Predicting success of single step hysteroscopic myomectomy: A single centre large cohort study of single myomas. (October 2015)

• Record Type: Journal Article
• Authors: Mazzon, Ivan; Favilli, Alessandro; Grasso, Mario; Horvath, Stefano; Bini, Vittorio; Di Renzo, Gian Carlo; Gerli, Sandro
• Is Part Of: International journal of surgery. Volume 22(2015)
• Page Start: 10
• Page End: 14
• Publication Date: 2015-10
• Subjects: Hysteroscopic myomectomy -- Myomas -- Cold loop -- One-step procedure -- Feasibility; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2015.07.714
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Introduction: Submucous myomas represent one of the main indications of operative hysteroscopy. Hysteroscopic resection of submucous fibroids should be a simple, well-tolerated and effective procedure and ideally accomplished in in only one surgical step. Methods: Retrospective cohort single Centre study of 1244 women undergoing hysteroscopic myomectomy. Data analysis included patients' and the myomas characteristics. A multiple logistic regression was carried out in order to assess which variables were able to determine a multiple step procedure. Results: 1090 myomas (87.62%) were completely resected in a single-step procedure (SS group) whereas a multiple-step procedure (MS group) was needed for the removal of 154 fibroids (12.38%). The mean size of myomas resected in the SS group was 22.83 ± 9.36 mm whereas fibroids of the MS group measured 29.67 ± 10.76 mm. The overall feasibility of hysteroscopic myomectomy in one surgical procedure was 88.28%. All hysteroscopic myomectomies of G0 fibroids were completed in a single step. The chance of success to accomplish the treatment in a single-step for G1 and G2 myomas were 88.59% and 82.55%, respectively. The multivariate analysis revealed an inverse correlation between age and multiple step procedures and size of myomas were all directly correlated to multiple step procedures. Conclusion: The grading, the size of the myomas and the age of patients play a crucial role in completing the hysteroscopic myomectomy in a single step. Only the diameter greater than 3 cm in G2 myomas is correlated to a higher risk of a multiple procedure. Highlights: A retrospective cohort study of 1244 women undergoing hysteroscopic myomectomy is described. We analysed the feasibility of performing the hysteroscopic myomectomy in a single-step procedure. Grading and size of myomas and age of patients influence the feasibility of one step procedure. G2 myomas greater of 3 cm are correlated to a higher risk of a multiple procedure.