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Dreessen JRJ, van der Meulen JF, Bongers MY, Mol BWJ, Langenveld J. Publication trends and usefulness of research in hysteroscopic myomectomy for heavy menstrual bleeding: A review of the published literature. Int J Gynaecol Obstet 2022; 161:692-701. [PMID: 36495222 DOI: 10.1002/ijgo.14613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Despite the amount of research into hysteroscopic myomectomy, questions about the optimal treatment of heavy menstrual bleeding remain. This study reviewed publication trends on this topic from 2002 to 2019 and assessed the usefulness of studies. A total of 580 articles were published on PubMed in this time frame, in 15 different languages. There were meta-analyses (1.6%), systematic reviews (12%), and randomized controlled trials (4.2%). Twelve percent were published in high impact factor journals. After applying our selection criteria, the usefulness of 37 articles was assessed: one article scored high, 31 scored moderate, and five scored low. The costs of these studies were estimated at US$ 971 700.
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Affiliation(s)
- Janique R J Dreessen
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Julia F van der Meulen
- Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands.,Grow School of Oncology and Developmental Biology, MUMC, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands.,Grow School of Oncology and Developmental Biology, MUMC, Maastricht, The Netherlands
| | - Ben W J Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Josje Langenveld
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen, The Netherlands
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Indraccolo U, Bini V, Favilli A. Likelihood of Accomplishing an In-Patient Hysteroscopic Myomectomy in a One-Step Procedure: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4208497. [PMID: 32090092 PMCID: PMC7015183 DOI: 10.1155/2020/4208497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the feasibility rate of one-step hysteroscopic myomectomy according to the technique adopted. METHODS In July 2016, PubMed, ClinicalTrials.gov, SCOPUS, Scielo, and AJOL databases were used for searching references. Series of in-patient hysteroscopic myomectomies reporting success rate in only one-step procedure, categorization of submucous fibroids, explanation of the surgical technique, and description of patients were considered eligible for meta-analysis (retrospective, prospective randomized studies). Two authors extracted the data. Rate of myomectomies accomplished in only a surgical step and rate of intraoperative complications were extracted per protocol. A modified GRADE score was used for quality assessment. Random-effect models were already assumed. Mean rates were compared among subgroups. RESULTS One thousand two hundred and fifty-seven studies were screened and 241 of these were read for eligibility. Seventy-eight series were included in qualitative synthesis and 24 series were included in quantitative synthesis. Wide heterogeneity was found. In series with <50% of G2 myomas treated, the slicing technique feasibility rate was 86.5% while techniques for enucleating the deep portion of the myomas showed a feasibility rate of 92.3% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (. CONCLUSION In case of submucous myomas with intramural development, the slicing technique was correlated with a lower rate of in-patient hysteroscopic myomectomies accomplished in a one-step procedure and a higher complications rate.
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Affiliation(s)
- Ugo Indraccolo
- Department of Obstetrics and Gynaecology, USL Umbria 1, Alta Valle del Tevere Hospital, Città di Castello (PG), Umbria, Italy
| | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessandro Favilli
- Department of Obstetrics and Gynaecology, USL Umbria 1, Alta Valle del Tevere Hospital, Città di Castello (PG), Umbria, Italy
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Tinelli A, Favilli A, Lasmar RB, Mazzon I, Gerli S, Xue X, Malvasi A. The importance of pseudocapsule preservation during hysteroscopic myomectomy. Eur J Obstet Gynecol Reprod Biol 2019; 243:179-184. [DOI: 10.1016/j.ejogrb.2019.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 11/29/2022]
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Risk Factors for the Completion of the Cold Loop Hysteroscopic Myomectomy in a One-Step Procedure: A Post Hoc Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8429047. [PMID: 29888280 PMCID: PMC5985071 DOI: 10.1155/2018/8429047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/31/2018] [Indexed: 01/01/2023]
Abstract
Introduction The aim of the study was to analyze which variables influenced the completion of a cold loop hysteroscopic myomectomy in a one-step procedure in a large cohort of patients. Materials and Methods A retrospective cohort study of 1434 cold loop resectoscopic myomectomies consecutively performed. The study population was divided into two groups according to the number of procedures needed to accomplish the treatment. Variables influencing the completion of hysteroscopic myomectomy in a one-step procedure were investigated. Results A total of 1434 resections were performed and 1690 myomas in total were removed. The procedure was accomplished in a one-step procedure in 1017 patients (83.7%), whereas 198 women (16.3%) needed a multiple-step procedure. The multivariate analysis showed that the size, the number of myomas, and the age of patients were significantly correlated with the risk of a multiple-step procedure. No correlation was revealed with the grading of myomas, parity, and the use of presurgical GnRH-agonist therapy. Conclusions In case of multiple fibroids, the intramural development of submucous myomas did not influence the completion of cold loop hysteroscopic myomectomy in a one-step procedure. The size of myomas and the age of patients were significantly correlated with the need to complete the myomectomy in a multiple-step procedure.
