Comparing Long-Term Symptomatic Leiomyoma Recurrence Rates After Resection Using the Hysteroscopic Morcellator Versus...

To determine the optimal hysteroscopic myomectomy technique by comparing symptomatic leiomyoma recurrence rates after mechanical tissue removal system vs bipolar resection.

This retrospective cohort study included premenopausal patients undergoing fibroid resection with the hysteroscopic mechanical tissue removal system (mTRS) or bipolar resectoscope (BR) for International Federation of Gynecology and Obstetrics (FIGO) type 0-2 leiomyomas. Patients who underwent resection from 2005 to 2021 were followed over time for symptom recurrence and medical or surgical treatments. The risk of fibroid recurrence and hysterectomy was estimated using the Kaplan-Meier method.

Single academic tertiary care center.

Patients with FIGO type 0-2 leiomyomas at the time of surgery were included. Those without pathology-confirmed leiomyoma or for whom hysteroscopic resection was completed with an alternative or unknown method were excluded. Patients that were postmenopausal at the time of the study were excluded as well.

Hysteroscopic Mechanical Tissue Removal System or Bipolar Resection.

In total, 89 patients were treated with the hysteroscopic mechanical tissue removal system and 358 with bipolar resection. Baseline demographics, including age, BMI, race/ethnicity, and obstetric history, were comparable between groups; abnormal uterine bleeding was the most common indication for index surgery. The mean fibroid size and median resected tissue volume were slightly greater in the bipolar resection group. The length of follow-up was variable, with a mean of 7.1 years (standard deviation, 5.4) among both groups. Symptomatic fibroid recurrence occurred in 29.2% of patients in the hysteroscopic mechanical tissue removal system compared to 38.5% in the bipolar resection group (p = NS). Additional hysteroscopic management, with a hysteroscopic mechanical tissue removal system or bipolar resection, was the most common method of treatment for fibroid recurrence. The cumulative incidence of hysterectomy was similar (mTRS = 15.7% vs BR = 22.3%), with abnormal uterine bleeding being the most common indication.

There was no significant difference between long-term recurrence rates for FIGO type 0-2 leiomyomas when comparing the hysteroscopic mechanical tissue removal system to bipolar resection; however, larger prospective cohorts with longer follow-up or randomized controlled trials may help to determine if one technique is indeed more effective.