Hysteroscopic myomectomy
Keywords:
Fibroma; Menometrorrhagia; hysteroscopy; myomectomy.Abstract
Background: Hysteroscopic resection of submucous myomas is a safe alternative to conventional surgery.Aim: To evaluate the anatomical and functional results of endoscopic resection of submucous myomas and to present the principle complications of this technique.
Methods: This is a retrospective study performed in the department "B" of gynecology and obstetrics in maternity center of Tunis “La Rabta”. It analyzes a series of 105 hysteroscopic resections of intracavitary fibroids during a period of 8 years from January 2003 to December 2010.
Results: The mean age of our patients was 41 years and 5 months. The most frequently reason for consultation was the disorder of the menstrual cycle type of menometrorrhagia (47.6%), menorrhagia (22.8%) and postmenopausal bleeding (11.4%). Preoperative assessment of the fibroid was based on transvaginal ultrasound in all cases associated with diagnostic hysteroscopy in 51.4% of cases and with hydrosonography in 28.6% cases. The mean size of the fibroid was 3.08 cm. Type 0 myomas represented 42.8% of cases. The most frequent emplacement of the myoma was the anterior surface of the uterus (44.7%). After surgery, the resection was considered as complete in 88 patients (83.8%), partial in 17 patients (16.2%) requiring a second operation. The functional result was good with disappearance of bleeding symptoms in 90% of cases after a mean follow up of 17 months.
Conclusion: Hysteroscopic resection of sub mucosal fibroids is a technique that respects the uterine cavity with satisfactory functional results and low morbidity.
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References
Letterie GS, Kramer DJ. Intra operative ultrasound guidance for intrauterine endoscopic surgery. Fertil Steril. 1994; 62: 654-6.
Neuwith RS. A new technique for an additional experience with hysteroscopic resection of submucous fibroids. Am J Obstet Gynecol 1978; 131:91-94.
Cravello L, D'Ecrole C, Azoualy P, Boubli L, Blanc B. Le traitement hystéroscopique des fibromes utérins. J Gynecol Obstet Biol Reprod 1995; 4: 374-80.
Cravello L, Farnarier J, Roger V, D'Ecrole C, Blanc B. Myomectomie hystéroscopique. Résultats fonctionnels avec un recul moyen de 6 ans .J Gynecol Obstet Biol Reprod 1998 ; 27:593-7.
Fernandez H, Kadoch O, Capella-Allouc S, Gervaise A, Taylor S, Frydman R. Résection hystéroscopique des myomes sous muqueux : Résultats à long terme. Ann Chir 2001, 126 : 58-64.
Chelli D, Chanoufi MB, Mrad M, Khoudhair H, Chelli H, Sfar E. Résection hyséroscopique des myomes utérins, expérience tunisienne à propos de 130 cas. La lettre du gynécologue 2006; 308: 12-15.
Cravello L,Agostini A,Beerli M, Roger V, Bretelle F, Blanc B. Résultats des myomectomies hystéroscopiques . Gynécol Obstét et Fertil 2004; 32 : 825-28.
Greenberg MD, Kazamel TI. Medical and socioeconomic impact of uterine fibroids. Obstet Gynecol Clin North Am 2000; 27: 625-36.
Cicinelli E, Romano F, Anastasio PS, Blasi N, Parisi C, Galantino P. Trans abdominal sonohysterography, transvaginal sonography, and hysteroscopy in the evolution of submucous myomas. Obstet Gynecol 1995; 85: 42-7.
Fedele L, Bianchi S, Dorta M, Brioshi D, Zanotti F, Vercellini P. Trans vaginal ultrasonography versus hysteroscopy in the diagnosis of uterine submucous myomas. Obstet Gynecol 1991; 77: 745-8.
Serden SP, Brooks PG. Treatment of abnormal uterine bleeding with the gynaecologic résectoscope. J Reprod Med 1991; 36: 697-9.
Leone FPG, Lanzani C, Ferrazi E. Use of strict sonohysterographic methods for preoperative assessment of submucous myomas. Fertil Steril 2003 ; 79 : 998-1002.
