A New System to Classify Submucous Myomas: A Brazilian Multicenter Study

Lasmar, Ricardo Bassil; Lasmar, Bernardo Portugal; Celeste, Roger Keller; Rosa, Daniela Baltar da; Depes, Daniella de Batista; Lopes, Reginaldo Guedes Coelho

doi:10.1016/j.jmig.2012.03.026

Cited by 36 publications

(23 citation statements)

References 12 publications

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“…There are uncommon uterine conditions, which can predispose patients to massive absorption and fluid overload. Taking into account the ESGE (European Society for Gynaecological Endoscopy) and STEPW (Size, Topography, Extension, Penetration, and Wall) classifications to submucous myomas, the STEPW classification allows better prediction of myoma removal, fluid balance, length of surgery and surgical complications in hysteroscopic myomectomy than ESGE classification 33 . Moreover, the location of the myomas does not matter when patient hasa uterus with multiple myomas and low compliance for fluid distention and high vascularization.…”

Section: Discussionmentioning

confidence: 99%

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases

Fonseca¹,

Andrade²,

Nogueira³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To verify the predictors of intravasation rate during hysteroscopy. METHODS: Prospective observational study (Canadian Task Force classification II-1). All cases (n=200 women; 22 to 86 years old) were treated in an operating room setting. Considering respective bag overfill to calculate water balance, we tested two multiple linear regression models: one for total intravasation (mL) and the other for absorption rate (mL.min -1). The predictors tested (independent variables) were energy (mono/bipolar), tube patency (with/without tubal ligation), hysterometry (cm), age≤50 years, body surface area (m 2 ), surgical complexity (with/without myomectomy) and duration (min). RESULTS: Mean intravasation was significantly higher when myomectomy was performed (442±616 versus 223±332 mL; p<0.01). In the proposed multiple linear regression models for total intravasation (adjusted R 2 =0.44; p<0.01), the only significant predictors were myomectomy and duration (p<0.01).In the proposed model for intravasation rate (R 2 =0.39; p<0.01), only myomectomy and hysterometry were significant predictors (p=0.02 and p<0.01, respectively). CONCLUSIONS: Not only myomectomy but also hysterometry were significant predictors of intravasation rate during operative hysteroscopy. ResumoOBJETIVO: Testar preditores do ritmo de intravasamento durante histeroscopia cirúrgica. MÉTODOS: Estudo prospectivo observacional (classificação: Canadian Task Force II-1) incluindo casos conduzidos em centro cirúrgico (n=200 mulheres; 22 a 86 anos de idade). Considerando os erros de aferição nas embalagens de solução de irrigação para calcular o balanço hídrico, nós testamos dois modelos de regressão linear múltipla: um para intravasamento total (mL) e outro para ritmo de intravasamento (mL.min -1 ). Os preditores testados (variáveis independentes) foram energia (mono/ bipolar), permeabilidade tubária (com/sem ligadura tubária), histerometria (cm), status ovariano (idade≤50 anos), área de superfície corporal (m 2 ), complexidade de cirurgia (com/sem miomectomia) e tempo de ressecção (min). RESULTADOS: O intravasamento médio foi significativamente maior quando miomectomia foi realizada (442±616 versus 223±332 mL, p<0,01). No modelo proposto para intravasamento total (R 2 ajustado=0,44; p<0,01), os únicos preditores significativos foram miomectomia e tempo de duração (p<0,01). No modelo proposto para a taxa de intravasamento (R 2 =0,39; p<0,01), somente miomectomia e histerometria foram preditores significativos (p=0,02 e p<0,01, respectivamente). CONCLUSÕES: Não só a miomectomia mas também a histerometria são preditores significativo da taxa de intravasamento durante histeroscopia cirúrgica.

