• Reference Number: HEY-865/2017
• Departments: Gynaecology
• Last Updated: 23 March 2017

Introduction

This leaflet has been produced to give you general information about your hysteroscopic tissue removal and retrieval procedure. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a hysterscopic tissue removal and retrieval procedure?

Hysteroscopic tissue removal and retrieval is a procedure performed under local or general anaesthesia, which allows your doctor to look inside your womb (uterus) and remove any polyps or fibroids under direct vision. A polyp is a small lump of tissue that can grow on the lining of the uterus. A fibroid is a benign (non-cancerous) growth.

Hysteroscopic tissue removal and retrieval procedure is done by inserting a small tube with a telescope at the end (hysteroscope) through the vagina and into your womb (uterus). The removal and retrieval device is passed down the hysteroscope and the polyp or fibroid can then be removed.

Why do I need a hysterscopic tissue removal and retrieval procedure?

This is a treatment for women who have heavy or irregular bleeding due to polyps or fibroids. It does not require an incision (cut) and can be performed in an outpatient setting. It may also be used to remove scar or other abnormal tissue within the uterus. Your doctor will discuss this with you if necessary.

What can I expect before the procedure?

Local Anaesthesia

If you are having the procedure performed under local anaesthesia (whilst you are awake) you will be asked to come in one hour before the procedure. You should take some analgesia (Ibuprofen 400 mg or paracetamol 1 gram) one hour prior to appointment time. Co-codamol is also a good alternative.

Entonox is commonly used for pain relief in hospitals during several procedures. It is self-administered and you will have complete control over how often you use it.

If you are having local anaesthesia and/or entonox you will need to make arrangements for your family i.e. childcare and for transport home from the hospital.

General Anaesthesia

If you are having general anaesthesia you will have a pre-op assessment during which the nurse will go through details of your hospital visit and explain the procedure. She will complete the necessary paperwork and take your blood pressure and pulse. Please let us know if you have any concerns or if there is anything we can do to make your stay with us more comfortable.

If you are having general anaesthesia, you will need to make arrangements for your family i.e. childcare and transport to and from the hospital. You will see an anaesthetist and the doctor before you go to theatre. Please feel free to ask them any questions about the operation.

It is not unusual to feel anxious, and the nursing staff will gladly help you to feel at ease.

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination

Can there be any complications or risks?

There are risks with any operation, but the risk from hysteroscopic removal and retrieval procedure is less than one percent. Potential complications can include: bleeding, infection, fluid overload and perforation of the uterus

Should perforation occur, you may require an operation to put a telescope through your naval under general anaesthesia (laparoscopy) to see if any other organs have been damaged and whether there is any bleeding from the site of perforation, but this is very unlikely.

What can I expect during the procedure?

The doctor will insert a speculum into the vagina (similar to a smear test). This will enable him to access your neck of the womb (cervix). The hysteroscope will then be passed through the cervix into your womb. Fluid is introduced into the womb to distend the cavity to make it easier for the doctor to see. You may feel some of this fluid coming out of your vagina during the procedure, which is normal. The hysteroscope has a camera attached and images of the inside of your womb are sent to a screen by the side of the bed, which can be viewed by the doctor and you.

The tissue removal and retrieval device is passed into the womb and held against the polyp / fibroid, which is then cut away. After the procedure, which takes approximately 10-25 minutes depending on the size or nature of what the doctor needs to remove, the hysteroscope and speculum will then be removed from the vagina.

What can I expect after the procedure?

Local Anaesthetic

If you have had local anaesthetic you will be helped to a reclining chair in the recovery area, where you will be offered a drink. We would advise you to rest for approximately an hour or until you feel well enough to go home.

General Anaesthesia

If you have had the procedure under general anaesthesia, you may experience some nausea and/or pain afterwards. This is common. Please let the nursing staffs know and they will help you. Your pulse, blood pressure, breathing and temperature will be monitored in the post-operative period. Once you are awake fully you will be able to start eating and drinking.

Local and General Anaesthetic

You may experience some period like cramps and bleeding. The bleeding is usually mild and should settle within a week. To reduce the risk of infection it is advisable to use sanitary towels rather than tampons whilst the bleeding continues.

We may give you pain relief medication to take home with you, which we advise you to take every 6 hours for the next 24-48 hours.

You may receive a phone call following your treatment as we would appreciate your feedback as to how you felt the procedure went during your visit.

Contraception

Please continue to use your normal method of contraception before and after your operation unless otherwise instructed by the doctor. If you have been using the coil (IUCD) for contraception or bleeding control, this may be removed at your operation if you so wish and you may be advised to choose a different method. If you would like to have another coil fitted following the procedure, please discuss this in advance with your doctor. If a coil is fitted, please read the information leaflet you are given and ensure you attend your appointments for a ‘coil check’.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Women and Children’s Hospital:

Gynaecology Outpatients            (01482) 607829

Gynaecology Ward                        (01482) 604387

 

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.