For type 2 fibroids, patients often ask me whether it is better to have a laparoscopy or a hysteroscopy if I want to have a baby.
First of all, let's talk about the conclusion: it must be hysteroscopy.
Why?
First of all, we need to understand that the composition of the myometrium includes the ancient uterus near the endometrium and the new uterus near the outside, the fibroids near the medial side belong to the submucosal fibroids, which belong to the scope of the ancient uterus, and hysteroscopic fibroids can generally be selected for removal, the wound of the ancient uterus is relatively easy to heal, the incision of the hysteroscopy can grow well on its own without suturing, and the uterus undergoing hysteroscopic surgery has not been reported to have uterine rupture during pregnancy.
The fibroids in the lateral myometrium, hysteroscopy is often not reached, it needs to be treated with laparoscopic surgery, the wound after the muscle layer is injured in the scope of the new uterus, relatively speaking, the healing ability of the myometrium is worse than that of the ancient uterus, after laparoscopic or laparotomy to remove fibroids, 5% of the uterus will rupture in the process of pregnancy.
The above is considered from the perspective of the healing ability after uterine surgical injury.
Another aspect is that for patients with uterine fibroids who have fertility requirements for endometrial damage after surgery, if the traditional method of resection of uterine fibroids is used, the damage to the endometrium is relatively large, so if the angle of protecting the endometrium is not as good as laparoscopic surgery, but if Lin's method is used, only the intima is cut on the endometrial surface, the fibroids are exposed, and the fibroids are separated, and the damage to the endometrium can almost be ignored.
From the perspective of adhesions, whether it is hysteroscopic resection of the uterus or laparoscopic resection of fibroids, if measures to prevent adhesions are not taken, adhesions may occur, but the types of adhesions are different.
From the perspective of trauma recovery, hysteroscopy is almost painless and the pain is mild, whereas laparoscopic pain is much more severe than hysteroscopy.
Of course, the technical difficulty of hysteroscopic surgery is much higher than that of laparoscope, the operating instruments of hysteroscopy are often only 3-4mm, and it will be difficult to remove fibroids above 4cm, especially most of the type 2 fibroids in the muscle wall, which is still a great challenge for many doctors, and it is easy to get complications such as water poisoning. Because of technical barriers, many fibroids that could have been removed by hysteroscopic surgery have been transferred to laparoscopy.
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