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Hysteroscopic resection of uterine septum

Hysteroscopic septum resection in women with unfavourable reproductive and clinical outcomes has become common practice worldwide to improve reproductive results. No clear evidence on the possible advantages and drawbacks of this procedure has been published. In this opinion paper, based on a SWOT (strengths, weaknesses, opportunities, threats) analysis, the different aspects of this strategy are evaluated. Currently, no level 1 published evidence supports uterine resection in women with septate uterus. Clinical evidence from the studies analysed matches the more recent guidelines and suggests an improvement in reproductive outcomes after hysteroscopic resection of the septum, particularly in infertile women and women who have experienced recurrent miscarriages. In a patient with no history of infertility or prior pregnancy loss, it may be reasonable to consider septum incision after counselling about the potential risks and benefits of the procedure.

Published clinical data in favor of the intervention, however, are based on studies with important methodological limitations. In this situation, the clinician and patient should reach an agreement together, based on the pros and cons of this intervention. Well-designed randomized controlled trials are required to confirm the clinical benefits and cost-effectiveness of this procedure.

Hysteroscopic myomectomy

Myomectomy is a type of surgery used to remove uterine fibroids. Your doctor might recommend this surgery if your fibroids are causing symptoms such as:

  • pelvic pain
  • heavy periods
  • irregular bleeding
  • frequent urination

A myomectomy can be done one of three ways:
  • Abdominal myomectomy lets your surgeon removes your fibroids through an open surgical cut in your lower belly.
  • Laparoscopic myomectomy allows your surgeon toremove your fibroids through several small incisions. This may be done robotically. It’s less invasive and recovery is faster than with abdominal myomectomy.
  • Hysteroscopic myomectomyrequires your surgeon to use a special scope to remove your fibroids through your vagina and cervix.

You will get a local anesthetic or be placed under general anesthesia during this procedure.

The surgeon will insert a thin, lighted scope through your vagina and cervix into your uterus. They’ll place a liquid in your uterus to widen it to allow them to see your fibroids more clearly. Your surgeon will use a wire loop to shave off pieces of your fibroid. Then, the liquid will wash out the removed pieces of fibroid. You should be able to go home the same day as your surgery.

Hysteroscopic endometrial resection

An endometrial resection is an operation to remove the lining (endometrium) of your uterus (womb).

The most common reason for having an endometrial resection is to relieve the symptoms of heavy periods (abnormal uterine bleeding). About a third of women who have the operation will not have periods anymore.

The operation is usually performed under a general anesthetic but various anesthetic techniques are possible. The operation usually takes about 30 minutes. Your gynecologist will examine your vagina. They will pass a small telescope (operating hysteroscope or resectoscope) through your vagina, across your cervix (neck of your womb) into your womb. Your gynecologist will pass fluid through the telescope to distend (swell) your womb. They will use a diathermy resecting loop (a loop of wire heated by electricity) to remove the lining of your womb and any polyps or small fibroids they find.