Surgical techniques and outcome in the management of submucous fibroids

Hysteroscopic myomectomy was a revolution for surgical treatment of symptomatic submucosal myoma.

A new International Federation of Gynecology and Obstetrics classification for myoma was recently described. Type 0, 1 and 2 are submucosal like in the European Society for Human Reproduction and Embryology. An intraoperative ultrasound control should be done to avoid bowel lesion when the margin between the deepest part of the myoma and the serosa is less than 5-8 mm. For monopolar resection, glycine is used as distension medium and a high frequency current is required. The bipolar system is a newer electrosurgical system. The distension medium used is isotonic saline. The advantage of this energy is that with the same safety and efficacy as the monopolar system, isotonic saline as a distension medium instead of glycine seems to reduce the risk of metabolic complications. For bleeding outcome, a success rate from 70 to 99% has been reported by different studies; the success rate seems to decline as the follow-up period increases for fertility outcome, submucosal fibroids have negative impact on pregnancy rates in the case of spontaneous fertility as in the case of assisted reproduction technologies.

Hysteroscopic resection of submucous myoma is a well tolerated procedure. Bipolar resection should be studied for safe diffusion. Fertility outcome and menorragia are both enhanced by hysteroscopic myomectomy.