Transrectal Ultrasound-Guided Hysteroscopic Myomectomy of Submucosal Myomas With a Varying Degree of Myometrial Penetration

Ludwin, Artur; Ludwin, I.; Pityński, Kazimierz; Basta, Paweł; Basta, Antoni; Banaś, Tomasz; Jach, Robert; Wiechec, M.; Grabowska, R; Stangel-Wójcikiewicz, Klaudia; Milewicz, Tomasz; Nocun, A.

doi:10.1016/j.jmig.2013.05.001

Cited by 35 publications

(24 citation statements)

References 27 publications

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“…In all patients, the bowel was prepared using a 150-ml sodium dihydrophosphate-sodium hydrophosphate enema (Laboratorium Galenowe, Olsztyn, Poland) 2 h before transrectal ultrasonography (Ludwin et al , 2013c). Antibacterial prophylaxis was with cefuroxime (1.5 g intravenous) (Biofuroksym, Polpharma, Poland).…”

Section: Methodsmentioning

confidence: 99%

Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty

Ludwin

Pityński

et al. 2014

Human Reproduction

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STUDY QUESTIONCan morphologic measurements (width, length and surface area) of the uterine septum predict healing-dependent abnormal anatomic results [ARs; residual septum (RS) and intrauterine adhesions in other locations (IUA-OLs)] after complete hysteroscopic metroplasty (HM)?SUMMARY ANSWERSignificant predictors of ARs are the septal width and, to a lesser extent, septal surface area.WHAT IS KNOWN ALREADYAnatomic results after hysteroscopic metroplasty have very large variation. A RS >1 cm and IUA-OLs can aggravate reproductive outcomes, resulting in the need for reoperation. New criteria for diagnosing a uterine septum according to the European Society of Human Reproduction and Embryology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE) have been suggested (ESHRE-ESGE criteria). Autocross-linked hyaluronic acid gel (autocross-linked polysaccharide) has an antiadhesive effect.STUDY DESIGN, SIZE, DURATIONA prospective, observational cohort study was performed with 96 women consecutively enrolled between 2007 and 2012.PARTICIPANTS/MATERIALS, SETTING, METHODSWomen who had uterine septum and previous miscarriage or infertility presented for evaluation at a university hospital, private hospital or private medical center were included. Preoperative septal width, length and surface area were determined with three-dimensional sonohysterography. Women were treated by hysteroscopy in a standardized manner with three- or four-dimensional transrectal ultrasound guidance (complete resection). Patients received either no adhesion barrier (49 patients) or adhesion barrier with autocross-linked polysaccharide (47 patients). Anatomic results were assessed with three-dimensional sonohysterography and second-look hysteroscopy. Healing-dependent ARs were reported using both American Society of Reproductive Medicine (ASRM) criterion of RS length >1 cm (ASRM>1 cm criterion) and ESHRE-ESGE criteria. Univariate and multivariate logistic regression were used to identify predictors of RS, IUA-OLs and ARs.MAIN RESULTS AND ROLE OF CHANCEIn patients who had no adhesion barrier, ARs were diagnosed in 11 of 49 patients (23%) using the ASRM > 1 cm criterion and in 20 of 49 patients (41%) using the ESHRE-ESGE criteria for RS [odds ratio (OR)ESHRE-ESGE:ASRM, 2.4, P = 0.05]. In the patients who had autocross-linked polysaccharide, ARsASRM > 1 cm were diagnosed in 2 of 47 patients (4%) and ARsESHRE-ESGE in 4 of 47 patients (9%). RSESHRE-ESGE was diagnosed significantly more often than RSASRM > 1 cm 19 of 96 (20%) versus 5 of 96 (5%) in all patients (ORESHRE-ESGE:ASRM > 1 cm = 4.5, P < 0.01). In patients who had no adhesion barrier, logistic regression with ASRM > 1 cm and ESHRE-ESGE criteria showed that the width and surface area were predictors of ARs. Models adjusted by patient group confirmed the significance of width as a predictor of ARsASRM > 1 cm [OR for width, 3.5 (P < 0.01); OR for group, 0.22 (P < 0.01)], width as a predictor of ARsESHRE-ESGE [OR for width, 2.2 (P < 0.01); OR for group, 0.26 (P < 0.01)] and surface area...

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Section: Methodsmentioning

confidence: 99%

Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty

Ludwin

Pityński

et al. 2014

Human Reproduction

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“…This study included patients with myoma of small/moderate size (diameter between 20 and 35 mm) [18]. In patients with myoma diameter >3.5 cm, the preoperative therapy may have a more relevant effect on completeness of surgery, which is dependent on myoma size [19,20]. In addition, myoma volume is also likely to influence the other objectives of the study (operative parameters and changes in myoma volume caused by hormonal therapy).…”

Section: Commentsmentioning

confidence: 99%

Three-month treatment with triptorelin, letrozole and ulipristal acetate before hysteroscopic resection of uterine myomas: prospective comparative pilot study

Bizzarri

Ghirardi

Remorgida

et al. 2015

European Journal of Obstetrics & Gynecology and Reproductiv

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“…One hundred and twenty patients with symptomatic submucous myomas were divided into two groups: the hysteroscopic myomectomy under transrectal ultrasound guidance [TRUS] group (n 5 58) and the hysteroscopic myomectomy without TRUS group (n 5 62). The rate of 1-step complete excision of submucous myomas was higher in the hysteroscopic myomectomy with TRUS group (91% vs 73%, p 5 .02) [25].…”

Section: Discussionmentioning

confidence: 83%

“…Intraoperative ultrasound imaging has been used successfully in monitoring hysteroscopic metroplasty and myomectomy to minimize the risk of uterine perforation and to achieve complete excision of the septum or myoma in a 1-step procedure [24,25]. In a prospective study, Ludwin et al evaluated the usefulness of intraoperative transrectal ultrasound in monitoring hysteroscopic resection of submucous myomas.…”

Section: Discussionmentioning

confidence: 99%

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

Zayed

Fouda

Zayed

et al. 2015

Journal of Minimally Invasive Gynecology

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Transrectal Ultrasound-Guided Hysteroscopic Myomectomy of Submucosal Myomas With a Varying Degree of Myometrial Penetration

Cited by 35 publications

References 27 publications

Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty

Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty

Three-month treatment with triptorelin, letrozole and ulipristal acetate before hysteroscopic resection of uterine myomas: prospective comparative pilot study

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

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