A resectoscopy is a more advanced part of an endoscopy of the uterus (hysteroscopy). Hysteroscopy is an endoscopic examination method for viewing the uterine cavity. An instrument called a hysteroscope is inserted through the cervix into the uterine cavity via vaginal access, expanding the uterine cavity with a gas or liquid to allow inspection of the inner walls of the uterine cavity.
The simple design of the hysteroscope is suitable for small, mechanically performed procedures. In this case, accessories can be introduced into the uterine cavity via an additional channel. Here, small polyps can be cut off and pulled out of the uterine cavity, adhesions in the uterine cavity can be loosened, samples can be taken from the uterine lining, or a contraceptive coil can be removed under visual control. However, the surgical possibilities are very limited with this instrument.
More advanced forms of endoscopic treatment are made possible by what is known as a resectoscope.
A resectoscope is the instrument used to perform a resectoscopy in gynecology. It has a handle into which various working elements can be inserted, such as a cutting loop, a pointed needle, or an electric rollerball. Via the natural access of the cervix, the physician can treat various changes in the uterine cavity under visual control (using the endoscope) inside the uterine cavity, which will be presented to you at Ackermann.
When is resectoscopy performed?
Resectoscopy is used for the following types of treatment:
- Endometrial ablation
During menopause, some women suffer from very heavy menstrual bleeding without any physical changes found in the uterus. The removal of the uterus (hysterectomy) was and is often performed in these situations. Endometrial ablation was developed as an alternative form of treatment if the uterus is retained. During this procedure, the lining of the uterus (endometrium) is heated with an electric rollerball electrode so that it is destroyed. Another option is to cut out the lining of the uterus with a loop electrode. In addition to organ preservation, the main advantage of endometrial ablation by resectoscopy is that it can be performed on an outpatient basis or during a short inpatient stay of 3 days.
The uterus consists of three layers: an inner mucosal layer (endometrium), a middle, thick muscular layer (myometrium), and an outer, thin peritoneal layer (perimetrium). A myoma is a benign lump formation of the muscular layer of the uterus. However, some myomas grow very close underneath the lining of the uterus and can be seen directly during hysteroscopy. With the possibility of hysteroscopic therapy (in this case resectoscopy), there is a simple form of treatment in which the physician removes the myoma through the vagina. For this purpose, the resectoscope is inserted into the uterine cavity and the myoma is divided into many small individual parts with the electric snare and then removed from the uterus.
Especially in older women, uncontrolled growths of the endometrium as polyp formations occasionally occur. These polyps are often benign. Only in rare cases are malignant changes found in a polyp. A polyp is often suspected by ultrasound examination of the uterus. The physician will then advise an endoscopy of the uterus with resectoscopy. During this procedure, the polyp is removed with scissors or with an electric snare under visual control. Septum resection A congenital malformation of the uterus that some women suffer from is a partition that divides the uterine cavity into two halves. Women with that type of a malformation of the uterus have increased miscarriages. During a resectoscopy, the physician inserts the resectoscope into the uterine cavity under visual control and severs the septum with an electric needle. This then subsequently results in a normal shape of the uterine cavity.
- Removing adhesions in the uterine cavity
Some women experience adhesions of the uterine walls, also known as synechiae, after curettage procedures, for example. Severe forms may result in a permanent absence of menstruation or in very light periods. A hysteroscopy in conjunction with resectoscopy provides the opportunity for the physician to identify and cut through the adhesions.
The risks of a resectoscopy
Hysteroscopy, and therefore resectoscopy, is a very gentle, patient-friendly surgical procedure. In its application it does require some practice and experience, because the uterine cavity, where the operation is taking place, is very small. The risks of hysteroscopy or resectoscopy are considered to be low.
Nevertheless, as with any medical procedure, unwanted complications can occur. These may primarily include infections or bleeding. There may also be an adverse circulatory reaction due to anesthesia or local anesthesia.
As a general rule, every patient is informed of the risks by the attending physician before every resectoscopy, as before any other medical procedure.
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Gynecological laparoscopy - gynecology-guide.com (accessed: 2/23/2021)
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