Office hysteroscopic myomectomy without myoma extraction: A multicenter prospective study

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Reproductive Medicine

Background:

• Submucous myomas (SM) can cause abnormal uterine bleeding and infertility.
• Hysteroscopic enucleation is a common treatment, but mass extraction can be challenging.
• Leaving enucleated SMs in the uterine cavity is an alternative approach.

Purpose of the Study:

• To assess the feasibility and safety of leaving submucous myomas (SM) in the uterine cavity after office hysteroscopic enucleation.
• To determine the resolution rate of SMs using this minimally invasive technique.

Main Methods:

• Prospective multicenter study involving 204 patients with single submucous myomas.
• Office hysteroscopic enucleation performed using a 5 mm continuous flow hysteroscope.
• Enucleated SMs were intentionally left in the uterine cavity; absence confirmed by ultrasound at 90 days.

Main Results:

• The procedure was completed in all patients, with high patient satisfaction (4.59/5).
• Minor complications included vasovagal reaction (1.5%) and minimal bleeding (3.4%).
• SMs were absent in 94.12% (98% CI: 89.03-96.93%) of patients at 90-day follow-up.

Conclusions:

• Office hysteroscopic myomectomy with SM enucleation without mass extraction is safe and effective for most patients.
• The technique demonstrated a high success rate, with resolution in over 89% of cases.
• Grade 2 SMs may be associated with a lower success rate.