Hysteroscopy vs Laparoscopy: Understanding Your Fibroid Removal Options

Deciding on surgery for fibroid removal can feel daunting, especially with different options to consider. The best approach depends on factors such as the size, location and number of fibroids, as well as your plans for future pregnancy. For women who wish to preserve the uterus, a myomectomy (fibroid removal) may be the preferred choice.

Two common minimally invasive surgical methods are hysteroscopic and laparoscopic myomectomies. Each has its own benefits and considerations, so learning the differences can help you make a confident, informed decision about your treatment. Keep reading to find out more.

What Is Hysteroscopic Myomectomy?

Hysteroscopic myomectomy is a minimally invasive procedure to remove submucosal fibroids, usually those less than 3–4 cm in size. Unlike other surgical methods, it requires no external incisions. Instead, a thin, lighted instrument is inserted through the vagina and cervix into the uterus. A clear fluid is introduced to gently expand the uterine cavity, allowing the surgeon to clearly see and access the fibroid.

During the procedure, the fibroid is cut into smaller pieces using either a wire loop with electrical energy or a small blade. This allows the surgeon to carefully shave away the fibroid tissue. The procedure takes about 30–60 minutes and is best suited for smaller fibroids, though larger ones may require more than one session.

What Are the Benefits of Hysteroscopic Myomectomy?

Unlike laparoscopic or open surgery, hysteroscopy removes fibroids through the cervix, making it ideal for treating fibroids that distort the uterine lining, affect fertility, or cause heavy bleeding.

Key benefits include:

• Outpatient Procedure: Most cases are completed within a few hours, with patients able to return home the same day.
• Quick Recovery: Normal activities can often be resumed within 24–72 hours, and many return to work within a week.
• Uterus Preservation: The procedure targets only problematic fibroids, avoiding hysterectomy and its hormonal or emotional impacts.
• Less Pain: With no abdominal incisions, postoperative discomfort is minimal, usually limited to mild cramping that resolves in a few days.

What Are the Risks and Complications of Hysteroscopic Myomectomy?

Though complications are uncommon, they may occur in complex cases or when larger fibroids are involved. Potential risks include:

• Fluid Absorption Issues: Excess absorption of the fluid used to expand the uterus can cause electrolyte imbalances.
• Infection: Warning signs include fever, unusual discharge, or persistent pelvic pain beyond the first few days.
• Heavy Bleeding: Excessive bleeding that lasts longer than a week or requires frequent pad changes should be reported to a gynaecologist.
• Intrauterine Scarring (Asherman’s Syndrome): Rarely, scar tissue may form in the uterine cavity, affecting periods or fertility.

What Is Laparoscopic Myomectomy?

Laparoscopic myomectomy is often recommended for fibroids that hysteroscopic surgery cannot reach, such as subserosal fibroids (growing outward from the uterus) and intramural fibroids (within the uterine wall). Unlike hysteroscopic myomectomy, laparoscopic surgery requires a few small cuts in the abdomen. Through these openings, the surgeon inserts a lighted telescope and specialised instruments to remove the fibroids, either in pieces or as a whole, while preserving the uterus.

This approach is better suited for larger or deeper fibroids but involves a slightly longer recovery. However, it still offers key advantages over traditional open surgery, including less bleeding, smaller scars, fewer complications, and faster return to normal activities.

What Are the Benefits of Laparoscopic Myomectomy?

Laparoscopic myomectomies allow surgeons to access and remove fibroids from multiple angles and locations within the pelvis, providing comprehensive treatment for complex fibroid patterns.

Other benefits of the procedure include:

• Quick Recovery: Most patients undergoing laparoscopic fibroid removal can return to light activities within a week and resume full normal activities within 2 to 4 weeks.
• Reduced Internal Scarring: The precise laparoscopic tools lead to less internal scarring compared to open surgery.
• Minimal Blood Loss: The use of energy devices for tissue sealing significantly reduces blood loss during surgery.
• Minimal Visible Scars: The small incisions used in laparoscopic surgery heal with minimal visible scarring, typically appearing as small dots that fade over time.
• Less Risk of infection: Smaller incisions and reduced tissue exposure during laparoscopic surgery result in lower infection rates compared to open surgical procedures.

What Are the Risks and Complications of Laparoscopic Myomectomy?

The minimally invasive nature of laparoscopy is generally safe and reduces complications compared to open surgery. However, as with all surgical procedures, there are risks involved. These include:

• Bleeding from the Incision: While uncommon, bleeding from incision sites can occasionally occur, particularly in patients with bleeding disorders or those taking blood-thinning medications.
• Postoperative Infection: Despite the reduced infection risk with laparoscopic surgery, post-operative infections can still occur.
• Abdominal Swelling: The carbon dioxide gas used during laparoscopy can cause temporary abdominal distension and shoulder pain as the gas is absorbed by the body.

When to Choose Hysteroscopic vs Laparoscopic Myomectomy

Ultimately, the best treatment option should be determined in consultation with an experienced gynaecologist who can assess your individual condition, reproductive goals and overall health. If you are considering fibroid removal in Singapore, schedule a consultation with our gynaecologist, Dr Christopher Ng, to explore the most suitable approach for you. Book an appointment today.