Hysteroscopic myomectomy in a submucous fibroid near from tubal ostia and 5 mm from the serosa: a case report from the Endoscopy Service of Ginendo-RJ

Abstract

This is a case report of a 27-year-old white woman, nuliparous, single, who presented a heavy menstrual flow with clots, dysmenorrhoea and anaemia. Gynaecological examination of the uterus revealed anteverted position, mobility, no pain, slight enlargement and right displacement. Magnetic resonance imaging of the pelvis showed a 29-mm submucous fibroid with intramural component more than 50%, type 2, in the posterior wall, with a 5-mm distance from serosa. In office hysteroscopy, a 30-mm submucous fibroid with an intramural component with more than 50%, type 2, near around 5 mm from left tubal ostia, classified in STEP-W submucous fibroids classification as score 6, group II, was noted. GnRH analogue was indicated for 3 months before intervention to treat anaemia. The patient was submitted to hysteroscopic myomectomy with direct mobilisation technique, with the fibroid completely removed without complications in a surgery which lasted for 52 min and 20 s.

Hysteroscopic Myomectomy

“…This is facilitated by the decompression of the myometrium, which, compressed by the growth of the nodule, progressively returns to its normal position by releasing the pseudocapsule, causing the intramural lesion to become intracavitary. This technique, like all those that perform myoma enucleation, has the same advantages: lower risk of perforation and risks associated with perforation (thermal injury to other organs), less thermal damage to the myometrium, and less bleeding and intravasation [35].…”

“…Medicina 2022, 58, x FOR PEER REVIEW 16 of 21 risk of perforation and risks associated with perforation (thermal injury to other organs), less thermal damage to the myometrium, and less bleeding and intravasation [35].…”

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].…”