Two-Step Office-Based Hysteroscopic Operation for Submucosal Myoma.

Area of Science:

• Gynecology
• Minimally Invasive Surgery

Background:

• Hysteroscopy has evolved from diagnostic to therapeutic, with small-diameter instruments enabling outpatient procedures.
• Traditionally, submucosal myoma resection required resectoscopic operation under general anesthesia, even for type 0 myomas.
• Advancements in hysteroscopy aim to provide less invasive outpatient treatment options.

Purpose of the Study:

• To evaluate the efficacy of a two-step hysteroscopy technique for type 0 submucosal myoma removal.
• To determine the usefulness of secondary office hysteroscopy following initial pedicle cutting.

Main Methods:

• The study involved a two-step hysteroscopy procedure for type 0 submucosal myomas in an outpatient clinic.
• The first step involved cutting the myoma pedicle using a 5-mm rigid operating mini-hysteroscopy.
• After a two-month observation period for shrinkage, a second hysteroscopy was used for removal if the myoma reduced significantly.

Main Results:

• In 14 of 24 patients, myomas shrank to less than one-third their original size and were removed with the second hysteroscopy.
• The remaining myomas were successfully removed with the second operating mini-hysteroscopy.
• Five patients required traditional resectoscopic operation under general anesthesia due to lack of significant shrinkage or absence of myoma.

Conclusions:

• The two-step hysteroscopy approach is a useful outpatient method for type 0 submucosal myoma removal.
• This technique offers a less invasive option compared to traditional resectoscopic surgery.
• Further evaluation may be needed for cases with limited myoma shrinkage.