Hysteroscopic Myomectomy: An Effective and Minimally Invasive Surgical Option for Submucous Myoma

Abstract

Study Objective: Hysteroscopic myomectomy is a minimally invasive technique for treatment of submucous myomas. It averts need for laparotomy, reduces morbidity and hospital stay considerably and improves conception in patients with infertility. To assess the safety and effectiveness of submucous myomectomy.Design: Retrospective study of forty patients undergoing hysteroscopic myomectomy.Setting: Tertiary care center.Patients: Forty patients with submucosal uterine myoma.Intervention: Hysteroscopic myomectomy.Measurements and Main Results: The indication for surgery were infertility in 25 (62.5%), menorrhagia in 14 (40%) and recurrent abortions in 1 (2.5%). Twenty-eight (70%) patients had single myoma and 12 (30%) had multiple myoma. Size of myoma varied from 3 x 3cm to 20 x20cm. Most (28, 70%) of the myoma were arising from fundus of the uterus, 3(7.5%) from anterior wall, 5(12.5%) from posterior wall and 4 (10%) from the side wall of the uterus. Twenty one (52.5%) myomas were confined to endometrium, 14 (35%) were infiltrating myometrium less than 50% and 5(12.5%) were infiltrating more than 50%. Four (10%) patients received preoperative uterine preparation (danazol in 2: GnRH analogues in 2). Procedure could be performed in single sitting in all except one (39, 97.5%). Laparotomy was needed in two patients (those with myoma infiltrating >50% of myometrium). None required blood transfusion. There was no perioperative or postoperative complication. All except two (95%) were discharged within 24 hrs. On follow up menorrhagia was persistent in 4 patients. One (2.5%) had recurrence of myoma. Conception rate in patient with infertility was 60% (15/25).Conclusion: Hysteroscopic myomectomy is safe and effective surgical option for submucous myoma in women presenting with abnormal uterine bleeding and infertility. Study Objective: Hysteroscopic myomectomy is a minimally invasive technique for treatment of submucous myomas. It averts need for laparotomy, reduces morbidity and hospital stay considerably and improves conception in patients with infertility. To assess the safety and effectiveness of submucous myomectomy. Design: Retrospective study of forty patients undergoing hysteroscopic myomectomy. Setting: Tertiary care center. Patients: Forty patients with submucosal uterine myoma. Intervention: Hysteroscopic myomectomy. Measurements and Main Results: The indication for surgery were infertility in 25 (62.5%), menorrhagia in 14 (40%) and recurrent abortions in 1 (2.5%). Twenty-eight (70%) patients had single myoma and 12 (30%) had multiple myoma. Size of myoma varied from 3 x 3cm to 20 x20cm. Most (28, 70%) of the myoma were arising from fundus of the uterus, 3(7.5%) from anterior wall, 5(12.5%) from posterior wall and 4 (10%) from the side wall of the uterus. Twenty one (52.5%) myomas were confined to endometrium, 14 (35%) were infiltrating myometrium less than 50% and 5(12.5%) were infiltrating more than 50%. Four (10%) patients received preoperative uterine preparation (danazol in 2: GnRH analogues in 2). Procedure could be performed in single sitting in all except one (39, 97.5%). Laparotomy was needed in two patients (those with myoma infiltrating >50% of myometrium). None required blood transfusion. There was no perioperative or postoperative complication. All except two (95%) were discharged within 24 hrs. On follow up menorrhagia was persistent in 4 patients. One (2.5%) had recurrence of myoma. Conception rate in patient with infertility was 60% (15/25). Conclusion: Hysteroscopic myomectomy is safe and effective surgical option for submucous myoma in women presenting with abnormal uterine bleeding and infertility.