Indications for Myomectomy of Deep Intramural Submucous Fibroids

Abstract

Objective: To establish indications for hysteroscopic versus transserosal myomectomy of submucous myomas located deep within the uterine wall.Design: Retrospective studySetting: Department of gynecology at a general hospital.Patients: Twenty-one women with submucous myomas, each with 6 mm. These fibroids were completely removed by hysteroscopic myomectomy. In one case of submucous fibroids with maximum diameter of > 40mm and SMT of 7 mm, the fibroids were removed by 2 sessions of hysteroscopic myomectomy. In 9 cases of fibroids with maximum diameter of > 40mm or SMT < 5 mm, the tumors were easily removed by transmural myomectomy. In 4 cases with tumor diameters between 30mm and 40mm, the challenge level of transcervical resection varied depending on the SMT, the fibroid location, the presence of complications, and the possibility of obtaining sufficient preoperative dilatation of the cervical canal.Three patients conceived after hysteroscopic myomectomy and five patients conceived after transserosal myomectomy. Uterine rupture did not occur, and complication rates were low with both procedures.Conclusion: Transmural excision of submucous myomas may be optimal when maximum tumor diameter exceeds 40mm, whereas hysteroscopic myomectomy is better suited for submucous fibroids with maximum diameter under 30mm. With tumor diameters between 30mm and 40mm, either procedure may be utilized. In such cases, SMT and other factors will be useful determinants of an appropriate surgical approach.