Reply of the Authors

Abstract

We would like to thank Leone et al. for the positive comments on our study, “Does Cold Loop Hysteroscopic Myomectomy Reduce Intrauterine Adhesions? A Retrospective Study” (1Mazzon I. Favilli A. Cocco P. Grasso M. Horvath S. Bini V. et al.Does cold loop hysteroscopic myomectomy reduce intrauterine adhesions? A retrospective study.Fertil Steril. 2014; 101: 294-298Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar). The excellent outcomes reported by Leone et al. (2Leone F.P. Calabrese S. Marciante C. Cetin I. Ferrazzi E. Feasibility and long-term efficacy of hysteroscopic myomectomy for myomas with intramural development by the use of non-electrical “cold” loops.Gynecol Surg. 2012; 9: 155-161Crossref Scopus (17) Google Scholar) in terms of safety, efficacy, and pregnancy rate (45%) confirm that cold loop hysteroscopic technique could improve fertility in patients seeking pregnancy, preserving the integrity of the myometrium and avoiding thermal damage to the healthy tissue close to the myoma. Indeed, the adhesions rate reported in the cited study is not significantly different from our results (P=.46), confirming the low synechiae rate achievable with our technique. In addition, these results and the short learning curve reported by Leone et al. (2Leone F.P. Calabrese S. Marciante C. Cetin I. Ferrazzi E. Feasibility and long-term efficacy of hysteroscopic myomectomy for myomas with intramural development by the use of non-electrical “cold” loops.Gynecol Surg. 2012; 9: 155-161Crossref Scopus (17) Google Scholar) demonstrate the reproducibility of the technique by the surgeon independently. In the same report (2Leone F.P. Calabrese S. Marciante C. Cetin I. Ferrazzi E. Feasibility and long-term efficacy of hysteroscopic myomectomy for myomas with intramural development by the use of non-electrical “cold” loops.Gynecol Surg. 2012; 9: 155-161Crossref Scopus (17) Google Scholar), the authors affirm that the “perioperative outcomes were significantly different when comparing myoma mean diameter <3.0 vs. ≥3.0 cm (75th percentile). Myoma mean diameter is the only significant preoperative variable for perioperative outcome, while myoma grading loses its role as a prognostic factor.” We strongly agree with Leone et al. regarding the relative importance of the grading of the myoma because the dynamic changes of the myometrial free margin have been widely demonstrated (3Casadio P. Youssef A.M. Spagnolo E. Rizzo M.A. Talamo M.R. De Angelis D. et al.Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question.Fertil Steril. 2011; 95 (.e1): 1764-1768Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar). In our report, we did not analyze perioperative outcomes in the same manner, so we were not able to assess which variables could influence it. Nevertheless, all patients concluded the treatment with a single procedure, independently on the size, the number and the grading of myoma treated. Furthermore, we demonstrated that the prevalence of the intrauterine adhesions was correlated neither with the gonadotropin-releasing hormone agonist therapy, nor with the number, the size, or the grading of the myomas. Unlike previous studies, we did not resort to “auto-cross-linked hyaluronic acid gel” (4Guida M. Acunzo G. Di Spiezio Sardo A. Bifulco G. Piccoli R. Pellicano M. et al.Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study.Hum Reprod. 2004; 19: 1461-1464Crossref PubMed Scopus (162) Google Scholar) or “poly-ethylene oxide-sodium carboxymethylcellulose gel” (5Di Spiezio Sardo A. Spinelli M. Bramante S. Scognamiglio M. Greco E. Guida M. et al.Efficacy of a polyethylene oxide-sodium carboxymethylcellulose gel in prevention of intrauterine adhesions after hysteroscopic surgery.J Minim Invasive Gynecol. 2011; 18: 462-469Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar); nevertheless, the adhesion rate we observed after cold loop hysteroscopic myomectomy was significantly lower than found in series using other medical devices. We believe that the cold loop resectoscopic myomectomy technique is a major advance in reducing the prevalence of intrauterine adhesions, and is particularly important for fertility patients. Cold loop hysteroscopic technique for submucous myomasFertility and SterilityVol. 101Issue 6PreviewIvan Mazzon et al. (1) recently published an interesting paper focusing on “the prevalence and the characteristics of intrauterine adhesions after cold loop resectoscopic myomectomy” for grade 1 (G1) and grade 2 (G2) submucous myomas. Although the study was retrospective, the large number of operated patients (688) and removed myomas (806) make it robust and relevant. The authors interestingly concluded that “cold loop resectoscopic myomectomy of G1–G2 myomas is effective and safe, with a prevalence of postsurgical intrauterine adhesions that appears to be lower than those reported in the literature. Full-Text PDF