Hysteroscopic Myomectomy Research Articles

A new uterine endometrium preservation hysteroscopic myomectomy: Introduction of improved procedures and a retrospective analysis of 94 cases

ObjectiveTo reduce the damage of uterine endometrium caused during hysteroscopic myomectomy (HM) for reproductive aged patients, a new uterine endometrium preservation hysteroscopic myomectomy (UEP-HM) has been developed. In this study, we introduced this technique with comparing to the conventional hysteroscopic myomectomy (C-HM). Study DesignThe data from 94 patients aged 42 or younger who underwent HM (38 cases with UEP-HM and 56 cases with C-HM) for treating single Type 1 or Type 2 submucosal leiomyoma (SL) were analysed retrospectively for comparing the characteristics of both patient and target SL. In this process, we defined the operation time 60 min or over as the longtime operation (LTO) and the SM sized 3 cm or over as the large submucosal leiomyoma (LSL) for detecting the influential factors, including this procedure, on the difficulty of HM. For assisting the prediction of operation time (OT), we investigated the relationship between the OT and the cube of average diameter (AD) of target SL referring with some past reports. ResultsAlthough when comparing UEP and control groups, parity, AD, the number of patients with Type 2 SL, OT, and the number of infertile patients showed significant difference, in the multivariate analysis only LSL showed the significant influence on the possibility of LTO. Next, we compared OT/Cube of AD, which calculated by dividing OT by the cube of AD for evaluating OT from the target SL size and confirmed that there was no difference in those 2 groups (3.7 ± 3.0 (95 %CI: 0.9 - 13.3, n = 38) vs. 3.9 ± 3.2 (95 %CI: 0.4 - 17.3, n = 56), p = 0.79). ConclusionsThe new UEP-HM can become an alternative method of C-HM without procedure-specific difficulty. In the future, to investigate the prognosis of this procedure, more patients and further analyses should be accumulated.

12066 Combined Transcervical RFA and Hysteroscopic Myomectomy: Institutional Case Series and Literature Review

12066 Combined Transcervical RFA and Hysteroscopic Myomectomy: Institutional Case Series and Literature Review

11395 Combined Vaginal and Hysteroscopic Myomectomy of a Prolapsing Intracervical Fibroid

11395 Combined Vaginal and Hysteroscopic Myomectomy of a Prolapsing Intracervical Fibroid

11958 Optimizing Fertility: Insights into One-Step Hysteroscopic Myomectomy for Large Submucosal Fibroids

11958 Optimizing Fertility: Insights into One-Step Hysteroscopic Myomectomy for Large Submucosal Fibroids

12215 Techniques for Hysteroscopic Myomectomy of Type 2-3 Fibroid after Prior Incomplete Resection

12215 Techniques for Hysteroscopic Myomectomy of Type 2-3 Fibroid after Prior Incomplete Resection

11529 Hysteroscopic Myomectomy in Office Using Combination of Techniques and Equipment

11529 Hysteroscopic Myomectomy in Office Using Combination of Techniques and Equipment

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.

HORMONAL STATUS OF PATIENTS AFTER HYSTEROSCOPIC MYOMECTOMY

Leiomyoma of the uterus is the most common tumor of women of reproductive age. Submucosal localization of myoma causes abnormal uterine bleeding, and also prevents the implementation of reproductive function. Hysteroscopic myomectomy is an option for organ-preserving surgical treatment of submucosal uterine myoma, but pregnancy after it remains a problem. The purpose of the study is to study the content of sex hormones in women after hysteroscopic treatment of submucous uterine myoma and the effect of the proposed preventive complex on it. Research material and methods – the concentration of reproductive hormones (prolactin, estradiol, progesterone, FSH, LH) was determined in the serum of 221 patients who underwent hysteroscopic myomectomy immediately after surgery and 3 months later. 121 women of the main group received within 3 months after the intervention a therapeutic complex of antiproliferative, anti-inflammatory and angioprotective action, 100 patients of the comparison group underwent only surgical intervention. The control group consisted of 100 healthy women of reproductive age. Results. In all patients who underwent hysteroscopic myomectomy, the main group and the comparison group, an increase in the level of estradiol (62.5 pg/ml and 60.3 pg/ ml against 40.7 pg/ml in the control group) and a decrease in progesterone (10, 3 nmol/l, 13.5 nmol/l and 23.9 nmol/l, respectively), most of the patients in the main group and the comparison group had hyperprolactinemia, as well as an increased ratio of LH/FSH. After 3 months of treatment in the main group, the normalization of all the indicated indicators was registered, in the comparison group the hormonal balance remained at the postoperative level. Conclusions: The hormonal status of patients who underwent hysteroscopic myomectomy is characterized by an increased content of prolactin and estradiol, a reduced concentration of progesterone and a disturbed ratio of gonadotropic hormones. Against the background of the proposed treatment complex, which is used in the postoperative period, a probable normalization of the concentration of prolactin, estradiol and progesterone, as well as the FSH/LH ratio, is observed.

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