Hysteroscopic Myomectomy for Submucosal Myoma: Literature Review

2021 ◽  
Vol 104 (8) ◽  
pp. 1393-1399
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Complete Removal ◽  
Care Patient ◽  
Cervical Ripening ◽  
Uterine Perforation ◽  
Electrical Currents ◽  
Hysteroscopic Myomectomy ◽  
Submucous Myoma ◽  
Low Viscosity ◽  
Step Procedure

Uterine myomas are usually asymptomatic, although, most women with submucous myoma have severe symptom including abnormal uterine bleeding and infertility. Hysteroscopic myomectomy is a minimally invasive surgery and is a key benefit to patient care. Patient with submucous myoma no longer requires hysterotomy. Hysteroscopic myomectomy became the gold standard treatment in women who desire to preserve fertility. Complete removal of myoma in one-step procedure should be considered. Pre-operative optimization with cervical ripening agents including osmotic dilators such as laminaria tents and prostaglandin such as misoprostol and dinoprostone is important and decrease the risk of cervical trauma as well as uterine perforation. During the procedure, low viscosity isotonic conductive media such as normal saline are recommended to use with bipolar resectoscope and mechanical morcellator, and fluid deficit should be closely monitored at a minimum of 10-minute intervals. Resectoscope is usually used with slicing technique for resection of myoma. Morcellator can be used as it is easy to use, reduces risk of perforation, and reduces non-electrical currents. However, there is a limited utility in type 2 myoma. In addition, hyaluronic acid and polyethylene oxidesodium carboxymethylcellulose gel may reduce intrauterine adhesion after hysteroscopic myomectomy. Keywords: Hysteroscopy; Morcellation; Myoma; Uterine myomectomy

scholarly journals A Multicenter Study Analyzing the different Indications of Hysteroscopy in General Population and the Complication Rate: An Experience of 11 Years

2015 ◽  
Vol 7 (1) ◽  
pp. 37-43
Author(s):  
Rahul Manchanda ◽  
Soma Ghoshal ◽  
BC Manjula
Keyword(s):  
General Population ◽  
Multicenter Study ◽  
Complication Rate ◽  
Air Embolism ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Indian Region ◽  
Uterine Perforation ◽  
Common Indication ◽  
The Common

ABSTRACT Study objectives An assessment of the common indications for hysteroscopy (either diagnostic or therapeutic), in multiple hospitals especially in the North Indian region, over the period of past 11 years. To do an analysis of the common intraoperative diagnosis and the different types of surgeries performed therefore. To estimate the incidence of complications in the same patient population over the same time period and describe their nature. Data collection Records were collected from twelve hospitals spread mainly over North Indian region, pertaining to all those patients who underwent hysteroscopy during the period from July 2003 to October 2014. Total cases analyzed was 1834. Design Retrospective analytic study. Patients All those patients who underwent hysteroscopy of all ages referring to the above mentioned hospitals during the period from July 2003 to October 2014. Results Of the 1834 hysteroscopic procedures, 588 (32.06%) were diagnostic hysteroscopies and 1246 (67.93%) were therapeutic hysteroscopies. The most common indication for hysteroscopy was abnormal uterine bleeding (28.14%) closely followed by the second most common indication, which was for infertility check-up (26.67%). The most common hysteroscopic intervention was endometrial biopsy. The second most common intervention and the most common therapeutic hysteroscopic procedure was polypectomy; and the third most common Hysteroscopic procedure was intrauterine adhesiolysis. The main complication as found in our present study was found to be uterine perforation (0.21%), followed by false passage. Air embolism also occurred in one patient. How to cite this article Ghoshal S, Manchanda R, Manjula BC. A Multicenter Study Analyzing the different Indications of Hysteroscopy in General Population and the Complication Rate: An Experience of 11 Years. J South Asian Feder Obst Gynae 2015;7(1):37-43.

scholarly journals Febrile morbidity post laparoscopic myomectomy for symptomatic large submucous myoma in an adolescent girl

2021 ◽  
Vol 10 (10) ◽  
pp. 3970
Author(s):  
Prabha Agrawal ◽  
Rahul Agrawal ◽  
Sri Varshini Muthineni
Keyword(s):  
Adolescent Girl ◽  
Urine Culture ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Laparoscopic Myomectomy ◽  
Postoperative Fever ◽  
Submucous Myoma ◽  
Inflammatory Changes ◽  
Antibiotic Coverage ◽  
Febrile Morbidity

The occurrence of post-operative fever after myomectomy without an apparent infectious cause has been reported in various studies. We here in report a case of an 18-year girl with abnormal uterine bleeding and severe anemia resulting from a large 5 cm submucosal fibroid. She underwent laparoscopic myomectomy. Surgery was uneventful. Post-operative she had fever of 100.4°F which lasted for 48 hours. Antibiotic coverage was continued for 48 hours. Her urine culture and hemogram were negative for infection. Early postoperative fever is most commonly caused by inflammatory changes rather than infectious causes. Large submucous fibroids can be managed by laparoscopy with excellent clinical outcomes and minimal morbidity.

