Multiple nodes and deep nodes
With several nodes, the surgeon removes them sequentially, limiting the time and extent of resection for safety (risk of fluid overload); a type 2 node, half lying in the wall, is cut off to the level of the myometrium, after which uterine contractions “squeeze out” the remaining part into the cavity - if there is a large remainder, the second stage is performed after 1–2 months. This approach preserves the uterine wall without a through defect and scar. Before surgery, ultrasound and MRI evaluate the distance from the node to the serosa (at least 5 mm); For large nodes, preliminary hormonal preparation is possible to reduce size and blood loss. After surgery - prevention of synechiae and control hysteroscopy.
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.
