A submucous myoma, also known as a submucosal fibroid, is a type of uterine fibroid that grows just underneath the lining of the uterus (the endometrium). These fibroids can cause symptoms such as heavy menstrual bleeding, prolonged menstrual periods, pelvic pain, and infertility.

Hysteroscopic resection is a procedure used to remove submucosal fibroids. It's a minimally invasive procedure that involves inserting a hysteroscope (a thin, lighted tube) into the uterus through the vagina and cervix. This allows the surgeon to see and access the fibroid without making any incisions in the skin.

Here's a brief overview of the procedure:

The surgeon inserts the hysteroscope into the uterus.
Specialized instruments are passed through the hysteroscope. These are used to cut the fibroid into small pieces.
The cut pieces of the fibroid are then removed through the hysteroscope.
The endometrium is left to heal. A balloon catheter or an intrauterine device may be inserted to prevent the sides of the uterus from sticking together during healing.
A 4 cm submucous myoma is relatively large for hysteroscopic removal. The procedure can be more complicated and time-consuming than for smaller fibroids, and it may require more skill and experience on the part of the surgeon. In some cases, the procedure may need to be performed in two stages to safely remove the entire fibroid.

Despite these challenges, hysteroscopic resection is generally safe and effective for treating submucosal fibroids. It can greatly reduce symptoms and improve quality of life for many women. However, as with any surgery, there are risks, including infection, bleeding, damage to the uterus, and complications related to anesthesia. The risk of these complications increases with the size of the fibroid.

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