Abstract
Even if uterine myomas are often asymptomatic, they have been associated with a number of clinical issues such as abnormal uterine bleeding (AUB), heavy menstrual bleeding (HMB), infertility, and recurrent pregnancy loss, especially when these masses are submucous. Gold standard treatment for symptomatic submucous fibroids has long been considered their laparotomic removal or a total hysterectomy. The development of endoscopy has made these fibroids accessible and removable from the inner surface of uterus. The development of different and new techniques allows to overcome the initial limitations of the traditional resectoscopic myomectomy. For a long time several authors have considered the myometrial free margin as a limiting factor when it is lower than 5–10 mm. The onset of the “cold loop technique” has made possible to treat safely G2 submucous myomas even when the thickness of the myometrium is considerably thin. It is feasible because the myometrial free margin can undergo dynamic changes after the various phases of hysteroscopic resection performed with cold handles. It decreases after the distension of the uterine cavity and then increases progressively after the various phases of resection reaching the maximum value at the end of the procedure. Not applying electric energy the cold loop technique does not damage muscle fibers allowing the myometrium separating the myoma from serosa to be a dynamic factor. Thus the myometrial free margin should not longer be considered a selection criteria for the resectoscopic myomectomy.
References
Fernandez H. Hysteroscopic resection of submucosal myomas in patients with infertility. Hum Reprod. 2001;16:1489–92.
Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004;104:393–406.
Meloni AM, Surti U, Contento AM, Davare J, Sandberg AA. Uterine leiomyomas: cytogenetic and histologic profile. Obstet Gynecol. 1992;80:209–17.
Savelli L, Cristina Scifo M (2015) Ecografia transvaginale nelle urgenze ginecologiche e del primo trimestre di gravidanza.
Ubaldi F, Tournaye H, Camus M, Van der Pas H, Gepts E, Devroey P. Fertility after hysteroscopic myomectomy. Hum Reprod Update. 1995;1:81–90.
Practice Report AAGL. Practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol. 2012;19:152–71.
Garcia CR, Tureck RW. Submucosal leiomyomas and infertility. Fertil Steril. 1984;42:16–9.
Smith DC, Uhlir JK. Myomectomy as a reproductive procedure. Am J Obstet Gynecol. 1990;162:1476–9. discussion 1479–82
Verkauf BS. Myomectomy for fertility enhancement and preservation. Fertil Steril. 1992;58:1–15.
Sudik R, Hüsch K, Steller J, Daume E. Fertility and pregnancy outcome after myomectomy in sterility patients. Eur J Obstet Gynecol Reprod Biol. 1996;65:209–14.
Berkeley AS, DeCherney AH, Polan ML. Abdominal myomectomy and subsequent fertility. Surg Gynecol Obstet. 1983;156:319–22.
Campo S, Campo V, Gambadauro P. Short-term and long-term results of resectoscopic myomectomy with and without pretreatment with GnRH analogs in premenopausal women. Acta Obstet Gynecol Scand. 2005;84:756–60.
Derman SG, Rehnstrom J, Neuwirth RS. The long-term effectiveness of hysteroscopic treatment of menorrhagia and leiomyomas. Int J Gynecol Obstet. 1992;38:146.
Bosteels J, Weyers S, Puttemans P, Panayotidis C, Van Herendael B, Gomel V, Mol BWJ, Mathieu C, D’Hooghe T. The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update. 2010;16:1–11.
Shokeir TA. Hysteroscopic management in submucous fibroids to improve fertility. Arch Gynecol Obstet. 2005;273:50–4.
Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91:1215–23.
Hallez JP. Single-stage total hysteroscopic myomectomies: indications, techniques, and results. Fertil Steril. 1995;63:703–8.
Muñoz JL, Jiménez JS, Hernández C, Vaquero G, Pérez Sagaseta C, Noguero R, Miranda P, Hernández JM, De la Fuente P. Hysteroscopic myomectomy: our experience and review. J Soc Laparoendsc Surg. 2003;7:39–48.
