Hysteroscopic myomectomy in a submucous fibroid 3 mm from the serosa: a case report

Abstract

This is a case report of a 39-year-old black woman, nulliparous, married who presented a heavy menstrual flow with clots and dysmenorrhea. Gynaecological examination of the uterus revealed RVF, mobility, no pain, slight enlargement, and right displacement. Magnetic resonance imaging (MRI) of the pelvis showed a 40 mm submucous fibroid with intramural component less than 50%, type 1, with a 3 mm distance from serosa. In an office hysteroscopy, it was noted a 40 mm submucous fibroid with an intramural component with less than 50%, type 1, classified in STEP-W submucous fibroids classification as a Score 6, Group II. The patient was submitted to partial hysteroscopic myomectomy, removing 60% of the fibroid volume in a 48.75-minute surgery. GnRH analogue was indicated for 3 months before another intervention. In the second evaluation MRI revealed a 22 mm-fibroid with intramural component more than 50%, type 2, with a 7 mm distance from serosa. Hysteroscopy found a 20 mm submucous fibroid, with intramural component more than 50%, type 2, Score 4, Group I on STEP-W classification. The patient was submitted to a second hysteroscopic myomectomy with complete removal and 10.5 minutes operating time, without complications.

Hysteroscopic Myomectomy

“…In these cases, fragmentation is necessary, even though the nodule is not completely free, but, even so, the safety level of the procedure is increased, since the largest portion of the nodule is already in the uterine cavity, with its migration from the myometrium deep to the surface. With this technique, the limit of hysteroscopic myomectomy can be extended in relation to the measurement of the myometrial mantle before surgery from 10 to 3 mm [36].…”

Office hysteroscopic cervical myomectomy

“…Saline infusion is used as distension media. This technique is similar to that in the hospital setting and allows the resection of fibroid very close to the uterine safely and efficiently [8,9].…”