Submucous myomas, which are located close to the innermost layer of the uterus and even spread the uterine cavity, create a risk by increasing the amount of menstrual bleeding and causing pregnancy losses. It increases after the thirties. These types of myomas can be removed hysteroscopically instead of traditionally performed abdominal surgeries or even hysterectomy. Serious side effects of this type of surgery are avoided. The important thing here is correct patient selection.
What should be known is that the recommendation of experienced surgeons is that the most ideal conditions for hysteroscopic surgery are advanced age, uterus size ≤6 cm, myoma size ≤3 cm and the anticipated surgery time is less than 20 minutes. Submucous myomas are divided into three. Type 0: stalked submucous myomas that do not extend into the uterine muscle layer, Type 1: myomas with less than 50% of the myoma volume extending into the intrauterine muscle layer, Type 2: myomas with more than 50% of the myoma volume extending into the intrauterine muscle layer. The hysteroscopic approach is mostly applied to myomas such as type 0 and 1. Sometimes, myomas that do not fall into this type are given GnRH-a treatment to try to shrink the myoma before the operation. Different procedures and tools have been described for the removal of myomas. The surgeon decides which one to use, based on his own knowledge and experience.
Ultrasonography, sonohysterography and office hysteroscopy can be used to diagnose myomas. An important advantage of sonohysterography is that it can also be used to calculate the volume of the myoma within the uterine wall. The procedure should be performed by experienced surgeons. A second session may be needed. This procedure is often planned when the endometrium (the inner layer of the uterus) is at its thinnest. Before the procedure, vaginal prostaglandin or laminaria can be used in women who have never given birth and in those with a narrow cervix. In order for the instruments to be used to pass into the uterus, a dilation of the cervix must be made at least equal to their diameter.
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