New hysteroscopic techniques for submucosal uterine fibroids

Abstract

Hysteroscopic resection of submucous uterine fibroids should be a simple, well tolerated and effective procedure. Innovations to the existing hysteroscopic techniques and the development of the hysteroscopic morcellator will hopefully result in a greater number of gynecologic surgeons being able to safely perform hysteroscopic resection of submucous uterine fibroids.

Elastography Improves the Diagnostic Accuracy of Sonography in Differentiating Endometrial Polyps and Submucosal Fibroids

“…However, it has to be noted that usually in the cases of both a suspected polyp and a submucosal fibroid, surgical hysteroscopy is performed. In submucosal fibroids, the hysteroscopic resection may be more difficult and may require the use of hysteroscopic morcellators 4 . That factor is why distinguishing these entities before attempting the surgery may be important.…”

“…The PALM–COEIN (polyps, adenomyosis, leiomyoma, malignancy and hyperplasia–coagulopathy, ovulatory disorders, endometrial causes, iatrogenic, not classified) classification by the International Federation of Gynecology and Obstetrics defines the possible reasons for abnormal uterine bleeding, and these include structural causes: endometrial polyps and submucosal fibroids. Even though in the cases of both endometrial polyps and submucosal fibroids, surgical hysteroscopy should be performed, differentiating intrauterine lesions may be important, as in suspected submucosal fibroids, hysteroscopic morcellators may be necessary 4 …”

“…Even though in the cases of both endometrial polyps and submucosal fibroids, surgical hysteroscopy should be performed, differentiating intrauterine lesions may be important, as in suspected submucosal fibroids, hysteroscopic morcellators may be necessary. 4 Transvaginal sonography is the first-line imaging examination in abnormal uterine bleeding. 1 The role of power Doppler imaging in the diagnosis of endometrial disorders has been reported.…”

The Role of Hysteroscopic and Robot-assisted Laparoscopic Myomectomy in the Setting of Infertility

“…In this case, the surgeon runs the risk of causing a uterine perforation, and another minimally invasive technique should be used. 27 Furthermore, certain locations of submucosal fibroid removal may be close to the cornual region of the uterus, and HM may ablate or occlude the tubal ostia. 27 The imaging modalities of transvaginal ultrasound (TVUS), saline sonohysterogram (SSH), and magnetic resonance imaging (MRI) can be utilized to ''map'' fibroids before surgery.…”

“…27 Furthermore, certain locations of submucosal fibroid removal may be close to the cornual region of the uterus, and HM may ablate or occlude the tubal ostia. 27 The imaging modalities of transvaginal ultrasound (TVUS), saline sonohysterogram (SSH), and magnetic resonance imaging (MRI) can be utilized to ''map'' fibroids before surgery. TVUS is the most widely used first-line pelvic imaging modality, but has its limitations: in our experience it is best utilized when assessing small uteri, with 4 or fewer fibroids.…”