TCRF is a procedure in which the fibroids in lining of the uterus are removed or shaved to make the lining normal (also called resected) with a wire loop. The operation is performed using a hysteroscope, an instrument like a telescope which allows the surgeon to see the inside of the uterus. Special instruments can then be passed along the hysteroscope so that surgical procedures can be carried out. When the hysteroscope carries a wire loop it is called a resectoscope.
Fibroids can be:
serosal - just under the outside surface of the uterus
intra-mural - within the muscle wall of the uterus
submucous - just under the inside surface of the uterus
There is evidence to suggest that fibroids that occupy the lining of the uterus may cause IVF failures and miscarriages. Sometimes when women have multiple fibroids operation some of the fibroids may be shaved to smoothen the lining as much as possible.
In the weeks leading up to the surgery, doctors may prescribe drugs to "thin" the lining of the uterus. These are usually GnRH agonists the procedure is done under a general anaesthetic.
Once asleep, the legs are placed in stirrups. An internal examination will be done and the cervix will be opened slightly, the hysteroscopy will then be inserted in the uterus and a salt watery solution will be used to distend the uterus so the doctor can see the inside more clearly.
After checking for any possible problems, the fibroid which occupies the lining of the uterus will be systematically removed. TCRF usually involves no incisions, stitches, drains or bladder catheters. Sometimes an intravenous drip may be needed and a balloon catheter may be .left inside the uterus for a few hours. This may be necessary if bleeding is heavier than usual.
There is a 2-3% incidence of complications during TCRF, and they are
A) Incomplete resection of the fibroid due to of the following reasons
- Severe bleeding obstructing the views (most common reason)
- Over-absorption of the fluid used to distend cavity leading to fluid overload which will necessitate stopping procedure (second most common)
- Perforation of the uterus – it may be necessary to do a laparoscopy (camera through the umbilicus) to assess for internal damage (least common)
If the resection is incomplete the surgery may have to be repeated after a few months. You will be kept overnight for observation.
B) Infection. A course of antibiotics will be given to prevent infection. You may need another course of you have a very smelly discharge a few days after the operation.
What happens after the surgery?
There will be some vaginal bleeding but this normally becomes light within 24 hours. Some women experience slight lower abdominal discomfort. Rest is recommended immediately after TCRF.
Normally, women will be able to resume usual activities, including return to work, within 1 2 weeks. The vaginal bleeding will gradually change (usually within 10 days) to a discharge which may continue for several weeks to a month. Women will be asked to return to the hospital for a six-week post op check. Sometimes the procedure will need to be repeated if the fibroid has been very large and could be only partially. In such cases medication will be prescribed to shrink the remaining fibroid. A two stage surgery is planned to reduce the risk. A fibroid which is partially in the muscle of the uterus (Intramural) may encroach on the lining once the projecting part is cut. This may need a second operation to remove the remnant of the fibroid.