Predicting outcome of one-step total hysteroscopic resection of sessile submucous myoma

Abstract

Study objective: To analyze variables for successful 1-step hysteroscopic myomectomies of sessile submucous myomas.

Design: Retrospective case-control study. (Canadian Task Force classification II-2).

Setting: Single operator's practice in a university hospital and its related hospitals.

Patients: Twenty-eight patients with sessile submucous myomas and menorrhagia, infertility, or both.

Interventions: Our strategy for hysteroscopic myomectomy is as follows. First, we scraped and/or vaporized intrauterine dome of myoma until top of myoma was even with level of wall of cavity. Next, the remnant intramural node was squeezed by uterine contractions induced by prostaglandin F2alpha injection. Finally, the newly raised myoma dome was sectioned or vaporized electrosurgically only within the space of the intrauterine cavity and/or was separated mechanically from healthy myometrium without electrosurgery.

Measurements and main results: Submucous myomas in 16 (57.1%) patients were completely removed after 1 surgery. By logistic regression analysis, thickness of outer myometrial layer of myoma node (OR 3.06, p = .02), myoma size (OR 0.86, p = .04), and intramural extension degree (OR 0.91, p = .03) were significantly associated with outcome of complete resection.

Conclusion: Thickness of outer myometrial layer of myoma node, myoma size, and intramural extension degree predicted outcome of 1-step hysteroscopic myomectomy. The chance of performing successful surgery increased with increased thickness of outer myometrial layer of myoma, and decreased with larger myomas and greater degrees of intramural extension.