Operative hysteroscopy has modified the surgical approach to benign uterine lesions. Lesions that previously required a laparotomy can now be treated by hysteroscopy. Neuwirth & Amin first described hysteroscopic resection of submucous myoma. This hysteroscopic management has reduced morbidity, duration of hospitalization and costs while attaining a success rate ranging from 67% to 98% for bleeding and 21% to 60% for infertility.
Classification of submucous myoma
Myoma can be divided into three groups according to the location of the largest part of the myoma.
Subserous myoma: located on the peritoneal surface of the uterus.
Intramural myoma: in the myometrium.
Submucous myoma: myoma protruding into the uterine cavity.
Only submucous myoma can be treated by operative hysteroscopy.
The European Society for Human Reproduction and Embryology (ESHRE) classification of submucous myoma
There are three types of submucous myoma:
Type 0: completely intracavitary (pedunculated myoma).
Type 1: largest diameter in the uterine cavity.
Type 2: largest diameter in the myometrium.
Type 0 and 1, and some type 2 myomas are accessible by hysteroscopy.
Contraindications of hysteroscopic myomectomy
The contraindications to operative hysteroscopy are contraindications to anesthesia, genital infections, pregnancy, and multiple myomas requiring myomectomy by laparotomy.