Direct Hysteroscopic Observation to Document the Reasons for Abnormal Bleeding Secondary to Submucous Myoma

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Abstract
Thirty submucous myomata uteri were directly observed and studied by hysteroscopy. All the myomas were noted to have thin-walled surface vessels that increased in size and complexity with the size of the tumor. Several vessels were seen to rupture spontaneously while being viewed. When one of the atypical sinuslike channels burst, subsequent neighboring vessels began spewing blood. Sites of previous hemorrhage were marked by attached clots or ecchymoses. Frequently, the surrounding endometrium also contained equally bizarre vessels. Analysis of preoperative blind curettage as a method for diagnosis of submucous myomata uteri was associated with a 30% error. In 23 patients, the myomas were ablated, devascularized, cut off, or extracted by the Nd:YAG laser delivered via a fine quartz fiber through the hysteroscope's operating channel. The thin-walled profuse vessels appeared to be coagulated by the front scatter characteristics of the Nd:YAG laser, and the substance of the myoma was irreversibly damaged. (J GYNECOL SURG 5:149, 1989)

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