Hysteroscopic myomectomy: a comprehensive review of surgical techniques
Open Access
- 6 December 2007
- journal article
- review article
- Published by Oxford University Press (OUP) in Human Reproduction Update
- Vol. 14 (2), 101-119
- https://doi.org/10.1093/humupd/dmm041
Abstract
Hysteroscopic myomectomy currently represents the standard minimally invasive surgical procedure for treating submucous fibroids, with abnormal uterine bleeding and reproductive issues being the most common indications. While hysteroscopic myomectomy has been shown to be safe and effective in the control of menstrual disorders, its effects on infertility remain unclear. The review provides a comprehensive survey of all hysteroscopic techniques used to treat fibroids found completely within the uterine cavity (G0) and those with intramural development (G1 and G2). MEDLINE and EMBASE searches identified published papers from 1970. The choice of the technique mostly depends on the intramural extension of the fibroid, as well as on personal experience and available equipment. ‘Resectoscopic slicing’ still represents the ‘gold standard’ technique for treating fibroids G0, even if several other effective techniques including ablation by neodymium-yttrium-aluminum-garnet laser, morcellation and office myomectomy have been proposed. On the other hand, the present review clearly indicates that there is still no single technique proven to be unequivocally superior for treating fibroids G1 and G2. Most techniques aim at the transformation of an intramural fibroid into a totally intracavitary lesion, thus avoiding a deep cut into the myometrium. At present, the ‘cold loop’ technique seems to represent the best option as it allows a safe and complete removal of such fibroids in just one surgical procedure, while respecting the surrounding healthy myometrium.Keywords
This publication has 96 references indexed in Scilit:
- Successful strategy for the hysteroscopic myomectomy of a submucous myoma arising from the uterine fundusFertility and Sterility, 2006
- Follow-up after incomplete hysteroscopic removal of uterine fibroidsActa Obstetricia et Gynecologica Scandinavica, 2006
- abnormal Uterine BleedingThe Nurse Practitioner, 2005
- Submucous myomas: A new presurgical classification to evaluate the viability of hysteroscopic surgical treatment—Preliminary reportJournal of Minimally Invasive Gynecology, 2005
- Résultats des myomectomies hystéroscopiquesGynécologie Obstétrique & Fertilité, 2004
- Six thousand office diagnostic-operative hysteroscopiesInternational Journal of Gynecology & Obstetrics, 2000
- The value of transvaginal sonography with and without saline instillation in the diagnosis of uterine pathology in pre‐ and postmenopausal women with abnormal bleeding or suspect sonographic findingsUltrasound in Obstetrics & Gynecology, 1997
- Modern surgical approaches to female reproductive tractHuman Reproduction Update, 1996
- GnRH agonist analogs and hysteroscopic resection of myomasInternational Journal of Gynecology & Obstetrics, 1993
- Effects of myomas or prior myomectomy on in vitro fertilization (IVF) performanceJournal of Assisted Reproduction and Genetics, 1992