Hysteroscopic Myomectomy

Uterine fibroids are common in women of reproductive age and various conservative treatments are available. In order to achieve a successful conservative treatment of fibroids, functional integrity of the uterus is as important as tumor removal or symptoms relief. In this context, intrauterine adhesions must be recognized as a possible complication of conservative management of uterine fibroids, but diagnostic pitfalls might justify an underestimation of their incidence. Hysteroscopic myomectomy can cause adhesions as a result of surgical trauma to the endometrium. The average reported incidence is around 10% at second-look hysteroscopy, but it is higher in certain conditions, such as the case of multiple, apposing fibroids. Transmural myomectomies also have the potential for adhesion, especially when combined with uterine ischemia. Uterine arteries embolization also carries a risk of intracavitary adhesions. Prevention strategies including bipolar resection, barrier gel or postoperative estradiol, might be useful, but stronger evidence is needed. In view of current knowledge, we would recommend a prevention strategy based on a combination of surgical trauma minimization and identification of high-risk cases. Early hysteroscopic diagnosis and lysis possibly represents the best means of secondary prevention and treatment of postoperative intrauterine adhesions.

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One-step hysteroscopic myomectomy using Lin dissecting loop and Lin myoma graspers

Gynecology and Minimally Invasive Therapy ◽

10.1016/j.gmit.2012.08.004 ◽

2012 ◽

Vol 1 (1) ◽

pp. 27-33 ◽

Cited By ~ 11

Author(s):

Bao-Liang Lin ◽

Takayuki Higuchi ◽

Akira Yabuno ◽

Kana Kashinoura ◽

Takeshi Suzuki ◽

...

Keyword(s):

Hysteroscopic Myomectomy ◽

One Step

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iInformation Box 16.3 Basic requirements for set-up for outpatient hysteroscopic myomectomy

Handbook of Outpatient Hysteroscopy ◽

10.1201/b13545-57 ◽

2005 ◽

pp. 224-230

Keyword(s):

Hysteroscopic Myomectomy ◽

Set Up

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Fibroids and infertility

International Journal of Infertility & Fetal Medicine ◽

10.5005/jp-journals-10016-1071 ◽

2014 ◽

Vol 5 (1) ◽

pp. 1-7

Author(s):

Harpreet Kaur

Keyword(s):

Female Genital Tract ◽

Uterine Cavity ◽

Reproductive Function ◽

Benign Tumors ◽

Hysteroscopic Myomectomy ◽

Final Treatment ◽

Unpublished Studies ◽

Cochrane Database ◽

Intramural Fibroids ◽

Female Genital

ABSTRACT Fibroids are the commonest benign tumors of female genital tract. Though fibroids may not be a sole cause for infertility in majority of cases, but it has been seen that there is an improvement in pregnancy rates after myomectomy. Fibroids that distort the uterine cavity and large intramural fibroids are shown to be associated with adverse effects on reproductive function. Available evidence suggests that submucosal, intramural, and subserosal .broids interfere with fertility in decreasing order of importance. In infertile women and those with recurrent pregnancy loss, myomectomy should be considered only after a thorough evaluation has been completed. Medical management of fibroids has no role in treatment of fertility rather it might lead to delay in the final treatment for infertility. Preoperative medical treatment with a GnRH agonist should be considered for women who are anemic and those undergoing hysteroscopic myomectomy. Subserosal fibroids have least effect on fertility, so they do not need removal before infertility treatment. Keymessage Fibroids are important cause of infertility; Removal of submucousal fibroids is warranted before IVF. Search methodology Data were sourced from the electronic database PubMed, MEDLINE, OVID, Cochrane Database of systematic reviews and published guidelines on fibroids and infertility. Abstracts from papers and posters presented at the international meetings, published and unpublished studies, and expert opinion was considered. How to cite this article Kaur H, Rao KA. Fibroids and infertility. Int J Infertil Fetal Med 2014;5(1):1-7

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Uterine submucosal leiomyomas: modern diagnosis and miniinvasive surgery

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/6.2.2 ◽

2021 ◽

Vol 6 (2) ◽

pp. 88-93

Author(s):

Oana Denisa Balalau ◽

◽

Mihai-George Loghin ◽

Sabin Vasilache ◽

Octavian Gabriel Olaru ◽

...

Keyword(s):

Recovery Time ◽

Uterine Fibroids ◽

Therapeutic Decision ◽

Common Complication ◽

Hysteroscopic Myomectomy ◽

Abdominal Myomectomy ◽

Pelvic Tumors ◽

Submucosal Fibroids ◽

Miniinvasive Surgery ◽

Vaginal Myomectomy

Uterine leiomyomatosis is one of the most common benign pelvic tumors diagnosed in women aged 25-44 years. Clinically, it is manifested by vaginal bleeding, pelvic pain, infertility, digestive and urinary symptoms. The diagnosis of uterine fibroids requires careful clinical and paraclinical evaluation. Based on these data, the therapeutic decision is conducted in most cases. The treatment of uterine leiomyomatosis involves several procedures, such as: total abdominal hystectomy, total vaginal hystectomy, abdominal myomectomy, vaginal, laparoscopic or hysteroscopic myomectomy. Hysteroscopic myomectomy is currently the preferred procedure for submucosal fibroids. It has multiple advantages: shorter recovery time, reduced pain related to movements, shorter duration procedure and fewer risks. The procedure has few contraindications. The most common complication is recurrence. The treatment of choice for prolapsed pedunculated submucous leiomyoma is vaginal myomectomy. As described, the procedure has multiple advantages and generally has a low recurrence rate.

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Complications of Uterine Fibroids and Their Management, Surgical Management of Fibroids, Laparoscopy and Hysteroscopy versus Hysterectomy, Haemorrhage, Adhesions, and Complications

Obstetrics and Gynecology International ◽

10.1155/2012/791248 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 29

Author(s):

Liselotte Mettler ◽

Thoralf Schollmeyer ◽

Andrea Tinelli ◽

Antonio Malvasi ◽

Ibrahim Alkatout

Keyword(s):

Surgical Treatment ◽

Surgical Management ◽

Critical Analysis ◽

Severe Pain ◽

Uterine Fibroids ◽

Statistical Analyses ◽

Hysteroscopic Myomectomy

A critical analysis of the surgical treatment of fibroids compares all available techniques of myomectomy. Different statistical analyses reveal the advantages of the laparoscopic and hysteroscopic approach. Complications can arise from the location of the fibroids. They range from intermittent bleedings to continuous bleedings over several weeks, from single pain episodes to severe pain, from dysuria and constipation to chronic bladder and bowel spasms. Very seldom does peritonitis occur. Infertility may result from continuous metro and menorrhagia. The difficulty of the laparoscopic and hysteroscopic myomectomy lies in achieving satisfactory haemostasis using the appropriate sutures. The hysteroscopic myomectomy requires an operative hysteroscope and a well-experienced gynaecologic surgeon.

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