Hysteroscopic Myomectomy Research Articles

Lung ultrasound diagnosis of pulmonary edema resulting from excessive fluid absorption during hysteroscopic myomectomy: a case report

BackgroundHysteroscopic surgery is a safe procedure used for diagnosing and treating intrauterine lesions, with a low rate of intraoperative complications. However, it is important to be cautious as fluid overload can still occur when performing any hysteroscopic surgical technique.Case PresentationIn this case report, we present a unique instance where lung ultrasound was utilized to diagnose pulmonary edema in a patient following a hysteroscopic myomectomy procedure. The development of pulmonary edema was attributed to the excessive absorption of fluid during the surgical intervention. By employing lung ultrasound as a diagnostic tool, we were able to promptly identify and address the pulmonary edema. As a result, the patient received timely treatment with no complications. This case highlights the importance of utilizing advanced imaging techniques, such as lung ultrasound, in the perioperative management of patients undergoing hysteroscopic procedures.ConclusionsThis case report underscores the significance of early detection and intervention in preventing complications associated with fluid overload during hysteroscopic myomectomy procedures.

Reproductive Outcome Following Hysteroscopic Myomectomy in Patients with Infertility

Reproductive Outcome Following Hysteroscopic Myomectomy in Patients with Infertility

LOCAL IMMUNE STATUS OF PATIENTS AFTER HYSTEROSCOPIC MYOMECTOMY AND METHODS OF ITS CORRECTION

Aim. To evaluate changes in the local immune status of women after hysteroscopic myomectomy and the effect of the proposed treatment complex on them. Materials and methods. 221 patients with submucous uterine myoma who underwent hysteroscopic myomectomy were examined. 121 patients of the main group in the semi-operative period received complex rehabilitation therapy, 100 patients of the comparison group did not receive additional treatment after surgery. 80 women who applied for a routine preventive examination formed the control group. In all patients, the content of factors of local immunity – IL-6, IL-10, lactoferrin and secretory inhibitor of leukocyte proteinase in cervical mucus was studied by enzyme-linked immunosorbent assay (ELISA) using Atiscare reagents in the laboratory conditions of the Center. The indicators were studied before surgery, 3 and 6 months after surgery. Results. In patients with submucosal uterine myoma, an increased content of pro-inflammatory IL-6 in cervical mucus was found (357.9 pg/ml and 345.3 pg/ml), in the control group 134.7 pg/ml and a decrease in the concentration of anti-inflammatory IL-10 (37 .6 pg/ml and 34.3 pg/ml) while the value of the control group was 78.5 pg/ml. The increase in the cervical content of the secretory inhibitor of leukocyte proteinase in women with submucous uterine myoma (274.2 pg/ml and 284.9 pg/ml against 114.5 pg/ml in the control group) is evidence of an active reaction of the mucous membrane to the inflammatory process. The role of the factor in the implementation of antisperm immunity is a factor of impaired fertility in such women. Elevated lactoferrin (27.4 ng/ml and 28.4 ng/ml vs. 3.5 ng/ml in healthy women) is also associated with infertility. Performing hysteroscopic myomectomy leads to a gradual, but incomplete normalization of the content of the specified immune factors in the cervical mucus, and the improvement of the treatment complex leads to the full achievement of the indicator of the control group after 6 months, which is important for the implementation of reproductive function. Conclusions. 1. Patients with submucous uterine myoma are characterized by an increased content of pro-inflammatory factors of local immunity – IL-6, lactoferrin and secretory inhibitor of leukocyte proteinase, as well as a reduced concentration of anti-inflammatory IL-10. 2. After hysteroscopic myomectomy for 6 months, there is a decrease in the content of pro-inflammatory factors and an increase in the concentration of IL-10 in the cervical mucus, but the indicators do not reach the values of healthy women. 3. The use of the proposed complex of treatment after hysteroscopic myomectomy allows to achieve faster changes in the indicators of local cervical immunity, and after 6 months to achieve the values obtained in healthy women.

Predictors of Infused Distending Fluid Volume in Hysteroscopic Myomectomy.

