Endometrial preservation during resection of type II and type III submucosal fibroids

Abstract

Background and objectives: Hysteroscopic myomectomy is considered the gold-standard treatment of submucosal fibroids. However, it is associated with disruption of the endometrium which may lead to complications such as intrauterine adhesions and loss of functional endometrium. In this video article we describe a technique to resect Type III and Type II fibroids whilst minimising the loss of overlying endometrium. Materials and methods: We present two patients with type II/III submucosal fibroids with minimal or no intracavitary component. The resection technique we demonstrate comprises either making an endometrial incision or making a small opening in the overlying endometrium to expose the fibroid pseudocapsule. Subsequent steps of resection are then performed through this small opening. Thus, complete resection is achieved without further resection of the endometrium. Main outcome measures: Evidence of endometrial healing and absence of intrauterine synechiae on follow up outpatient hysteroscopy or ultrasound scan. Results: Full resection was achieved in both patients with no or minimal loss of overlying endometrium. A follow up outpatient hysteroscopy was performed 8 weeks later in the first patient, demonstrating completely healed uterine cavity. She had a successful conception and delivery following IVF treatment for male factor infertility. The second patient is currently in the process of IVF treatment. Conclusions: Our technique enables endometrial preservation and potentially better reproductive outcomes following resection of type II and type III submucosal fibroids. Larger scale studies are required to elucidate long term outcomes on bigger patient population.

Impact of FIGO type 3 uterine fibroids on in vitro fertilization outcomes: A systematic review and meta‐analysis

“…After the evaluation of the full text, 12 studies were excluded [23][24][25][26][27][28][29][30][31][32][33][34] ; three studies [35][36][37] were included in the present meta-analysis (Figure 1).…”

Feasibility and Surgical Outcomes of Hysteroscopic Myomectomy of FIGO Type 3 Myoma: A Systematic Review

“…After the evaluation of the full text, 16 studies were excluded: 11 manuscripts [ [14][15][16][17][18][19][20][21][22][23][24] were articles without disaggregated data; 1 molecular and in silico study [25]; 2 articles not considering the removal of type 3 myoma [26,27]; 1 study where type 3 myoma removal was performed by other techniques [28]; 1 additional study was not in the English language [29]. Finally, a total number of three studies [30][31][32] that met the abovementioned inclusion criteria were included in the present systematic review (Figure 1). As summarized in Table 1, the studies embedded a total of 56 patients who underwent hysteroscopic myomectomy for type 3 myomas; 2 were retrospective studies [30,31] and 1 was a video case report [32] coming from France, China and the United Kingdom, respectively.…”

The challenge of FIGO type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties

“…The patient subsequently underwent successful IVF. 44 Unfortunately, the available evidence on the feasibility of hysteroscopic myomectomy for FIGO type 3 ULs is limited. While hysteroscopic treatment appears to be safe and feasible, no definitive recommendations can be made regarding its effectiveness in improving reproductive outcomes.…”

“…The patient did not experience any postoperative complications, and follow‐up hysteroscopy confirmed an intact endometrium without intrauterine synechiae. The patient subsequently underwent successful IVF 44 …”