Single-step hysteroscopic myomectomy for submucous leiomyoma

Leiomyomas are most commonly observed benign tumors in the female genital tract. Depending on the size, number, and location, the complete resection of Type 0, 1, and 2 leiomyomas by hysteroscopy can be completed in a single-step or multi-step procedure. The purpose of this study is to document the cases of hysteroscopic myomectomy performed via the resectoscopic technique in the gynecology department of a university hospital. Moreover, we assessed the applicability of single- or multi-step hysteroscopic myomectomy with respect to the diameter of the leiomyoma.

We retrospectively reviewed the records of hysteroscopic myomectomy performed between 2012 and 2018. According to the diameter of the submucous leiomyomas, we divided 46 patients into 2 groups. Group 1 (n=25) consisted of patients with submucous leiomyomas <3 cm, whereas patients in group 2 (n=21) had submucous leiomyomas ≥3 cm in diameter. We recorded the number of removed leiomyomas and completed hysteroscopy sessions.

Myomectomy was completed by single-step hysteroscopy in all the patients of group 1, whereas eight patients in group 2 needed multiple sessions of hysteroscopy. None of the patients in group 1 had fluid overload; however, two patients in group 2 had mild asymptomatic hyponatremia.

The success of hysteroscopic myomectomy depends on the diameter, localization, and number of the leiomyomas. This study revealed that Type 0, 1, and 2 leiomyomas of less than 3 cm can be resected by single-step hysteroscopy. For larger leiomyomas, the possibility of need for further sessions should be shared with the patients.