Background and Objectives: The use of a bipolar resectoscope has become popular due to the lower risk of hyponatremia. However, gynecologists might overlook the risk of water intoxication. Water intoxication is associated with the infusion of distending fluid. We were interested in the prediction of the infused distending fluid volume in the era of bipolar hysteroscopy. Thus, the aim of this study was to identify the predictors of the infused distending fluid volume for hysteroscopic myomectomy. Materials and Methods: All consecutive women who underwent monopolar (n = 45) or bipolar (n = 137) hysteroscopic myomectomy were reviewed. Results: Myoma diameter (cm, coefficient = 680 mL, 95% confidence interval (CI) = 334-1025 mL, p <0.001) and bipolar hysteroscopy (coefficient = 1629 mL, 95% CI = 507-2752 mL, p = 0.005) were independent predictors of infused distending fluid volume. A myoma diameter ≥4.0 cm was the optimal cutoff value to predict the presence of >5000 mL of infused distending fluid. One woman in the bipolar group developed life-threatening water intoxication. Conclusions: Myoma diameter is associated with an increase in infused distending fluid volume, especially for myomas ≥4 cm. Meticulous monitoring of the infused distension fluid volume is still crucial to avoid fluid overload during bipolar hysteroscopic myomectomy.

Revolutionizing diffuse uterine leiomyomatosis treatment: A case report and literature review on "no-distension" hysteroscopic myomectomy with thoracic tissue forceps.

Diffuse uterine leiomyomatosis (DUL) is a prevalent leiomyoma variant in women of childbearing age, characterized by a uniformly enlarged uterus with numerous interconnected small myomas. Given that most DUL patients are in their reproductive years, treatments that preserve fertility are increasingly vital. This case report introduces an innovative hysteroscopic technique that forgoes uterine distension to remove multiple submucosal fibroids in a single procedure, maintaining endometrial integrity and fertility. A 27-year-old single woman experienced prolonged and heavier menstruation. Magnetic resonance imaging (MRI) scans showed an enlarged uterus with several round-like masses in the uterine wall/submucosa. Addressing the patient's financial limitations and treatment preferences, a groundbreaking hysteroscopic surgery was performed using thoracic tissue forceps, alongside bedside ultrasonography, enabling fibroid excision without uterine distension. In total, 38 uterine fibroids were successfully excised without complications such as uterine perforation or hyponatremia. According to the FIGO classification system: three were type III, nine were type II, 15 were type I, and 11 were type 0. Postoperative follow-up indicated normalized menstrual cycles, improved hemoglobin levels, and no recurrence of fibroids. A hysteroscopic examination 1 month after surgery revealed no significant fibroids or endometrial thickening. This case report underscores the effectiveness of a novel hysteroscopic surgical approach in treating DUL. This method eliminates the need for multiple staged surgeries and the risks of endometrial damage inherent in traditional techniques. It offers a minimally invasive, fertility-preserving alternative for young DUL patients, marking a significant advancement in gynecologic surgery.

Effectiveness of a Hysteroscopic Tissue Removal System Device for Hysteroscopic Myomectomy on Patients’ Quality of Life: A Randomized Clinical Trial

Background: This is the first prospective randomized analysis comparing outcomes of medical therapy versus hysteroscopic myomectomy using the TruClearTM hysteroscopic tissue removal system to treat heavy menstrual bleeding from sub-mucosal leiomyoma(s). Objective: To evaluate the quality of life in patients treated for submucosal leiomyomas after hysteroscopy myomectomy compared to medical therapy. Study Design: Setting: private practice and community-based hospital; subjects: female patients with symptomatic submucosal leiomyomas from 2014-2017. A total of 69 patients enrolled, with 47 completed. Statistical analysis used: randomized clinical trial. Each patient was randomized to oral contraceptive pills/progesterone releasing intrauterine device or hysteroscopic myomectomy. Each patient was to complete the Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire at baseline, one month, three months, and greater than or equal to six months after treatment. Primary outcome was the health-related quality of life (HR-QOL), as reflected from UFS-QOL scores. Contrasts were constructed from a linear mixed-effects model to compare the two treatment groups for changes from baseline in UFS-QOL scores. Results: UFS-QOL scores were similar at baseline between the two treatment groups. There was an overall improvement in all UFS-QOL scores within each group. Higher improvement scores were noted in the surgical group compared to the medical group for almost all UFS-QOL scores. At ≥6 months, in comparison to the medically managed patients, the most considerable score improvements for the surgical group were reported in HR-QOL concern, activities, self-consciousness and symptom severity scores having mean change scores (95% CIs) of 35.3 (22.3 – 48.2), 28.9 (16.3 – 41.5), 28.6 (15.0 – 42.1), and 32.2 (21.5 – 43.0), respectively. Conclusion: Patients with submucosal leiomyomas who received medical or surgical treatment reported similar improvement in overall HR-QOL scores.

