal of the endometrial polyp (hysteroscopy) is performed under intravenous anesthesia. The external genitals, vagina and cervix are treated with an antiseptic solution. The lower segment of the uterus is fixed with bullet forceps. With the help of a fallopian umbrella examine the depth, position and condition of the uterus. Perform dilation of the cervical canal for the free introduction of an endoscopic instrument. The uterus is filled with gas or liquid. This provides ample space for tooling and visual control of the operation.

A resectoscope and a video camera are introduced into the uterine cavity, which transfers the image to the monitor screen. The doctor examines the uterus, evaluates the condition of the mucous membrane (endometrium), determines the location of pathological tumors. Polyps resection is performed by an endoscopist.

Single polyps with a well-marked leg are removed using endosurgical scissors or a special loop. Loop electrode is often used to eliminate large neoplasias located near the wall of the uterus or having a fibrous structure. To prevent bleeding and reduce the likelihood of recurrence of the disease, the bed of the formations are cauterized.

After removing the endometrial polyp, an expert removes the entire instrument from the uterus and removes gas or liquid. The average duration of the operation is 20-40 minutes. With multiple polyps, technical difficulties last longer. The duration of anesthesia may also be increased.

After operation

After surgery, the patient is transferred to the ward. If the removal of a polyp of the endometrium has passed without complications, the patient is allowed to go home within a few hours after she moves away from the anesthesia.

In the postoperative period, a course of antibiotics is prescribed for the prevention of infectious diseases. In the early days, a woman may experience aching painful sensations. To eliminate them, the doctor prescribes pain relievers.

After surgery, the woman is normally observed poor spotting. Usually they pass on their own within 3-5 days.

The removed polyps are sent for histological examination. The results are usually ready in a week, at the same time the patient needs to visit a gynecologist to determine the subsequent therapeutic tactics. After removal of the glandular polyp of the endometrium, hormone treatment is prescribed without fail.

Recovery period

The rehabilitation period for each woman passes in different ways. It all depends on the severity of the pathology, the presence of comorbidities, the age of the patient, the quality of the operation.

In the first few days a slight increase in temperature is possible. The healing process can be accompanied by rare spasmodic pains. Their duration depends on the characteristics of the organism. In order for the recovery period after the removal of the endometrial polyp (hysteroscopy) to proceed smoothly, certain recommendations should be followed.

  • Baths should not be taken for 2 weeks after surgery.
  • Should abandon intensive warming.
  • Temporarily cancel or transfer some physiotherapeutic procedures (electrophoresis, laser therapy).
  • It is forbidden to swim in the pools and ponds.
  • Eliminate physical activity and sports.
  • You can not douche and apply vaginal suppositories without the appointment of a gynecologist.
  • It is necessary to refuse use of vaginal tampons.
  • For 3-4 weeks it is necessary to abstain from sex.

Treatment after removal of the endometrial polyp

In some cases, the doctor may prescribe additional drug therapy. Drugs are not always prescribed, it all depends on the type of tumor. In general, treatment is prescribed after removal of the endometrial glandular polyp. This type of neoplasia is most often observed at a young age. Hormone therapy is aimed at the full restoration of the reproductive function of women.

Selection of hormonal contraception carries a doctor. The combination of “Ethinyl estradiol” (estrogen hormone) and “Dienogest” (suppresses the trophic effect of estrogens) or “Desogestrel” is considered the most effective. The course of treatment can be from 3 to 6 months.

Also for the normalization of hormonal processes establish intrauterine devices "Mirena" or "Dzhaydes". The active substance of the contraceptive levonorgestrel, which causes a decrease in the endometrial implant function. Spiral set for 5 years.

If the histological examination revealed additional pathologies, treatment will be prescribed depending on the type of disease. In case of detection of malignant cells in polyps, additional complex examination will be prescribed and, most likely, more radical treatment will be carried out.

Most women are satisfied with how the surgery went. They note the convenience of the fact that in a few hours after surgery you can go home.

