Abstract
Purpose To assess the feasibility rate of one-step hysteroscopic myomectomy according to the technique adopted. Methods In July 2016, PubMed, ClinicalTrials.gov, SCOPUS, Scielo, and AJOL databases were used for searching references. Series of in-patient hysteroscopic myomectomies reporting success rate in only one-step procedure, categorization of submucous fibroids, explanation of the surgical technique, and description of patients were considered eligible for meta-analysis (retrospective, prospective randomized studies). Two authors extracted the data. Rate of myomectomies accomplished in only a surgical step and rate of intraoperative complications were extracted per protocol. A modified GRADE score was used for quality assessment. Random-effect models were already assumed. Mean rates were compared among subgroups. Results One thousand two hundred and fifty-seven studies were screened and 241 of these were read for eligibility. Seventy-eight series were included in qualitative synthesis and 24 series were included in quantitative synthesis. Wide heterogeneity was found. In series with <50% of G2 myomas treated, the slicing technique feasibility rate was 86.5% while techniques for enucleating the deep portion of the myomas showed a feasibility rate of 92.3% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (Conclusion In case of submucous myomas with intramural development, the slicing technique was correlated with a lower rate of in-patient hysteroscopic myomectomies accomplished in a one-step procedure and a higher complications rate.
Highlights
Uterine myomas, called leiomyomas or fibroids, are benign, monoclonal tumours developing from the smooth muscle cells of the myometrium
The main limit in performing hysteroscopic myomectomy has always been represented by the intramural component of submucous myomas, as it is responsible for unsatisfactory surgical outcomes, intraoperative complications, and need for repeated procedures [9, 10]. e difficulty to manage submucous myomas with a deep myometrial development was well described and demonstrated by Wamsteker in 1993, conceiving a new classification—still used today—based on the amount of intramural component of submucous myomas. e authors suggested limiting the treatment of deeper submucous myomas only in selected cases because it correlated with high risk of repeated procedures [9]
It can be stated that there is still no single hysteroscopic technique proven to be unequivocally superior to the others for treating submucous fibroids with intramural development in one-surgical step
Summary
Called leiomyomas or fibroids, are benign, monoclonal tumours developing from the smooth muscle cells of the myometrium. Neuwirth in 1976 described the first “excision of submucous fibroids with hysteroscopic control,” performed by classical slicing technique This new surgical approach was a breakthrough in the treatment of submucous myomas, the authors recommended resectoscopic myomectomy be performed only by expert endoscopic surgeons [7, 8]. The main limit in performing hysteroscopic myomectomy has always been represented by the intramural component of submucous myomas, as it is responsible for unsatisfactory surgical outcomes, intraoperative complications, and need for repeated procedures [9, 10]. In order to minimize the need of repeated procedures, the authors conceived techniques to accomplish the treatment in only one surgical time [11], as multiple treatments can cause physical and mental stress for both surgeons and patients, along with a higher surgical risk [12]. As a secondary outcome, the rate of intraoperative complications recorded in the selected clinical series, when reported, was meta-analysed to assess the safety of each technique
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