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Liang Y, Ren Y, Wan Z, Guo L, Dong J, Chen Y, Lv L. Clinical evaluation of improved MyoSure hysteroscopic tissue removal system for the resection of type II submucosal myomas. Medicine (Baltimore) 2017; 96:e9363. [PMID: 29390412 PMCID: PMC5815824 DOI: 10.1097/md.0000000000009363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to determine whether clinical evaluation of improved MyoSure hysteroscopic tissue removal system can remove type II submucosal myomas with safety and high success rate of the first operation.Fifty-three patients with type II submucosal myomas hospitalized in the Huzhou Maternity and Child Care Hospital were enrolled in this study. The submucosal myomas were with the diameter of >2 cm and ≤5 cm. All patients have surgical indications.Fifty-one of 53 hysteromyomas were successfully resected through 1-time operation. The average time was 37.92 ± 18.57 minutes, average amount of bleeding: 24.80 ± 12.12 mL, average length of stay: 2.02 ± 0.14 days. One patient had a transient postoperative fever and one patient had slight fluid overload with hyponatremia.The success rate of the first operation for resecting type II submucosal myomas showed an increase using improved MyoSure hysteroscopic tissue removal system, which can be a new, safer, and more efficient operation for treating type II submucosal myomas.
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Yoong W, Zhao W, Cai H, D'Cruz R, Corrieri A, Hamilton J, Fakokunde A. Vaginal Myomectomy Using the Dührssen (Longitudinal Median Cervical) Incision: A Case Series of 19 Patients. J Minim Invasive Gynecol 2017; 24:811-814. [PMID: 28411085 DOI: 10.1016/j.jmig.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To examine demographics and outcome measures of women having undergone vaginal excision of myomas through the Dührssen (longitudinal median cervical) incision. DESIGN Prospective case series (Canadian Task Force classification II-3). SETTING A London teaching hospital. PATIENTS Nineteen patients with either a submucous myoma (type 1) located near the cervix or a pedunculated intracavity myoma (type 0), excised via the Dührssen incision. INTERVENTIONS Dührssen (median longitudinal) incision on the anterior or posterior cervical lip. MEASUREMENTS AND MAIN RESULTS Duration of procedures, intraoperative complications, estimated blood loss, length of stay, percent of patients discharged in 24 hours, and readmission rates were studied. Between 2009 and 2016, 19 women had their myomas (submucous type 1, n = 17; pedunculated intracavity type 0, n = 2) removed vaginally with the Dührssen incision. The median age at time of procedure was 46 years (range, 43-55), and the most common indication was menorrhagia, which occurred in 90% of cases. The median myoma size was 7 cm (range, 6-9), whereas the median duration of surgery was 60 minutes (range, 40-120). Anterior cervical incisions were performed in 60% of cases, and 20% of the patients received gonadotropins for medical debulking of the myomas before surgery. One patient sustained a bladder injury that occurred when making the anterior cervical incision. The median length of stay was 8 hours (range, 6-36) and the median estimated blood loss was 90 mL (range, 50-150). The median duration of follow-up was 4 years (range, .5-6), and no patients had symptoms that were attributable to the procedure. CONCLUSION This is a useful technique that complements a minimally invasive surgeon's repertoire and is a viable alternative when hysteroscopic myomectomy is deemed unsuitable because of location and size of the myomas.
