Laser Hysteroscopic Myomectomy Guided by Laparoscopically Assisted Intra-Abdominal Sonohysterography (LHMY-GLAIS): A Preliminary Report

Abstract

The purpose of this study was to evaluate a new method of hysteroscopic myomectomy based on laser energy delivered by hysteroscopy and guided laparoscopically by intra-abdominal sonography. Laser photo-irradiation and vaporization of myomas was clearly monitored by intra-abdominal sonography, particularly in patients with intramural myomatous components. Fluids used for uterine distention and intra-abdominal washings were those containing electrolytes, therefore abolishing risk for hyponatremia. The exact position of the ultrasound transducer was monitored by laparoscopy while sonohysterography confirmed the exact location of the laser fiber tip and the direction of the laser beam. The actual direction of the laser was controlled by hysterofiberoscopy. Complete removal or vaporization of myomas was successfully performed in 21 of 24 selected women, an 87.5% success rate in patients with single myomas, and 33.3%, 1 of 3, in patients with multiple myomas. No complications occurred. We conclude that this novel method for hysteroscopic myomectomy, permits the monitoring and precise control of the Nd:YAG laser energy in the treatment of submucous and partially intramural submucous leiomyomas. Further innovations may include the automatic tracking of the ultrasound system for laser irradiation and decrease in diameter of ultrasonic probe to 5 mm with possible incorporation of the ultrasound system in the laparoscope itself.