Hysteroscopic myomectomy without anesthesia

Abstract

Objective Scarce literature about myoma removal without anesthesia has been published. The aim of this paper is to evaluate the feasibility of a new alternative for a hysteroscopic myomectomy in a conventional office setting, without need for anesthesia. Methods Step-by-step description of the surgical technique has been provided, based on video images. An office hysteroscopy was performed in a Gynecological Endoscopy Department of a tertiary European hospital. Results A 49-year-old woman was referred for management of severe hypermenorrhea. Consent and approval were received from the patient and the institutional review board, respectively. The introduction of a Truclear ® hysteroscopic polyp morcellator of 5.5 mm with optic of 0 degrees into the uterine cavity did not require any kind of anesthesia or cervical dilatation. The use of saline flow helped distend the cavity and identify a submucosal myoma. Under direct vision, a full myomectomy was performed via mechanical energy with continuous cutting movements, without any complication. After the procedure was completed, the excised material was aspirated through the device into a collecting pouch. A successful complete morcellation of a Type-0 submucosal leiomyoma with a polyp morcellator device was performed in an outpatient setting. Good medical results, good tolerance by the patient besides lower surgical risks due to mechanical instead of electrical energy are shown. Conclusion In conclusion, this video demonstrates that a hysteroscopic myomectomy can be performed successfully in office with lower risk of complications from the procedure and without use of general anesthesia besides good tolerance by the patient.

Utilization of Pleth Index in Hysteroscopic Surgery: A Randomized Controlled Trial

“…Hysteroscopic surgery has become an established and widely practiced minimally invasive approach for treating intrauterine pathologies including endometrial polyps, submucous broids, uterine septa, intrauterine adhesions, and retained products of conception [1]. Outpatient hysteroscopy involves short, minimally painful procedures with thinner instruments (< 5-mm hysteroscopes [16]), and generally does not require anesthesia. However, some non-anesthetized patients who have anxiety or who have previously undergone failed surgical procedures cannot tolerate the pain of cervical dilatation, which may lead to vasovagal syndrome (a 0.21-30% incidence [17]) during this procedure.…”

Anesthetic Techniques for Gynecological Surgeries in Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria

“…"Uterine fibroids (also known as myomas or leiomyomas) are the most common benign solid tumors found in the female genital tract. Incidence ranges from 30% to 80% depending on the age of the patient" [11]. They occur in 20-25% of women of reproductive age causing 3-5% of gynecology consultations [6], [12].…”

Evaluation of whether there is residual polyp tissue after hysteroscopic morcellation at Cam and Sakura City Hospital: a retrospective cohort study

“…Recent studies have shown that mechanical hysteroscopic morcellators that simultaneously cut and remove the targeted endometrial pathology are safe and effective alternatives to conventional hysteroscopy [ 4 – 6 ]. Advances in hysteroscopy instruments and ancillary equipment used in visualization have enabled especially mechanical hysteroscopic morcellators to be used in an office setting without the need for operating room conditions or general anesthesia [ 7 , 8 ].…”