scholarly journals Value of Ultrasonographic Guidance For Operative Hysteroscopy on the Safety and Outcome of the Procedure: Randomized Control Trial

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M I Amer ◽  
W Elbasuony ◽  
M A Ali
Keyword(s):  
Success Rate ◽  
Ultrasound Guidance ◽  
Rare Complication ◽  
Abnormal Uterine Bleeding ◽  
University Hospital ◽  
Uterine Perforation ◽  
Safe Procedure ◽  
Simultaneous Treatment ◽  
Operative Hysteroscopy ◽  
Significant Difference

Abstract Background Hysteroscopy is a minimally invasive intervention that can be used to diagnose and treat many intrauterine and endocervical problems. Hysteroscopic polypectomy, myomectomy are just a few of the commonly performed procedures. Hysteroscopy has nearly replaced standard D&C for the management of abnormal uterine bleeding (AUB), as it allows for direct visualization and diagnosis of intrauterine abnormalities, and it often offers an opportunity for simultaneous treatment. Operative hysteroscopy is a safe procedure resulting in complication in 0.95-3% of cases. The most frequently observed complications include hemorrhage (2.4%), uterine perforation (1.5%), and cervical laceration (1-11%). Another rare complication is excessive fluid absorption with or without resultant hyponatremia. Can use of ultrasound guidance during operative hysteroscopy decrease the rate of the operative complication? Objective To assess the value of ultrasound guidance for operative hysteroscopy on decreasing the complication and improving the success rate of the procedure. Patients and Methods It is estimated that a sample size of 88 patients that were divided to 44 patients in the Ultrasound guidance group and 44 patients in the group that didn’t perform ultrasound. The patients were encountered from those presented at the gynecology clinic of the Ain Shams university hospital or those presented at ECDU with the inclusion criteria in the period between December 2017 to November 2018. The patients were approached to participate on study and a written informed consent was taken from all the patients. Results Comparative study between the 2 groups revealed; highly significant increase in success rate in ultrasound guided hysteroscopy (USH) group; compared to conventional hysteroscopy (CH) group; with highly significant statistical difference (p < 0.01) and non-significant difference as regards failure and complications rates (p > 0.05). Conclusion Our study found that ultrasound assistance for difficult hysteroscopy reported that ultrasound appears to be a safe and reliable method of assistance.

Hysteroscopic Myomectomy of Large Submucous Myomas in a 1-Step Procedure Using Multiple Slicing Sessions Technique

2015 ◽  
Vol 22 (7) ◽  
pp. 1196-1202 ◽  
Author(s):  
Mohamed Zayed ◽  
Usama M. Fouda ◽  
Shereef M. Zayed ◽  
Khaled A. Elsetohy ◽  
Ahmed T. Hashem
Keyword(s):  
Hysteroscopic Myomectomy ◽  
Step Procedure

scholarly journals Risk Factors for the Completion of the Cold Loop Hysteroscopic Myomectomy in a One-Step Procedure: A Post Hoc Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ivan Mazzon ◽  
Alessandro Favilli ◽  
Mario Grasso ◽  
Stefano Horvath ◽  
Vittorio Bini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Cohort ◽  
Agonist Therapy ◽  
Hysteroscopic Myomectomy ◽  
Post Hoc Analysis ◽  
Step Procedure ◽  
Study Population ◽  
One Step ◽  
Post Hoc ◽  
Multiple Step

Introduction. The aim of the study was to analyze which variables influenced the completion of a cold loop hysteroscopic myomectomy in a one-step procedure in a large cohort of patients. Materials and Methods. A retrospective cohort study of 1434 cold loop resectoscopic myomectomies consecutively performed. The study population was divided into two groups according to the number of procedures needed to accomplish the treatment. Variables influencing the completion of hysteroscopic myomectomy in a one-step procedure were investigated. Results. A total of 1434 resections were performed and 1690 myomas in total were removed. The procedure was accomplished in a one-step procedure in 1017 patients (83.7%), whereas 198 women (16.3%) needed a multiple-step procedure. The multivariate analysis showed that the size, the number of myomas, and the age of patients were significantly correlated with the risk of a multiple-step procedure. No correlation was revealed with the grading of myomas, parity, and the use of presurgical GnRH-agonist therapy. Conclusions. In case of multiple fibroids, the intramural development of submucous myomas did not influence the completion of cold loop hysteroscopic myomectomy in a one-step procedure. The size of myomas and the age of patients were significantly correlated with the need to complete the myomectomy in a multiple-step procedure.

scholarly journals Likelihood of Accomplishing an In-Patient Hysteroscopic Myomectomy in a One-Step Procedure: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-20
Author(s):  
Ugo Indraccolo ◽  
Vittorio Bini ◽  
Alessandro Favilli
Keyword(s):  
Meta Analysis ◽  
Intraoperative Complications ◽  
Random Effect ◽  
Qualitative Synthesis ◽  
Hysteroscopic Myomectomy ◽  
Step Procedure ◽  
Quantitative Synthesis ◽  
In Series ◽  
One Step ◽  
Complications Rate

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). Complications were significantly lower for alternative techniques to the classical slicing. 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.

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