Feasibility and long-term efficacy of hysteroscopic myomectomy for myomas with intramural development by the use of non-electrical “cold” loops

Abstract

This study aimed to assess the feasibility and the short-and long-term efficacy of hysteroscopic myomectomy for submucous myomas with intramural development [grade 1 (G1) and grade 2 (G2)] by using non-electrical "cold" loops and to verify the role of preoperative variables on surgical outcomes. Symptomatic (bleeding and infertility) premenopausal patients with the diagnosis of submucous myoma at transvaginal sonography, and with G1 and G2 grading at sonohysterography, were included in this prospective study. Hysteroscopic myomectomy was performed by the combined monopolar electrical slicing and traction-andleverage manoeuvres by non-electrical "cold" loops. One hundred fifty-nine patients were recruited, and 169 procedures were performed. Operating time, fluid deficit, complications and complete resection at first procedure (perioperative outcomes) and persisting symptoms and additional surgery for persisting symptoms (long-term outcomes) were not significantly different for G1 vs. G2 myomas. Perioperative outcomes were significantly different when comparing myoma mean diameter <3.0 vs. ≥3.0 cm (75th percentile). Multivariate analysis and multiple regression analysis proved that myoma mean diameter was the only significant variable for surgical outcomes. Hysteroscopic myomectomy by non-electrical "cold" loops is an effective and efficient treatment for submucous myomas with intramural development. Myoma mean diameter is the only significant preoperative variable for perioperative outcome, while myoma grading loses its role as a prognostic factor.

Hysteroscopic Myomectomy of Large Submucous Myomas in a 1-Step Procedure Using Multiple Slicing Sessions Technique

“…Previous studies revealed that hysteroscopic excision of large myomas and myomas with intramural extension are associated with increased risks of uterine perforation, cervical laceration, and intravasation of excessive amounts of distension media. The incidence of major complications in previous studies ranged between 2.75% and 9.01% [16,18].…”

“…I and type II submucous myomas revealed that the rates of 1-step complete removal for type I and type II submucous myomas were 92% and 85%, respectively [16]. In a prospective study including 59 patients with submucous myomas with intramural development, Bettocchi et al [10] used a bipolar Versapoint twizzle electrode or scissors (Gynecare; Ethicon Inc., Somerville, NJ) to incise the mucosa covering the myoma at the level of its reflection on the uterus.…”

Likelihood of Accomplishing an In-Patient Hysteroscopic Myomectomy in a One-Step Procedure: A Systematic Review and Meta-Analysis

“…None of the good quality series falls among the ones in which estimating the rare event has been needed. In the study of Leone et al [54], the main myoma diameter was reported as median. Hallez et al [44] provided intervals for diameters of myoma.…”

Office hysteroscopic cervical myomectomy

“…This classification includes intracavitary fibroids only; cervical fibroids are not contemplated. Hysteroscopic myomectomy may be performed by different techniques: direct mobilization, slicing, or both [6,7]. It can be used with U or L resectoscope handle, with or without energy, either monopolar or bipolar.…”