Safety and efficacy of hysteroscopic resection of uterine leiomyoma embedded at the base of a uterine septum

BACKGROUND

To determine the safety and efficacy of hysteroscopic resection of uterine leiomyoma embedded at the base of a uterine septum.

METHODS

This case series included 11 patients with infertility or recurrent pregnancy loss who were found to have a uterine septum (one septate and 10 sub-septate) and a uterine leiomyoma embedded at the base of the uterine septum. All patients underwent a hysteroscopic division of the uterine septum and hysteroscopic resection of the uterine leiomyoma. Safety was determined by any intra-operative complications, and any immediate or late postoperative complications. Efficacy was determined based on the findings on a postoperative trans-vaginal 3D ultrasound (TV 3D US) with a saline infusion sonohysterogram (SIH) and reproductive outcomes.

RESULTS

There were no reported intra-operative complications, or immediate or late postoperative complications. Eleven patients underwent TV 3D US with SIH; findings were normal in 8 (72.7%); 3 patients underwent a second operative hysteroscopy and subsequent TV 3D US with SIH were also normal. The analysis of reproductive outcomes was limited to patients who were < 40 years (9 patients). Seven patients conceived (77.8%), six delivered (66.7%) and one miscarried (14.3%).

CONCLUSIONS

Hysteroscopic myomectomy of a leiomyoma, which is embedded at the base of a uterine septum, can be safely performed at the same session of hysteroscopic division of the uterine anomaly. Improvement in reproductive outcomes is to be expected after such procedures.

Reproductive Outcome following Hysteroscopic Monopolar Metroplasty: An Analysis of 203 Cases

BACKGROUND

: The aim of this study was to evaluate the reproductive outcome of women with history of infertility or recurrent miscarriage following hysteroscopic septum resection.

MATERIALS AND METHODS

:This was a retrospective descriptive study performed on 263 patients, among whom 248 patients were infertile (79% with primary infertility and 21% with secondary infertility) and 15 patients presented with histories of recurrent miscarriage (three or more miscarriages) between 2005 and 2009. All participants underwent hysteroscopic septum resection using monopolar knife electrode. The main outcome measure was reproductive outcome after hysteroscopic metroplasty.

RESULTS

The septum was completely removed during the first hysteroscopy in 242 (92%) patients. A residual septum was seen in 21 (8%) patients who required a second sitting of surgery. Three cases were complicated by minor perforations which required no further interventions. One operation complicated with bleeding which was controlled by a Foley catheter. There were no cases of postoperative Asherman's syndrome. Postoperatively, out of 263 patients, outcomes of 203 individuals were analyzed. According to the results, the miscarriage rate reduced significantly from 20.2 to 4.9%. Postoperative ectopic pregnancy rate and preterm labor were lower than prior to septum resection. Term deliveries increased significantly from 2.5 to 33.5%.

CONCLUSION

Hysteroscopic septum resection is a safe and effective method for patients with history of infertility or recurrent miscarriage.