A new technique of hysteroscopic myomectomy with enucleation in toto

Abstract

Study objective: To determine the safety and effectiveness of a new technique for hysteroscopic resection of uterine submucous myomas with high intramural involvement (G2 type, European Society of Hysteroscopy classification).

Design: Prospective study (Canadian Task Force classification II-1).

Setting: University hospital.

Patients: Forty-four women.

Intervention: Hysteroscopic myoma enucleation in toto.

Measurements and main results: With a hysteroresectoscope and Collins electrode, an elliptic incision of endometrial mucosa that covers the myoma is made at the level of its reflection on the uterine wall until the cleavage zone of the myoma is reached. Connecting bridges between myoma and surrounding muscle fibers are resected. This allows nearly complete protrusion of the myoma into the uterine cavity, facilitating complete myomectomy by slicing. The procedure was performed in 41 (93.1%) of 44 women. Of these, 38 (92.6%) had myomas between 2 and 4 cm in diameter and 3 (7.4%) had myomas exceeding 4 cm. Mean operating time was 27 minutes (range 10-45 min).

Conclusion: This technique is efficient and allows complete resection of submucous myomas with large intramural component by favoring intracavitary protrusion of that part.