Leiomyomatosis: A Rare Case of Mistaken Identity

Abstract: Diffuse uterine leiomyomatosis (DUL) is a rare benign uterine pathology that is often misdiagnosed as uterine leiomyomas. We present a case of a woman with abnormal uterine bleeding treated with multiple medical therapies without symptomatic relief. She underwent two surgeries, almost a year apart, with the histopathologic diagnosis of leiomyomas. After numerous failed attempts at medical and surgical treatments, the patient requested definitive surgery and underwent a robotic-assisted laparoscopic hysterectomy. Histopathologic analysis of the entire uterine specimen confirmed diffuse uterine leiomyomatosis. Case Report: A 31-year-old female was referred to our office with a history of abnormal uterine bleeding and heavy menstrual bleeding who failed hormonal therapies. Levonorgestrel-releasing intrauterine devices were inserted at two different times and were expelled due to heavy menses. Pelvic magnetic resonance imaging reported leiomyomas. The patient underwent hysteroscopy and a robotic-assisted myomectomy. Pathology revealed leiomyomas. Seven months after her first surgery, her bleeding recurred, and the patient became severely anemic, requiring hospitalization and transfusion of 2 units of packed RBCs. Over a year later, the patient underwent a second hysteroscopic and robotic myomectomy after failed medical therapies of tranexamic acid, progesterone medication, and gonadotropin-releasing hormone antagonist with minimal symptom relief. Her quality of life suffered tremendously due to ongoing AUB-HMB. After seven months, the patient requested definitive surgical therapy and underwent a robotic-assisted laparoscopic hysterectomy. Pathology reported diffuse uterine leiomyomatosis. Diffuse uterine leiomyomatosis is a rare benign uterine pathology that is often misdiagnosed as uterine leiomyomas. Early diagnosis of DUL is challenging and often inconclusive. Less than 50 diffuse uterine leiomyomatosis cases have been reported in the literature. The myometrium in DUL is almost entirely replaced by numerous ill-defined benign smooth muscle tumors. MRI offers mapping of the size, site, and distribution of leiomyomas, but findings are difficult to differentiate from DUL. The pathophysiology of DUL development remains poorly understood, with patients frequently complaining of abnormal uterine bleeding, heavy menstrual bleeding, fertility issues, and dysmenorrhea. DUL is often misdiagnosed as leiomyomas or adenomyosis clinically, given the similarity in manifestations. Leiomyomatosis is histologically characterized by the proliferation of smooth muscle cells forming fascicles and nodules, which blend with normal myometrium tissue. Hysterectomy is the definitive treatment of DUL, with this case report demonstrating the close similarity between the two.

Feasibility, safety and efficacy of high intensity focused ultrasound ablation as a preoperative treatment for challenging hysteroscopic myomectomy