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Section: Discussionmentioning

confidence: 99%

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases

Fonseca¹,

Andrade²,

Nogueira³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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“…Fibroids level 0 and some level 1 can be removed without anesthesia in the same procedure of hysteroscopy. The myomectomy technique is the direct mobilization of the fibroid [5], uses no energy of any kind, allows the use of smaller diameter material, and causes less discomfort for the patient. It is also possible to use bipolar energy with small diameter instrument, allowing office hysteroscopic myomectomy to be performed with less discomfort and securely [12].…”

Section: Discussionmentioning

confidence: 99%

“…In 2005, Lasmar et al developed the STEPW classification [4,5] which provides the degree of difficulty of hysteroscopic myomectomy by classifying the fibroids preoperatively. This classification includes intracavitary fibroids only; cervical fibroids are not contemplated.…”

Section: Introductionmentioning

confidence: 99%

Office hysteroscopic cervical myomectomy

Lasmar

Pillar

2012

Gynecol Surg

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“…The first was a multicenter and prospective study in six hysteroscopy centers in Brazil (205 submucous fibroids removal) and concluded that classifying submucous myomas with the STEPW classification allows better prediction of myoma removal, fluid balance, length of surgery and surgical complications in hysteroscopic myomectomy than ESES classification. (7) The second was multicenter, prospective study conducted in four hysteroscopy centers in Brazil, China, Italy, and the United States (465 submucous myomas removed hysteroscopically) and also it concluded that the STEPW classification was helpful in predicting which submucous fibroids would be incompletely removed by hysteroscopic myomectomy. (8) In this study, correlation of the 2 system classification was done with complete or incomplete myomectomy, length of surgery, fluid balance and surgical complication in Egyptian women undergoing hysteroscopic myomectomy and it agreed with the results and conclusion of the previous 2 multicenter studies.…”

Section: Disscusionmentioning

confidence: 99%

“…Since then, only few studies have been conducted comparing the 2 classification systems. One study included only Brazilian women (7) and the other was a multicenter study conducted in China, Italy and United States as well as Brazil (8) . Both studies reached the same conclusion that STEPW classification allows better prediction of myoma removal, fluid balance, surgical complications and operative time in hystroscopic myomectomy than ESES classification.…”

Section: Introductionmentioning

confidence: 99%

Submucous Fibroid: Different Presurgical Classification Methods and Their Effect on Hysteroscopic Surgical Management

Amin

Ahmed

Seksaka

et al. 2013

Zagazig University Medical Journal

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Objective: To compare the degree of difficulty and outcome measures of hysteroscopic myomectomy of submucous fibroid according to 2 classification systems. Methods: This prospective study conducted in the Cytogenetic & Endoscopy unit, Zagazig University Hospitals during the period from July 2009 to July 2012, included 100 patients candidates for hysteroscopic resection of submucous fibroids. All fibroids were diagnosed and assessed by saline infusion sonohysterography and diagnostic hysteroscopy. Presurgical classification was performed according to the two classification systems; the European Society of Endoscopic Surgery (ESES)-considering only the penetration of the fibroid into the myometrium -and STEPW considering size, topography, extension, penetration and wall affected. Primary outcome measure was incomplete resection of the fibroid. Secondary outcome measures were operating time (in minutes), the fluid deficit (in milliliters) and any intraoperative complications. Sensitivity, specificity and kappa measure of agreement were calculated for each classification at their best cut off. P value less than 0.05 is considered significant. Results: Myomectomy was considered incomplete in 8 out of 104 fibroids (7.7%) According to ESES, 2 belonged to type 0 and 6 belonged to type 1.Risk ratio and 95% confidence interval (CI) was 0.56 (0.07-3.3) and the difference was not significant (p=0.7); whereas according to the STEPW classification, the incomplete myomectomies were one in group I (1/8, 12.5%) and seven in group II (7/8, 87.5%). The risk ratio (95% CI) was 0.02 (0.0-0.18) and the difference was significant (p= 0.000). Considering the area under the ROC curve, the dichotomized STEPW scores performed better than the dichotomized ESES scores (P<.001). Conclusion:The application of STEPW classification of submucous fibroid gives better prediction of myoma removal than ESES classification.

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A New System to Classify Submucous Myomas: A Brazilian Multicenter Study

Cited by 36 publications

References 12 publications

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases

Office hysteroscopic cervical myomectomy

Submucous Fibroid: Different Presurgical Classification Methods and Their Effect on Hysteroscopic Surgical Management

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