Hysteroscopic myomectomy

Batra, Neelam; Khunda, Aethele; O’Donovan, Peter

doi:10.1016/j.ogc.2004.06.003

Cited by 23 publications

(13 citation statements)

References 75 publications

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“…The bleeding symptoms disappeared in 84% of patients and hysteroscopic myomectomy offered long-term improvement in the menstrual pattern and patient satisfaction, as is also reported by others [28]. Appropriate selection of patients (with no multiple myomas and no deep myomas penetrating the uterine wall) is essential for the success of the procedures, which were performed as outpatient surgery in most cases.…”

Section: Discussionsupporting

confidence: 61%

Fertility rates after hysteroscopic treatment of submucous myomas depending on their type

et al. 2006

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Section: Discussionsupporting

confidence: 61%

Fertility rates after hysteroscopic treatment of submucous myomas depending on their type

et al. 2006

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“…Large-diameter hysteroscopic resectoscopes that were developed originally to resect the endometrium for the treatment of HMB 89 can also be used to resect focal pathologies, such as SMFs 77,90 or polyps. 91,92 They have the advantage of speed and manipulation, but the large diameter of the instruments necessitates general anaesthesia, specialised skills are required 93,94 and potential serious complications from fluid overload and inadvertent electrosurgical injury can occur. 95 In contrast with firm SMFs of myometrial origin, polyps are generally softer structures that are derived from the underlying endometrium.…”

Section: Blind Uterine Polypectomymentioning

confidence: 99%

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Clark

Middleton

Cooper

et al. 2015

Health Technol Assess

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BackgroundUterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited.ObjectivesTo test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined.DesignA multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study.SettingOutpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals.ParticipantsWomen with AUB – defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding – and hysteroscopically diagnosed uterine polyps.InterventionsWe randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia.Main outcome measuresThe primary outcome was successful treatment at 6 months, determined by the woman’s assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained.ResultsAt 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively.ConclusionsWhen treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower.Trial registrationCurrent Controlled Trials ISRCTN 65868569.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.

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“…It eliminates the need for a laparotomy and is associated with lower morbidity than abdominal myomectomy [2]. Abnormal uterine bleeding and reproductive issues are the most common indications [3].…”

Section: Introductionmentioning

confidence: 99%

“…Abnormal uterine bleeding and reproductive issues are the most common indications [3]. The benefits of the procedure are reflected by the improvement in menstrual pattern, fertility rate and overall patient satisfaction [2]. To achieve the full potentials of this technique, appropriate case selection and surgical expertise are essential [2].…”

Section: Introductionmentioning

confidence: 99%

“…The benefits of the procedure are reflected by the improvement in menstrual pattern, fertility rate and overall patient satisfaction [2]. To achieve the full potentials of this technique, appropriate case selection and surgical expertise are essential [2]. It should be the preferred conservative surgical therapy for management of symptomatic intracavitary fibroids [4].…”

Section: Introductionmentioning

confidence: 99%

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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

Lasmar

Barrozo

Rosa³

et al. 2008

Gynecol Surg

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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.

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Hysteroscopic myomectomy

Cited by 23 publications

References 75 publications

Fertility rates after hysteroscopic treatment of submucous myomas depending on their type

Fertility rates after hysteroscopic treatment of submucous myomas depending on their type

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

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

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