Safety and efficacy of combining transcervical fibroid ablation with operative hysteroscopy

Minimally-invasive, organ-preserving techniques for uterine fibroid management have gained popularity. This study assesses the safety and effectiveness of combining transcervical fibroid ablation (TFA) with operative hysteroscopy (HSC).

We aimed to evaluate whether a combined approach that involves performing TFA and operative HSC during a single session increased the intra- and postoperative risks.

A total of 200 women were included in this retrospective study. They were divided into 2 groups: 100 underwent combined TFA and operative HSC (group 1), and 100 underwent HSC alone (group 2). Surgical procedures included fibroid / polyp resection, endometrial ablation, and septum dissection. Outcomes assessed comprised intra- and postoperative complications and symptom improvement.

Complication rates were low and comparable in both groups. Among the patients in group 1 with available follow-up (n = 60), 83.3% reported improvement in bleeding symptoms, particularly those treated with TFA combined with myomectomy (84%). The combined approach enabled treatment of a broader range of fibroid types (International Federation of Gynecology and Obstetrics score 0-6) and intrauterine pathologies in a single session. No severe or life-threatening complications were observed. The risk of bleeding during fibroid resection was reduced when the resection was preceded by TFA (P = 0.001).

Combining TFA and HSC appears to be a safe, effective, and versatile approach for treating uterine fibroids and intrauterine pathologies. It offers procedural efficiency, broadens treatment eligibility, and may reduce the need for reintervention.