Office Hysteroscopic Laser Enucleation of Submucous Myomas without Mass Extraction: A Case Series Study

Abstract

Background and Objectives. A new two-step hysteroscopic myomectomy carried out in the office setting and without anesthesia was feasible for the excision of submucous myomas. The objective of this study was to assess whether removal of submucous myomas from the uterine cavity after hysteroscopic laser enucleation is necessary. Methods. Between June 2009 and April 2013, all outpatients with symptomatic myomatosis (bleeding, pelvic pain, and infertility) assessed ultrasonographically were eligible to participate in a prospective study. All patients underwent office hysteroscopic enucleation of submucous myomas. Enucleated myomas were left in the uterine cavity. Neither anesthesia nor antibiotic prophylaxis was used. Results. Sixty-one women (mean age: 47.3 years) were included. Regardless of hysteroscopic localization and grading, all myomas were enucleated. The mean (standard deviation, SD) diameter of the myoma as measured by the ultrasound scan was 22.6 (8.5) mm. In 29 cases (47.5%), the diameter of the resected myoma was >20 mm and in 10 cases (16.4%) >30 mm. After a mean follow-up of 68.2 (16.5) days, none of the patients showed a residual myoma inside the uterine cavity. Conclusions. The present results indicate that leaving laser-enucleated submucous myoma in the uterine cavity is a feasible and safe therapeutic option.

Office Hysteroscopic Treatment of Uterine Fibroids

“…These authors reported on further 61 patients with office hysteroscopic myomectomy, using a similar technique [14]. It is not clear whether the patients who were included in the previous report were included again in this second report, although there is overlap of the times of these two studies.…”

New Hysteroscopic Approaches to Uterine Fibroids

“…If the myoma remains enucleated and free in the uterine cavity, there are authors that advocate leaving it for spontaneous expulsion, in the Haimovich series (after laser myomectomy) the median duration to expulsion being 68 days, with no complication [5].…”

“…The incidence of infection following operative hysteroscopy varies between 0.01 [5] and 1.42% [32]. Prevention of infection may be possible by reducing the duration of the intervention.…”

Nesa Days 2015, Conference Report

“…Dr. Sergio Haimovic from Spain presented the feasibility of a new two-step technique for office hysteroscopic resection of submucous myomas, by office laser treatment [34]. He enrolled patients in reproductive age with symptomatic lesions sonographically diagnosed as single mainly intracavitary (G1 or G2) myoma <4.0 cm, Patients underwent a two-step hysteroscopic procedure, which included preparation of partially intramural myomas with incision of the endometrial mucosa and the pseudocapsule covering the myoma in the first step, and excision of the myoma by means of diode laser four weeks later.…”