Purpose To investigate the feasibility, safety and efficacy of high intensity focused ultrasound ablation (HIFU) as a preoperative treatment for challenging hysteroscopic myomectomies. Materials and methods A total of 75 patients diagnosed with types 0–III of uterine fibroids were enrolled. Based on the Size, Topography, Extension of the base, Penetration and lateral Wall position (STEPW) classification scoring system, 25 cases with a score ≥ 5 points were treated with HIFU followed by hysteroscopic myomectomy (HIFU + HM group), whereas 50 cases with a score < 5 points were treated with hysteroscopic myomectomy (HM group). Results The median preoperative STEPW score was 7 in the HIFU + HM group and 2 in the HM group. The average non-perfused volume (NPV) ratio achieved in fibroids after HIFU was 86.87%. Patients in the HIFU + HM group underwent hysteroscopic myomectomy one to four days after HIFU, and downgrading was observed in 81.81% of fibroids. The operation time for patients in the HIFU + HM group was 73 min and the success rate of myomectomy in a single attempt was 60%. The volume of distention medium used during the operation was greater in the HIFU + HM group than in the HM group (15,500 ml vs. 7500 ml). No significant difference was observed between the two groups in terms of intraoperative blood loss, the incidence of intraoperative and postoperative complications, menstrual volume score, or uterine fibroid quality of life score. Conclusion HIFU can be utilized as a preoperative treatment for large submucosal fibroids prior to hysteroscopic myomectomy. HIFU offers a novel approach in the management of this subset of patients.

Prostaglandin Injection for Myoma Expulsion (PRIME): Case Series of a Novel Approach to Hysteroscopic Resection of FIGO Type 2 Myomas

Study ObjectiveTo evaluate the use of dilute carboprost tromethamine injection at the endometrium/myoma junction during hysteroscopy to facilitate myoma expulsion and removal in a single procedure. DesignCase series. SettingSingle high-volume academic medical center. PatientsSeven patients aged 32 to 51 years old with FIGO type 2 uterine myomas and symptoms of abnormal uterine bleeding or infertility undergoing hysteroscopic resection with a morcellation device from November 2022 to July 2023. InterventionDilute injection of carboprost tromethamine (10 µg/mL) at time of hysteroscopic myomectomy. Measurements and Main ResultsThe main outcome measure was ability to complete the hysteroscopic myomectomy in a single procedure using a hysteroscopic morcellator. Secondary outcomes included total operative time, fluid deficit, and postoperative pharmacologic side effects and/or surgical complications. Among our 7 patients, all had successful single procedure complete resections of myomas ranging from 0.9 to 4.6 cm in maximal diameter. Average operative time was 30 minutes, and average fluid deficit was approximately 839 mL. The carboprost dosages used ranged from 30 to 180 µg. One patient experienced prolonged postoperative nausea and vomiting that resolved with antiemetics. One patient experienced postoperative endometritis that improved with antibiotics. ConclusionIn this pilot study, injection of dilute carboprost intraoperatively facilitated one-step hysteroscopic myomectomy of FIGO 2 myomas, via enhanced extrusion of the intramural portion of the fibroid into the uterine cavity, with both short operative times and acceptable fluid deficits.

Endometrium sparing technique during hysteroscopic myomectomy

Endometrium sparing technique during hysteroscopic myomectomy

Long-Term Risk of Reintervention After Surgical Leiomyoma Treatment in an Integrated Health Care System.

To compare long-term risk of reintervention across four uterus-preserving surgical treatments for leiomyomas and to assess effect modification by sociodemographic factors in a prospective cohort study in an integrated health care delivery system. We studied a cohort of 10,324 patients aged 18-50 (19.9% Asian, 21.2% Black, 21.3% Hispanic, 32.5% White, 5.2% additional races and ethnicities) who had a first uterus-preserving procedure (abdominal, laparoscopic, or vaginal myomectomy [referred to as myomectomy]; hysteroscopic myomectomy; endometrial ablation; uterine artery embolization) after leiomyoma diagnosis in the 2009-2021 electronic health records of Kaiser Permanente Northern California. We followed up patients until reintervention (second uterus-preserving procedure or hysterectomy) or censoring. We used a Kaplan-Meier estimator to calculate the cumulative incidence of reintervention and Cox regression models to estimate hazard ratios and 95% CIs comparing rates of reintervention across procedures, adjusting for age, parity, race and ethnicity, body mass index (BMI), Neighborhood Deprivation Index, and year. We also assessed effect modification by demographic characteristics. Median follow-up was 3.8 years (interquartile range 1.8-7.4 years). Index procedures were 18.0% (1,857) hysteroscopic myomectomies, 16.2% (1,669) uterine artery embolizations, 21.4% (2,211) endometrial ablations, and 44.4% (4,587) myomectomies. Accounting for censoring, the 7-year reintervention risk was 20.6% for myomectomy, 26.0% for uterine artery embolization, 35.5% for endometrial ablation, and 37.0% for hysteroscopic myomectomy; 63.2% of reinterventions were hysterectomies. Within each procedure type, reintervention rates did not vary by BMI, race and ethnicity, or Neighborhood Deprivation Index. However, rates of reintervention after uterine artery embolization, endometrial ablation, and hysteroscopic myomectomy decreased with age, and reintervention rates for hysteroscopic myomectomy were higher for parous than nulliparous patients. Long-term reintervention risks for uterine artery embolization, endometrial ablation, and hysteroscopic myomectomy are greater than for myomectomy, with potential variation by patient age and parity but not BMI, race and ethnicity, or Neighborhood Deprivation Index.