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Affiliation(s)
- Wai Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
| | - Wei Zhao
- The Affiliated Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Cai
- Hangzhou First People's Hospital, Hangzhou, China
| | | | | | - John Hamilton
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Gillingham, Kent, United Kingdom
| | - Abiodun Fakokunde
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom
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Zayed M, Fouda UM, Zayed SM, Elsetohy KA, Hashem AT. Hysteroscopic Myomectomy of Large Submucous Myomas in a 1-Step Procedure Using Multiple Slicing Sessions Technique. J Minim Invasive Gynecol 2015; 22:1196-202. [PMID: 26093183 DOI: 10.1016/j.jmig.2015.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/25/2015] [Accepted: 06/11/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of our technique for resectoscopic removal of large symptomatic submucous myomas. DESIGN Prospective study (Canadian Task Force classification II-3). SETTING A university teaching hospital and a private hospital. PATIENTS Forty-nine patients with submucous myomas ≥ 4 cm in diameter complaining of abnormal uterine bleeding. Seventeen patients were also complaining of infertility. INTERVENTIONS The intrauterine portion of submucous myomas was resected using the slicing technique. Slicing started at the site of the maximum bulge of the myoma and was continued down to the level of the endometrial surface. Each slicing session lasted for 5 to 10 minutes. After each slicing session, saline infusion was discontinued and restarted alternatively several times to induce rapid changes in the intrauterine pressure (hydromassage) to stimulate uterine contractions. The resectoscope was removed, and ovum forceps was used to extract the myoma fragments. Bimanual massage of the uterus was performed to induce extrusion of the intramural portion of the myoma into the uterine cavity. The same steps (slicing session lasting for 5-10 minutes to excise the portion of the myoma extruded into the uterine cavity, hydromassage, and uterine massage) were repeated several times until complete removal of the myoma. MEASUREMENTS AND MAIN RESULTS The mean diameter of the principle myomas was 51.94 ± 5.58 mm. The rate of 1-step complete resection of myomas was 91.84% (45/49). Improvement of bleeding symptoms was observed in all patients with complete resection of myomas. Nine of the 17 infertile women conceived after hysteroscopic myomectomy. One-step complete resection of myomas was more frequent in patients with myomas < 6 cm (43/44 [97.73%] vs 2/5 [40%], risk ratio [RR] = 2.44, p = .002), single myomas (39/40 [97.5%] vs 6/9 [66.67%], RR = 1.46, p = .016), principle myomas with a Lasmar score < 7 (32/32 [100%] vs 13/17 [76.47%], RR = 1.31, p = .011), and myomas with less than 50% extension into the myometrium (26/26 [100%] vs 19/23 [82.61%], RR = 1.21, p = .042). The rate of 1-step complete removal of myomas was 95% (19/20) for type II myomas < 6 cm and 0% (0/3) for type II myomas ≥ 6 cm. CONCLUSION Our technique of hysteroscopic myomectomy is a safe and effective management for submucous myomas up to 6 cm in diameter.
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Affiliation(s)
- Mohamed Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Usama M Fouda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Shereef M Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled A Elsetohy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed T Hashem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Is Cold Loop Hysteroscopic Myomectomy a Safe and Effective Technique for the Treatment of Submucous Myomas With Intramural Development? A Series of 1434 Surgical Procedures. J Minim Invasive Gynecol 2015; 22:792-8. [PMID: 25796220 DOI: 10.1016/j.jmig.2015.03.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To assess the safety and efficacy of cold loop hysteroscopic myomectomy in a large series of cases. DESIGN Retrospective study (Canadian Task Force Classification III). SETTING Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy. PATIENTS A total of 1215 patients with 1 or more G1-G2 submucous myomas. INTERVENTION Cold loop hysteroscopic myomectomy. MEASUREMENT AND MAIN RESULTS A total of 1690 myomas were removed. A minimum of 1 to a maximum of 5 fibroids for each surgical procedure were totally removed. Out of 1215 patients, 1017 (83.7%) were treated with a single surgical procedure. Twelve intraoperative complications occurred (0.84%). No cases of uterine perforation with the thermal loop or clinical intravasation syndrome were reported. CONCLUSION Cold loop hysteroscopic myomectomy seems to represent a safe and effective procedure for the removal of submucous myomas with intramural development, while at the same time respecting the anatomic and functional integrity of the myometrium. The use of a cold loop in resectoscopic myomectomy is associated with a low rate of minor intraoperative complications and an absence of major complications. This could be of primary relevance with a view to fertility and future pregnancies.
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Mazzon I, Favilli A, Gerli S. Reply of the authors. Fertil Steril 2014; 101:e41. [PMID: 24726217 DOI: 10.1016/j.fertnstert.2014.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Alessandro Favilli
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Sandro Gerli
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
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Leone FPG. Cold loop hysteroscopic technique for submucous myomas. Fertil Steril 2014; 101:e40. [PMID: 24726224 DOI: 10.1016/j.fertnstert.2014.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/06/2014] [Indexed: 11/30/2022]
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Transrectal Ultrasound-Guided Hysteroscopic Myomectomy of Submucosal Myomas With a Varying Degree of Myometrial Penetration. J Minim Invasive Gynecol 2013; 20:672-85. [DOI: 10.1016/j.jmig.2013.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 11/17/2022]
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Leone FPG. Re: Is it possible to obtain a presurgical Lasmar score for hysteroscopic myomectomy by ultrasound alone? M. Camanni, L. Bonino, M. Tessarolo, G. Migliaretti, B. Ferrero and F. Deltetto. Ultrasound Obstet Gynecol 2012; 40: 106-111. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:7-8. [PMID: 22753321 DOI: 10.1002/uog.11207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- F P G Leone
- Department of Obstetrics & Gynecology, Hospital L. Sacco, Via G.B. Grassi 74, Milan 20157, Italy.
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Leone FP. Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question. Fertil Steril 2012; 97:e1-2; author reply e3. [DOI: 10.1016/j.fertnstert.2011.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/24/2011] [Indexed: 12/01/2022]
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