Long-term Results of Hysteroscopic Myomectomy for Abnormal Uterine Bleeding

Emanuel, Mark Hans; Wamsteker, Kees; Hart, A. A. M.; Metz, Godfried C.H.; Lammes, F. B.

doi:10.1097/00006250-199905000-00021

Cited by 34 publications

(33 citation statements)

References 13 publications

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“…In a study including 94 patients who underwent conventional hysteroscopic myomectomy and after 9 years of follow up, 84% of patients had not required further surgery [28]. These data suggest the effectiveness of this method over the long term, as it is reported and by others [29][30][31]. Although transcervical resection of submucous myomas is an effective treatment of abnormal uterine bleeding, many gynecologists combine the procedure with an endometrial ablation in patients with no future pregnancy desire [32].…”

Section: Review Of the Literaturementioning

confidence: 77%

“…Although transcervical resection of submucous myomas is an effective treatment of abnormal uterine bleeding, many gynecologists combine the procedure with an endometrial ablation in patients with no future pregnancy desire [32]. According to the number of myomas, transcervical resection of submucous myomas is safe and is the method of choice for patients with a normal-sized uterus and not more than two myomas [29]. Depending on the size of the intramural part of a submucosal myoma, one-or two-step surgery is required [33,34]; whereas, GnRH agonists are useful in reducing myoma size and expelling the myoma inside the uterine cavity [35].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…The resection of the intramural portion is firmly related to the increased loss of the irrigating and distending fluid. Resection of type II myomas with extensive intramural involvement should therefore be performed only by experienced surgeons in selected cases [29]. For type 0 and I myomas, rarely does any patient need more than one procedure to achieve complete resection, and the technique seems to be the best choice.…”

Section: Review Of the Literaturementioning

confidence: 99%

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Hysteroscopic myomectomy

Stamatellos

Bontis

2007

Eur Clinics Obstet Gynaecol

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Hysteroscopic treatment of submucous myomas is a safe and effective treatment in patients presenting with abnormal uterine bleeding and subfertility. Resection of fibroids can be performed with the assistance of monopolar or bipolar energy, hysteroscopic scissors or by applying yttrium aluminium garnet (Nd:YAG) laser. Modern resectoscopic techniques have expanded treatment options for these patients. Before surgery, the size, number, localization and intramural extent should be determined by hysteroscopy and/or sonohysterography to be able to ascertain the possibilities for resection and the technique to be used. Appropriate patient preparation will make the operation easier and reduce complication rates. There is a greater chance of successful procedure with the smaller proportion of the myoma within the myometrium. Long-term results have shown high satisfaction rates with improved menstrual symptoms and pregnancy rates. Pre-operative counseling and accurate documentation is essential. When complications do occur, it is rarely required to have prompt diagnosis and immediate treatment.

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Section: Review Of the Literaturementioning

confidence: 77%

Section: Review Of the Literaturementioning

confidence: 99%

Section: Review Of the Literaturementioning

confidence: 99%

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Hysteroscopic myomectomy

Stamatellos

Bontis

2007

Eur Clinics Obstet Gynaecol

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“…Emanuel and colleagues 23 noted that almost all ESH type 0 myomas could be removed with one surgical procedure. When uterine fi broids, even type 0, weighed more than 15 g, the chance increased that multiple procedures were needed for complete removal.…”

Section: Resultsmentioning

confidence: 99%

Hysteroscopic Resection of Myomas and Polyps

Bradley¹

2009

Hysteroscopy

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In 1860, Pantaleoni performed the fi rst operative hysteroscopy when he cauterized a bleeding polyp in a postmenopausal woman. A century later, modifi cations of the urologic resectoscope provided gynecologists a new visually directed method to resect intrauterine polyps and submucosal fi broids, to treat synechiae, and to obtain targeted biopsies ( Fig. 19-1). The fi rst operative hysteroscopic polypectomy and myomectomy were performed by Neuwirth in 1976, using ovum forceps and electrosurgery. 1 Gynecologists are slowly embracing operative hysteroscopy to treat myriad intrauterine conditions. The development of a continuous fl ow resectoscope permitted distention of the uterine cavity with fl uid and removal of blood and debris. Since the 1990s, improvements in optics, video recording, and intrauterine distention systems, as well as scrutiny of types and amounts of fl uid used during operative hysteroscopy have improved the safety of hysteroscopic surgery. Preoperative pain management, cervical dilating agents, paracervical blocks, and smaller-diameter hysteroscopes have increased the number of procedures performed in the offi ce or under minimal sedation. Physician awareness of the benefi ts of operative hysteroscopy and excellent outcomes has increased its use. Patient demand for minimally invasive surgery has also been infl uential. Monopolar instrumentation, bipolar equipment, and hysteroscopic morcellators that remove uterine debris (fi broid chips or polyp pieces) are now available. Hysteroscopic morcellators are the newest devices available to gynecologists. These two new modifi cations in the hysteroscope increase the speed of the procedure, remove intrauterine debris, and improve intraoperative visualization.The desire of many women to retain the uterus and return to normal activities quickly prompted development of lessinvasive technologies for treating uterine fi broids. Operative hysteroscopy fulfi lls those goals in appropriately triaged patients who have intracavitary lesions amenable to hysteroscopic intervention. GENERAL PRINCIPLESPerforming operative hysteroscopic myomectomy requires six essential components: • Determining indications and contraindications for hysteroscopic surgery • Excellent preoperative evaluation of uterine fi broids, including a detailed knowledge of the number, size, location, and depth of myometrial involvement of the uterine fi broid (Fig. 19-2) • Superb eye-hand coordination • Detailed understanding of fl uid management and fl uid management systems • Astute surgical skills and intraoperative judgment • Judgment and common sense regarding when to abandon the hysteroscopic approach PATIENT SELECTION AND COUNSELINGThe desire of many women to retain their uterus and return to normal activities quickly prompted the development of lessinvasive technologies for treating symptomatic fi broids. Fibroids are associated with abnormal uterine bleeding, bulk symptoms, and infertility. Choosing the right procedure requires a marriage between the symptoms and the procedure most like...

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“…Myomectomy is a standard surgical method for women who want to preserve their fertility, and this procedure allows preservation of the uterus [6]. Myomectomy has been traditionally performed by laparotomy, but over the last decade, laparoscopic [11] and hysteroscopic [7] techniques have been developed. The surgery can now be performed laparoscopically and hysteroscopically.…”

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confidence: 99%