Di Spiezio Sardo A, Mazzon I, Bramante S, Bettocchi S, Bifulco G, Guida M, Nappi C. Hysteroscopic myomectomy: a comprehensive review of surgical techniques. Hum Reprod Update. 2008;14:101–19.
Yang JH, Lin BL. Changes in myometrial thickness during hysteroscopic resection of deeply invasive submucous myomas. J Am Assoc Gynecol Laparosc. 2001;8:501–5.
Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol. 1993;82:736–40.
Salim R. A comparative study of three-dimensional saline infusion sonohysterography and diagnostic hysteroscopy for the classification of submucous fibroids. Hum Reprod. 2004;20:253–7.
Munro MG, HOD C, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113:3–13.
Cicinelli E, Romano F, Anastasio PS, Blasi N, Parisi C, Galantino P. Transabdominal sonohysterography, transvaginal sonography, and hysteroscopy in the evaluation of submucous myomas. Obstet Gynecol. 1995;85:42–7.
Lasmar RB, Barrozo PRM, Dias R, de OMAP. Submucous myomas: a new presurgical classification to evaluate the viability of hysteroscopic surgical treatment—preliminary report. J Minim Invasive Gynecol. 2005;12:308–11.
Corson SL. Hysteroscopic diagnosis and operative therapy of submucous myoma. Obstet Gynecol Clin N Am. 1995;22:739–55.
Wieser F, Tempfer C, Kurz C, Nagele F. Hysteroscopy in 2001: a comprehensive review. Acta Obstet Gynecol Scand. 2001;80:773–83.
Murakami T, Tamura M, Ozawa Y, Suzuki H, Terada Y, Okamura K. Safe techniques in surgery for hysteroscopic myomectomy. J Obstet Gynaecol Res. 2005;31:216–23.
Sutton C. Hysteroscopic surgery. Best Pract Res Clin Obstet Gynaecol. 2006;20:105–37.
Romano F, Cicinelli E, Anastasio PS, Epifani S, Fanelli F, Galantino P. Sonohysterography versus hysteroscopy for diagnosing endouterine abnormalities in fertile women. Int J Gynecol Obstet. 1994;45:253–60.
Goldstein SR. Use of ultrasonohysterography for triage of perimenopausal patients with unexplained uterine bleeding. Am J Obstet Gynecol. 1994;170:565–70.
Leone FPG, Bignardi T, Marciante C, Ferrazzi E. Sonohysterography in the preoperative grading of submucous myomas: considerations on three-dimensional methodology. Ultrasound Obstet Gynecol. 2007;29:717–8.
Takeda A, Manabe S, Hosono S, Nakamura H. Preoperative evaluation of submucosal myoma by virtual hysteroscopy. J Am Assoc Gynecol Laparosc. 2004;11:404–9.
Isteroscopia chirurgica resettoscopica—MIGYS. MIGYS. http://www.migys.it/percorso-endoscopia/isteroscopia/isteroscopia-chirurgica-resettoscopica/. Accessed 24 Jan 2017
Stamatellos I, Bontis J. Hysteroscopic myomectomy. Eur Clin Obstet Gynaecol. 2007;3:17–23.
Indman PD. Hysteroscopic treatment of submucous myomas. Clin Obstet Gynecol. 2006;49:811–20.
Neuwirth RS, Amin HK. Excision of submucus fibroids with hysteroscopic control. Am J Obstet Gynecol. 1976;126:95–9.
Isaacson K. Hysteroscopic myomectomy: fertility-preserving yet underutilized. OBG Manag. 2013;15:69–83.
Mazzon I. Manuale di chirurgia resettoscopica in ginecologia. Avellino: Centro di Endoscopia Ginecologica; 1997. p. 191–217.
Emanuel MH, Wamsteker K. The intra uterine morcellator: a new hysteroscopic operating technique to remove intrauterine polyps and myomas. J Minim Invasive Gynecol. 2005;12:62–6.