Fernandez H. Hystéroscopie opératoire. Encycl Med Chir. Technique chirurgicale gynécologie, 1998 ; 9p ; 541-59.
Isaacson K. New developments in operative hysteroscopy. Obstet Gynecol Clin North Am 2000 ; 27: 375-83.
Mergui JL, Renolleau C, Salat-baroux J. Hystéroscopie opératoire et fibromes. Gynécologie 1993; 1: 325-37.
Donnez J, Polet R, Anaf V, Matieux PE, Casanas-roux F, Nisolle M. Treatment of dysfunctional bleeding and fibroids by advanced endoscopic technics with the Nd-YAG laser : from the present to the future. Clin Obstet Gynecol 1995; 9: 329-45.
Murakami T, Shimizu T, Katahira A, Terada Y, Yokomizo R, Sawada R. Intra operative injection of prostaglandin F2 in a patients undergoing hysteroscopic myomectomy, Fertil steril 2003 ; 79 : 6.
Barbot G, parent B. Echec et/ou récidives après myomectomies par voie hystéroscopique. In : Dubinson J B, Charpon C eds. Les fibromes utérins. Paris : Arnette 1994 : 67-75.
Fedele L, Marchini M, Baglioni A, Carinelli SG, Candiani GB. Endometrial reconstruction after hysteroscopic netroplasty. Obstet Gynecol 1991; 77 : 745-8.
Hallez J P. single stage total hysteroscopic myomectomie : Indications, techniques and results. Fertil steril 1995 ; 63: 703-8.
Murakami T, Shimizu T, Katahira A, Terada Y, Yokomizo R,Sawada R. Intraoperative injection of prostaglandin F2· in a patient undergoing hysteroscopic myomectomy. Fertil Steril 2003; 79: 1439-41.
Derman SG, Rehenstrom M Newirth RS. The long-term effectiveness of hysteroscopic treatment of menorrhagia and leiomymomas. Obstet gynecol 1991; 77: 591-4.
Wamsteker K, Emanuel MH, Dekruif JH. Transvaginal hysteroscopic resection of sub mucous fibroids for abnormal uterine bleeding. Results regarding the degree of intramural extention. Obstet Gynecol 1993; 82: 736-40.
Townsend DE, Fields G, Clausend A, Kufmann K. Diagnostic and operative hysteroscopy in the management of persistant postmenopausal bleeding. Obstet Gynecol 1993; 82: 419-21.
Cravello L, Demongolfier R, D'ecrole C, Blan B. Hysteroscopic surgery in post menopausal women, Acta Obstet Gynecol Scand 1996 ; 75: 563-6.
Cravello L, D'ercole C, Rouge P, Boubli B, Blanc B. Hysteroscopic management of menstrual disorders: A review of 195 patients. Eur J Gynecol Reprod Biol 1996; 67: 163-7.
Gimpelson RJ. Hysteroscopy treatment of the patient with intracavitary pathology. Obstet Gynecol Clin North Am 2000 ; 27: 327-33.
Bautrant E, Boubli L, Blanc B. La résection endo-utérine transcervicale : efficacité et innocuité d'une technique opératoire. Gynécologie 1991; 42: 115-20.
Pritts E. Fibroids and infertility: A systematic review of the evidence. Obstet Gynecol Surv 2001; 56: 483-91.
American Association of Gynecologic Laparoscopists. Survery of office hysteroscopy national statistics. J Reprod Med 1990; 355: 584-91.
Franklin D, Loffer M D. Contrindications and complications of hysteroscopy. Obstet Gynecol clin North Am 1995 ; 22 : 445-54.
Cravello L, D'ercole C, Blanc B. Les complications des résections hystéroscopiques. Gynécol Obstét Prat 1996 ; 84 ; 1-4.
Gbossour GM, Madras M, Roche A, Bruan JL, Mairelte P. Trouble transitoire du rythme cardiaque révélateur d'une intoxication majeure à la glycine au cours d'une hystéroscopie. Ann Fr Anesth Réa 1995; 14: 370-3.