Risk of Placenta Accreta Spectrum Following Myomectomy: A Nationwide Cohort Study

ABSTRACT Placenta accreta spectrum (PAS) is described as a partial or total lack of decidua with adherence or invasion of the placenta to the myometrium and is a major cause of postpartum hemorrhage and peripartum hysterectomy. The risk of PAS is approximately 1 in 272 in the United States. Prior uterine surgeries including myomectomy disrupt the integrity of the endometrium and myometrium and may increase the risk of PAS. However, the association between myomectomy and PAS remains controversial. This retrospective nationwide cohort study aimed to investigate the effect of myomectomy, stratified by method of myomectomy, on the risk of PAS. Data were obtained from the Taiwan National Health Insurance Research Database, which includes prenatal, perinatal, demographic, and treatment data on nearly all pregnant patients in Taiwan. All pregnant people who gave birth after 20 weeks of gestation between January 2008 and December 2017 were included. Patients with incomplete data, previous history of PAS before myomectomy, robotic-assisted myomectomy, or a diagnosis of adenomyosis were excluded. Patients were classified into 3 groups according to method of myomectomy: laparotomic, laparoscopic, and hysteroscopic. A 1:1 propensity-score estimation matching with logistic regression was used for patients with and without history of myomectomy to minimize selection bias. The primary outcome was placenta accreta, whereas secondary outcomes included placenta previa, postpartum hemorrhage, placenta abruption, uterine rupture, and preterm delivery. Logistic regression models were used to analyze the association between myomectomy and adverse pregnancy outcomes and the risk of placenta accreta for the entire population. Analysis of variance and post hoc tests were used to analyze differences in clinical characteristics and adverse pregnancy outcomes according to different methods of myomectomy. A total of 1,393,628 patients were included in this study. Among them, 11,255 patients had a history of myomectomy. Placenta accreta spectrum occurred in 0.96% of those with a history of myomectomy and 0.20% of those without. The risk of PAS was significantly higher in patients with a history of myomectomy, compared with those without (adjusted odds ratio, 2.28; confidence interval [CI], 1.85–2.81; P &lt; 0.01). There was an elevated risk of other adverse pregnancy outcomes including placenta previa, postpartum hemorrhage, cesarean hysterectomy, uterine rupture, preterm delivery, and placenta abruption among those with a history of myomectomy compared with those without. The presence of placenta previa significantly increased risk of PAS, as did the number of prior myomectomies. The propensity score–matched cohort analysis found a similar increase in PAS risk associated with myomectomy. Compared with subjects without a history of myomectomy, the risk of PAS was greater after hysteroscopic (adjusted odds ratio, 3.88; 95% CI, 2.68–5.63), laparoscopic (2.02; 95% CI, 2.79–5.62), and laparotomic myomectomy (1.86; 95% CI, 1.33–2.60). The results of this study find that a history of myomectomy is significantly associated with increased risk of PAS in subsequent pregnancies. Hysteroscopic myomectomy was associated with the highest risk of PAS, and the presence of placenta previa or history of multiple myomectomies further increased the risk.