Gallinat A. The Master Resectoscope. J Minim Invasive Gynecol. 2005;12:S31–S32.
Emanuel MH. New developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol. 2013;27:421–9.
Bettocchi S, Ceci O, Di Venere R, Pansini MV, Pellegrino A, Marello F, Nappi L. Advanced operative office hysteroscopy without anaesthesia: analysis of 501 cases treated with a 5 Fr. bipolar electrode. Hum Reprod. 2002;17:2435–8.
Di Spiezio Sardo A, Ceci O, Zizolfi B, Nappi C, Bettocchi S. Office myomectomy. Minerva Ginecol. 2016;68(3):321–7.
Bettocchi S, Nappi L, Ceci O, Selvaggi L. What does “diagnostic hysteroscopy” mean today? The role of the new techniques. Curr Opin Obstet Gynecol. 2003;15:303–8.
Emanuel MH, Wamsteker K, Hart AA, Metz G, Lammes FB. Long-term results of hysteroscopic myomectomy for abnormal uterine bleeding. Obstet Gynecol. 1999;93:743–8.
Gallinat A. The master resectoscope. J Minim Invasive Gynecol. 2005;12:S31–2.
Donnez J, Polet R, Smets M, Bassil S, Nisolle M. Hysteroscopic myomectomy. Curr Opin Obstet Gynecol. 1995;7:311???316.
Phillips DR, Nathanson HG, Meltzer SM, Milim SJ, Haselkorn JS, Johnson P. Transcervical electrosurgical resection of submucous leiomyomas for chronic menorrhagia. J Am Assoc Gynecol Laparosc. 1995;2:147–53.
Neuwirth RS. A new technique for and additional experience with hysteroscopic resection of submucous fibroids. Am J Obstet Gynecol. 1978;131:91–4.
Loffer FD. Removal of large symptomatic intrauterine growths by the hysteroscopic resectoscope. Obstet Gynecol. 1990;76:836–40.
Casadio P, Youssef AM, Spagnolo E, et al. Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question. Fertil Steril. 2011;95:1764–1768.e1.
Litta P, Vasile C, Merlin F, Pozzan C, Sacco G, Gravila P, Stelia C. A new technique of hysteroscopic myomectomy with enucleation in toto. J Am Assoc Gynecol Laparosc. 2003;10:263–70.
Lasmar RB BPR (2002) Histeroscopia: uma abordagem pratica. Medsi, pp 121–142.
Hamou J. Electroresection of fibroids endoscopic surgery for gynecologists. London: WB Saunders; 1993. p. 327–30.
Hallez JP. Single-stage total hysteroscopic myomectomies: indications, techniques, and results. Presented in part at the world congress of gynaecological endoscopy, Bombay, India, 2–5 Dec 1993. Fertil Steril. 1995;63:703–8.
Mazzon I Nuova tecnica per la miomectomia isteroscopica: enucleazione con ansa fredda. In: Cittadini E, Perino A, Angiolillio M, Minelli L, editors Testo-atlante di chirurgia endoscopica ginecologica Palermo: COFESE cap XXXIIIb.
Murakami T. Intraoperative injection of prostaglandin F2α in a patient undergoing hysteroscopic myomectomy. Fertil Steril. 2003;79:1439–41.
Salim R, Lee C, Davies A, Jolaoso B, Ofuasia E, Jurko- vic D. A comparative study of three-dimensional saline infusion sonohysterography and diagnostic hysteroscopy for the classification of submucous fibroids. Hum Reprod. 2005;20:253–7.
Leone FP. Comment on Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question. Fertil Steril. 2011;95(5):1764-8.e1.
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Casadio, P., Guasina, F., Talamo, M.R., Magnarelli, G., Mazzon, I., Seracchioli, R. (2018). Is the Distance Between Myoma and Serosa a Limiting Factor?. In: Tinelli, A., Alonso Pacheco, L., Haimovich, S. (eds) Hysteroscopy. Springer, Cham. https://doi.org/10.1007/978-3-319-57559-9_38
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