Is Cold Loop Hysteroscopic Myomectomy a Safe and Effective Technique for the Treatment of Submucous Myomas With Intramural Development? A Series of 1434 Surgical Procedures

Digital Image Analysis with Fully Connected Convolutional Neural Network to Facilitate Hysteroscopic Fibroid Resection

“…Laser can be used for the preparation, and intrauterine morcellators [14] are available on the market for the fibroid resection. Mazzon et al [8] have also described the cold loop technique. All of these methods follow the "respect the pseudocapsule" principle, hypothesizing the special role of this structure [15] in the healing of the uterine wall.…”

“…Several methods are published for transcervical resection [7]. Monopolar and bipolar resectoscopes are used in office or in-patient settings, and cold loop technique [8] is widely known as well for removing the myomas.…”

Complications in modern hysteroscopic myomectomy

“…Uterine perforation is the most common HM-related complication [15][16][17]. However, in a multicenter study by Aydeniz et al, in nearly 22,000 patients, it was reported only in 0.15% of the cases [16].…”

“…According to Mazzon et al, thin free myometrial margin (FMM) is the major risk factor for this kind of complication [15]. The value of 10 mm in the myometrial margin allows the surgeon to consider hysteroscopy as a safe procedure [15]. According to other sources, it can even be as low as 5 mm [8].…”

Nesa Days 2015, Conference Report

“…Hysteroscopic resection of submucous fibroids should be a simple, welltolerated and effective procedure and ideally accomplished in in only one surgical step. Numerous techniques for the hysteroscopic treatment of submucous myomas have been described, but the cold loop intracapsular myomectomy was conceived with the aim of preserving muscle fibers in the myometrium, providing greater safety for patients, and ensuring the complete removal of the myoma, without causing thermal damage to the myometrium [54]. The cold loop intracapsular myomectomy is articulated in three different steps: 1. slicing of the intracavitary component of myoma; 2. enucleation of the intramural component of myoma by the "cold loop", which is inserted into the cleavage plane between myoma and its pseudocapsule to disconnect by blunt dissection the connective fibers anchoring the myoma to the myometrium; 3. slicing of the intramural component of myoma, which becomes an endocavitary neoformation, safely removable by slicing, without damaging the surrounding myometrium.…”