Prevention, diagnosis, and management of complications in hysteroscopic myomectomy: a literature review

Prevention, diagnosis, and management of complications in hysteroscopic myomectomy: a literature review

Surgical Treatment of Uterine Leiomyomas from 2016-2022 in the Republic of Kazakhstan

Background: Due to the transition to a mandatory health insurance system (MHIS) and also taking into account the impact of the COVID-19 pandemic, the purpose of this study was to evaluate the surgical treatment of uterine leiomyoma in Kazakhstan in recent years, taking into account the ratio of uterine-preserving surgery (UPS) and hysterectomy. Methods and Results: This epidemiological study was carried out upon the request of the Republican E-Health Center (RCEZ) to assess the dynamics of surgical treatment of uterine leiomyomas (UL) in Almaty at the expense of the Republican budget from 2016 to 2022. Since 2016, by 2022 there was a decrease in the total number of treated cases of UL at the expense of the Republican budget (from 1,478 to 1,063). From 2016 to 2019, there were statistically significantly more hysterectomies, whereas from 2020 to 2022 the number of uterine-preserving surgeries increased statistically significantly. The number of laparoscopic myomectomy and hysteroscopic myomectomy for treating submucous leiomyomas increased statistically significantly from 2016 to 2019. However, there were no statistical differences in the number of treated cases with this technique from 2020 to 2022. Conclusion: Although high-tech fibroid surgery has been performed more frequently in recent years, these numbers are insufficient today, which justifies the need to train more specialists in advanced technologies.

Effect of misoprostol before hysteroscopic polypectomy on Dilatation of the cervix and time of the procedure

Introduction: Using misoprostol (analog prostaglandins E1, PGE1) prior to hysteroscopic intervention to induce ripening of cervix was implemented in gynecological problems management as submucosal myoma, endometrial polyps.1,2 Aim of study: The aim was to assess the effect of using misoprostol on easy dilatation of the cervix and on reducing the time needed for dilatation of cervix and the overall time needed for the procedure Patients and methods: An observational cross sectional study was performed on women who were complaining from vaginal bleeding and diagnosed to have an endometrial polyp either received misoprostol or not prior to hysteroscopic myomectomy and were subjected to hysteroscopic polypectomy under general anesthesia. Results: the time needed for cervical dilatation was more in the control group who did not receive misoprostol (P value &gt;0.001). Conclusion: The use of a regimen of 400 mcg vaginal misoprostol administered 6 hours before hysteroscopic polypectomy is a simple, safe and effective method of cervical priming to facilitate the procedure with less total operative time , less time needed for cervical dilatation and less complications (as cervical lacerations or false passage).

Intraoperative Ascites and Pulmonary Edema during Hysteroscopic Myomectomy: A Case Report

Background:: Operative hysteroscopy is a surgical technique for various procedures of the uterus, for example, hysteroscopic myomectomy[1]. This has been an effective alternative [2] to conventional hysterectomy and has produced better surgical outcomes in terms of faster recovery, less post-operative pain and better patient satisfaction. Case Presentation:: A 49-year-old female was presented to the PAC clinic for hysteroscopic myomectomy for her dysfunctional uterine bleeding. There was no medical history of any previous medical or surgical problems. Her physical examination and routine labs did not reveal any abnormalities. She was labeled an ASA class 1 patient. Hysteroscopic myomectomy under spinal anesthesia was approved by the patient. On the day of the surgery, the patient was presented to the preoperative patient holding and was calm and comfortable. Vital parameters recorded were under normal limits. 20 G intravenous cannula was taken on her left dorsum of the wrist, and she was wheeled to the operating room. She was connected to ASA standard monitors, and her blood pressure, pulse rate, and spo2 were recorded. Spinal anesthesia was performed in a sitting position with a 27 G pencil point needle in a single attempt, and the procedure was regular. The level of anesthesia was ascertained to be till T6, and the patient was handed over to the surgical team. Surgery was started in a low lithotomy position. 65 minutes into the surgery, the patient started to complain of intra-abdominal pain, difficulty breathing, and started being restless. Blood pressure was 133/83mmhg, and SpO2 dropped from 98% to 86%. Her pulse rate was 112 beats per minute. Conclusion:: The patient’s abdomen was examined by moving the operative drapes, and gross abdominal distention was noted. Lung auscultation revealed crepitations on the basal lobes. Immediately, distention syndrome was suspected.