Most often, the patient, in a review of the consequences of hysteroscopy (removal of the endometrial polyp), writes about a long-term bleeding that opened a few days after resection. But after taking the medicine, everything is quickly restored. But in general, women respond positively, especially those who were prescribed conservative treatment, which proved ineffective.

Многие пациентки отмечают высокую стоимость операции, но сами же говорят, что конечный результат того стоит. После гистероскопии врачи часто назначают курс оральных контрацептивов. Women who have not previously used such drugs, note the presence of side effects and too long a course.

Pregnancy after hysteroscopy

Infertility after the removal of the pathological neoplasm of the endometrium of the uterus develops only if the operation was performed with a severe degree of the disease or if the woman had problems with conceiving or carrying a pregnancy.

In the responses about hysteroscopy (removal of the endometrial polyp), young women say that they got pregnant very quickly, and the whole period went away normally. Based on the observations, doctors recommend planning conception after a 3-4 menstrual cycle. It is believed that by this time the mucous membrane is fully restored, which reduces the risk of miscarriage.

Hysteroscopy is a modern and effective method for the treatment of endometrial polyps. But a successful outcome depends not only on the surgeon's professionalism, but also on timely recourse for help and implementation of all postoperative recommendations.

Description of the procedure

Hysteroresectoscopy of the endometrial polyp. What is it and why is the procedure so much in demand? Immediately reassure those who have this procedure. It is quite simple.

You can even say that this is a very simplified version of the usual operation. But if a standard surgical intervention could provoke a number of negative processes in a woman’s body, then hysteroresectoscopy reduces all these risks to a minimum.

The advantage of the procedure is not only simplicity. Many patients note that recovery takes much less time. And this is true because the procedure significantly reduces the time required for the full recovery of the body.

Although we have already mentioned the simplicity of the operation more than once, some clarification should be made. This simplicity is conditional, because only patients feel it.

But only a highly qualified doctor with extensive experience can perform this procedure correctly. Since, in order to perform hysteroresectoscopy, it is necessary to use modern equipment.

By removing the endometrial polyp hysteroscopy, the doctor uses a special device. At the end of the instrument there is a very small camera.

It allows the doctor to see exactly where the polyp is located. Focusing on the resulting image, the doctor gradually removes polyps.

At the same time he uses a large arsenal of devices. With their help, the doctor not only removes the polyp, but also produces cauterization.

To make it more clear to you exactly how the procedure takes place, we will write it down step by step.

  1. The first stage includes preparatory measures. The patient is given anesthesia, the dose of which is calculated by a specialist. It is noteworthy that anesthesia is designed for a short time. And so it is much easier to get out of it. Consequently, the risk of complications due to anesthesia is reduced.
  2. A special fluid is introduced into the space of the uterus. In some cases, even use gas. It is administered through the cervical canal (more on a polyp of the cervical canal). Such a manipulation is necessary in order to enable the doctor to differentiate healthy and pathological tissues.
  3. Next to the uterus is placed a camera. It is fixed on a flexible and very thin tube, therefore it does not cause any discomfort. As soon as the doctor connects the camera, he will see on the monitor an image of the working field and will be able to assess the situation, as well as see the entire mucosa.
  4. After that, the doctor introduces a resectoscope. It is with the help of this tool and the excision of the affected tissues. It should be noted that this tool allows you to make the separation of affected tissues quickly and clearly.
  5. To remove a polyp, the doctor uses a nozzle with a loop or hook. As soon as a polyp is removed, it will burn the bed.

Hysteroscopy of the endometrial polyp, as you understand, is divided into many stages. And at the last stage of the operation, the doctor removes fluid from the vagina. Immediately after this, the patient goes to her room.

She is accompanied by an anesthesiologist, who is responsible for ensuring that the patient normally comes out of anesthesia. It should be noted that after removal of the polyp, it must be sent for a histological examination, which is performed in a special laboratory.

This is necessary in order to find out if the formation was malignant.

Advantages of hysteroresectoscopy

Today, this method is the most progressive.

