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. 2024 Dec;16(4):383-397.
doi: 10.52054/FVVO.16.4.054.

European Society for Gynaecological Endoscopy (ESGE) Good Practice Recommendations on surgical techniques for Removal of Fibroids: Part 2 Hysteroscopic Myomectomy

T J Clark, L Antoun, A Di Spiezio Sardo, V Tanos, J Huirne, E W Bousma, T Smith-Walker, E Saridogan

European Society for Gynaecological Endoscopy (ESGE) Good Practice Recommendations on surgical techniques for Removal of Fibroids: Part 2 Hysteroscopic Myomectomy

T J Clark et al. Facts Views Vis Obgyn. 2024 Dec.

Abstract

Submucosal uterine fibroids are the rarest type of fibroids. They can lead to abnormal uterine bleeding and may play a role in infertility and miscarriage. Hysteroscopic myomectomy is the preferred treatment to relieve bleeding caused by these fibroids and to restore the normal structure of the uterine cavity. The European Society for Gynaecological Endoscopy Uterine Fibroids Working Group developed recommendations based on the best available evidence and expert opinion for the surgical treatment of uterine fibroids. In this second part of the recommendations, hysteroscopic approaches are described. This review explores the techniques related to hysteroscopic myomectomy, focusing on narrower scopes, fluid management and advances in tissue removal systems and electrosurgery.

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Figures

Figure 1
Figure 1
Types of submucosal fibroids. A. Type 0 fibroid, note that the fibroid is entirely intracavitary. B. Type 1 fibroid, more than 50% of the cavity is intracavitary, an acute angle of < 90ᵒ can be seen on the right side and the largest diameter of the fibroid is within the cavity. C. Type 2 fibroid, less than 50% is intracavitary, note obtuse angles of >90ᵒ can be seen on both sides.
Figure 1
Figure 1
Types of submucosal fibroids. A. Type 0 fibroid, note that the fibroid is entirely intracavitary. B. Type 1 fibroid, more than 50% of the cavity is intracavitary, an acute angle of < 90ᵒ can be seen on the right side and the largest diameter of the fibroid is within the cavity. C. Type 2 fibroid, less than 50% is intracavitary, note obtuse angles of >90ᵒ can be seen on both sides.
Figure 1
Figure 1
Types of submucosal fibroids. A. Type 0 fibroid, note that the fibroid is entirely intracavitary. B. Type 1 fibroid, more than 50% of the cavity is intracavitary, an acute angle of < 90ᵒ can be seen on the right side and the largest diameter of the fibroid is within the cavity. C. Type 2 fibroid, less than 50% is intracavitary, note obtuse angles of >90ᵒ can be seen on both sides.
Figure 2
Figure 2
Type 0 fibroid before (A) and after (B) resection.
Figure 2
Figure 2
Type 0 fibroid before (A) and after (B) resection.
Figure 3
Figure 3
Type 2 fibroid before (A) and after (B) resection.
Figure 3
Figure 3
Type 2 fibroid before (A) and after (B) resection.
Figure 4
Figure 4
Type 1 fibroid removal using 5Fr electrode. A. Type 1 submucosal fibroid. B. Incision is made to open the fibroid pseudocapsule. C. Connective tissue bands are divided using the electrode.
Figure 4
Figure 4
Type 1 fibroid removal using 5Fr electrode. A. Type 1 submucosal fibroid. B. Incision is made to open the fibroid pseudocapsule. C. Connective tissue bands are divided using the electrode.
Figure 4
Figure 4
Type 1 fibroid removal using 5Fr electrode. A. Type 1 submucosal fibroid. B. Incision is made to open the fibroid pseudocapsule. C. Connective tissue bands are divided using the electrode.
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