Hemostatic Effect of Intrauterine Instillation of Oxytocin in Hysteroscopic Myomectomy: A Randomized Double Blinded Control Trial

Introduction: Progesterone and oestrogen can have an impact on benign smooth muscle tumours of the uterus called uterine myomas. The majority of fibroids don’t cause any symptoms and don’t need to be treated or investigated further. Fibroids originate in the smooth muscles of the uterus and move to an area of decreased resistance, where they can either stay intra-myometrial or develop into subserosal or submucous myomas. Aim of the Work: This study’s primary goal was to find out if oxytocin intrauterine infusion into the distention medium during hysteroscopic myomectomy would lessen blood loss and enhance surgical visibility. Patients and Methods: This clinical trial was undertaken at the Early Cancer Detection Unit (ECDU) at Ain Shams University hospitals using a randomised controlled double blind design. Sixty women who were scheduled for a hysteroscopic myomectomy were enrolled in this study and split into two equal groups: Group A (Oxytocin group): 10 IU of oxytocin were administered for every 1000 millilitres of the distending medium during the hysteroscopic myomectomy performed on 30 women. Group B (Placebo group): Thirty women had hysteroscopic myomectomy, and for every 1000 millilitres of the distending medium, a sterile bacteriostatic water ampule was used. Results: There was no statistically significant difference between the groups’ demographic (age) and surgical (myoma size, number, and duration of operation) data, nor were there any differences in intraoperative fluids. Each group’s Hgb and Hct decrease exhibited a significant difference, with the control group exhibiting a greater mean difference than the oxytocin group. Our findings demonstrated that there was a statistically significant difference in post-operative Hgb and HCT between groups, and that groups were similar in terms of needing blood transfusions and needing a second operation. When it came to the surgeon’s assessment of the visual fluid clarity, the groups were equivalent, but there was a statistically significant difference in the surgeons’ ratings of bleeding. According to our findings, there was no statistically significant variation in the number of uterine and medical difficulties across the groups, and the groups’ levels of complications were comparable. Conclusion: During diagnostic hysteroscopy, complications frequently arise. During a hysteroscopic myomectomy, oxytocin is infused intrauterine into the distention medium to minimise blood loss and enhance operative visibility. To confirm these results, more research using a range of doses and techniques is required.

A Novel Approach of Intralesional Vasopressin using an Ovum Pick up Needle in Hysteroscopic Myomectomy

The aim was to evaluate the efficacy of vasopressin injected into the center of submucosal myomas using an ovum pick up needle during hysteroscopic myomectomy. Design: Canadian task force II-2 clinical study Setting: Urban clinical research center,38 patients were enrolled in the study Materials and Methods: A retrospective Canadian Task Force II-2 clinical study design conducted on women aged 22-55 years in an urban clinical research center. 38 symptomatic patients underwent hysteroscopic myomectomy after injection of dilute vasopressin (10U in 100mL Normal Saline). Around 5-8 mL was injected into the center of myomas using an ovum pick up needle, and the study was carried out between 2018-2021. Measured parameters were surgical operative time, and the secondary outcomes were related to fluid volume, visual clarity, and pregnancy outcome in patients with infertility. Results: The Wamsteker Grading System adopted by the European Society for Gynecological Endoscopy was used to classify the myomas. The mean time of myomectomy was 22 minutes (normal range: 15-40 minutes), with a median fluid deficit of 700 mL (normal range: 500- 900mL); one patient had more than 1000 mL fluid deficit which was detected immediately and managed efficiently. This patient had the longest surgical operative time of 40 minutes with 10 multiple myomas between 1 and 4 cm in size. The diagnosis of the size, number, and grade of submucosal myomas was made by transvaginal ultrasound. In our study it was observed that the use of vasopressin injection during hysteroscopic myomectomy resulted in significantly reduced surgical operative time, minimal fluid deficit, lesser bleeding with a clear surgical field, and improved pregnancy outcome in infertility patients. Conclusion: Injection of vasopressin during hysteroscopic myomectomy was found to be effective in decreasing surgical operative time, improvement of visual clarity, thereby improving pregnancy outcomes in patients presenting with infertility.