Indeed, compared with other methods, it has several advantages:

  • During the procedure, the doctor is able to correctly assess the condition of the endometrium. This is possible thanks to the camera mounted on the instrument. That is why the doctor without any problems separates the damaged tissue from healthy tissue. And, as a result, the risk of re-occurrence of polyps is minimized,
  • during the procedure, the doctor performs and cauterizes the polyp bed. That is, it is not necessary to perform re-manipulation in order to burn the bed. This means that the risk of infection of tissues that are located near the place of removal, is zero,
  • even a large number of polyps can be removed without harming the mucous membrane. It’s not possible to do this during a standard operation.
  • Hysteroresectoscopy makes it possible to completely keep other layers of the uterus intact,
  • for the manipulation does not require cutting the abdominal wall,
  • the rehabilitation period does not require much time.

If you have undergone hysteroresectoscopy, then you may not worry about any unpleasant symptoms. For example, abdominal pain. Polyp endometrial hysteroscopy also eliminates the occurrence of adhesions and infertility.

Recommendations after hysteroresectoscopy

Given that any intervention should be treated as a full-fledged operation, it is recommended to follow a number of medical instructions for successful recovery.

In early postoperative it is important:

  • Observe the security regime
  • Avoid colds, hypothermia,
  • Observe sexual peace, careful hygiene,
  • Wear cotton breathable underwear
  • Do not exercise,
  • Regularly change the underwear and urological pads,
  • Acceptance of antibacterial and hormonal drugs according to the scheme.

After removal of endometrial polyps, the appearance of blood, brown mucous secretions is considered normal. Normally, if a woman is experiencing discomfort in the lower abdomen, malaise. After 3-5 days, these symptoms disappear, to 10 days pass without a trace. A month after the operation, it is necessary to conduct a control ultrasound examination.

Often, on the day of surgery, the doctor prescribes drug therapy with hormonal and antibacterial drugs to restore the function of the genital organ.

Late rehabilitation period includes:

  • Limitation of physical activity
  • Exclusion from the diet of oxidizing urine products
  • Sexual rest up to 1 month
  • The exclusion of douching.
  • Refusal to visit tanning salons, hot saunas, baths, from taking baths.

It is important to follow all medical recommendations if women have a cystic component, adenoma or tumor caused by a polypous disease removed.

Pregnancy should be planned only 12 months after the manipulation and not earlier than 6 months after the end of hormonal contraceptives. More information about when you can become pregnant after the removal of a polyp in the uterus, we wrote in a separate article.

Rehabilitation period

Now we will consider how the rehabilitation course goes after the treatment after hysteroscopy of the endometrial polyp has been completed. As already mentioned, the rehabilitation period for hysteroresectoscopy does not take much time.

And this is the main advantage of the procedure. However, do not hope that healing will occur instantly. It's impossible.

On average, a full rehabilitation takes 2-3 weeks. But sometimes the process takes more time. For example, there have been cases when patients took 4 weeks to recover.

Throughout the recovery period, the woman will notice bloody discharge. In the first few days, some may experience some discomfort, as in the first days of menstruation.

These symptoms should not cause any fear in the beautiful women. Since these are absolutely normal phenomena, which indicate that healing is normal.

During the rehabilitation period, women are prescribed antibiotics to prevent the onset and development of infectious diseases.

In some cases, doctors prescribe and pain relievers. But this is rather an exception to the rule. Please note that after the procedure, the woman is discharged from the hospital the very next day.

However, this does not mean that you should not follow any recommendations after discharge. Women are not allowed after discharge to engage in heavy physical labor, sports, and doctors insist on respect for sexual peace.

In a month it is necessary to come to the follow-up visit to the doctor, so that he controls how the healing process is going.

Previously, contact the clinic is necessary in such cases:

  • bleeding is abundant, you can see clots in them, which may have a different color,
  • there is an unpleasant smell from the vagina that looks like putrid
  • severe abdominal pains begin to give in the lumbar and taking painkillers does not affect the degree of pain.

It is also recommended to apply an unplanned visit to the doctor if the body temperature rises and it has nothing to do with a cold.

Since this suggests that the rehabilitation process is not as it should.

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