One to two nodes in the cavity
Small nodes, mainly located in the cavity, are cut off with a resectoscope loop completely in one step with minimal blood loss and short operation time; the pedunculated node (type 0) is removed with coagulation of the base. The doctor controls the depth of resection to the level of the surrounding myometrium without damaging the wall, and removes accompanying polyps. The uterine cavity after healing is restored without a scar; Menstruation is normalized from the first cycle. Control hysteroscopy after 1–2 months when planning pregnancy excludes synechiae.
Indications
- submucosal (submucosal) fibroids of types 0, 1 and 2, up to 4–5 cm in size, causing heavy menstruation and anemia;
- submucosal node in case of infertility, miscarriage, before IVF;
- combination of a node with polyps and endometrial hyperplasia;
- limitations: nodes larger than 5-6 cm, deep intramural component (more than 50%) - two-stage or other approach.
Advantages of the method
Hysteroscopic myomectomy is the only way to remove a node growing into the uterine cavity, without incisions on the abdomen and uterus: there is no scar on the myometrium, so natural childbirth is possible after the operation; recovery takes days, not weeks; bleeding stops from the first cycle in 80–90% of patients. Success depends on the type of node: type 0 (pedunculated) and type 1 (more than half in the cavity) are removed in one stage, type 2 (more than half in the wall) - sometimes in two stages with an interval of 1-2 months. Before surgery, the node is assessed by ultrasound and hysteroscopy; for large ones, hormonal preparation is possible.