Revolutionizing hysteroscopy outcomes: AI-powered uterine myoma diagnosis algorithm shortens operation time and reduces blood loss.

The application of artificial intelligence (AI) powered algorithm in clinical decision-making is globally popular among clinicians and medical scientists. In this research endeavor, we harnessed the capabilities of AI to enhance the precision of hysteroscopic myomectomy procedures. Our multidisciplinary team developed a comprehensive suite of algorithms, rooted in deep learning technology, addressing myomas segmentation tasks. We assembled a cohort comprising 56 patients diagnosed with submucosal myomas, each of whom underwent magnetic resonance imaging (MRI) examinations. Subsequently, half of the participants were randomly designated to undergo AI-augmented procedures. Our AI system exhibited remarkable proficiency in elucidating the precise spatial localization of submucosal myomas. The results of our study showcased a statistically significant reduction in both operative duration (41.32 ± 17.83 minutes vs. 32.11 ± 11.86 minutes, p=0.03) and intraoperative blood loss (10.00 (6.25-15.00) ml vs. 10.00 (5.00-15.00) ml, p=0.04) in procedures assisted by AI. This work stands as a pioneering achievement, marking the inaugural deployment of an AI-powered diagnostic model in the domain of hysteroscopic surgery. Consequently, our findings substantiate the potential of AI-driven interventions within the field of gynecological surgery.

Surgeon reported measures of stress and anxiety prior to and after elective gynecological surgery.

Performing surgical procedures is a recognized source of stress for surgeons. Vocational stress is an important contributor to performance, patient care, and burnout with dispositional and environmental factors contributing. Accurately assessing surgeon stress is critical to measuring effectiveness of stress reduction programs. The primary aim was to identify differences between surgeons' self-reported anticipated stress and anxiety prior to gynecological surgery, compared with their recollection of experienced stress and anxiety during surgery. Secondary aims assessed any differences by level of training, surgical type, and surgeon role. Attending and resident gynecologists performing routine elective surgeries completed a visual analog scale (VAS) assessing perceived stress and the State-Trait Anxiety Inventory (STAI) prior to and immediately after completing 161 elective surgeries including total laparoscopic hysterectomy, laparoscopic excision of moderate-severe endometriosis, or hysteroscopic myomectomy. Eight attending gynecologists and nine residents participated. Residents commenced as primary surgeon in 62/90 (69%) procedures. Stress experienced during surgery was greater than anticipated in 92/161 (57%) surgery episodes (mean VAS increase: 3.9; 95% CI: 1.1-6.8, p = 0.009). State anxiety was greater than anticipated in 99/161 (62%) episodes (mean state anxiety increase: 4.4; 95% CI: 3.0-5.8, p < 0.001). Greater preprocedural anticipatory stress and anxiety was observed in residents vs. attending gynecologists (VAS 51.9 vs. 22.8, p < 0.001; state anxiety 38.3 vs. 28.1, p < 0.001) and in primary vs. assistant surgeons (VAS 47.2 vs. 29.9, p < 0.001; state anxiety 36.9 vs. 28.3, p < 0.001). Intraoperative stress and anxiety were greater in primary surgeons (VAS 50.4 vs. 30.5, p < 0.001; anxiety 41.3 vs. 32.5, p < 0.001) and residents (VAS 43.4 vs. 31.7, p < 0.001; anxiety 53.5 vs. 33.7, p < 0.001) compared with assistants and attending gynecologists. Perceived stress and anxiety were positively correlated at both timepoints (r = 0.68, p < 0.001; r = 0.82, p < 0.001). When asked to reflect on stress experienced during surgery, our data show that stress during surgery is greater than anticipated for many surgical episodes. Self-reported stress symptoms commence prior to surgery and are more commonly reported by surgeons operating as primary surgeon and by those in training. Future research should focus on determinants of presurgical stress and examine when stressors become inhibitory to performance.