[Change in the spectrum of uterus-preserving myoma operations including endoscopy and dual myoma therapy].
OBJECTIVE
On the basis of the evaluation of 300 patients who underwent myoma surgery with the desire for uterus preservation at the Department of Obstetrics and Gynaecology of Heidelberg University, a management scheme including endoscopic techniques was developed.


METHODS
Despite the patients' wish for organ preservation, in 12 cases (family planning complete, therapy-resistant sterility, no desire for a child) with an extremely large uterus (20th-24th week of gestation) or a degenerated, intramural myoma (a sarcoma not being excluded), a primary hysterectomy had to be performed. Overall, 37.9% of patients underwent conventional, 42% laparoscopic and 20.1% hysteroscopic surgery. Additionally, to objectify the role of a pretreatment with GnRH analogues (GnRHa), the following control parameters were examined in 128 patients with and 160 patients without pretreatment: rate of primary laparotomies, conversion, secondary hysterectomy, intraoperative bleedings, amount of distension medium and percentage of repeat interventions.


RESULTS
No significant differences in the study parameters between study and control groups could be found in the patients treated by laparoscopy. In the hysteroscopy group, conversion rate (13.3 vs. 7%), operation time (35 vs. 21.9 min), rate of severe intraoperative bleeding (33.3 vs. 9.3%), amount of distension medium necessary (difference 2.1 litres) and rate of repeat interventions (40.4 vs. 16.3%) differed significantly between study and control groups.


CONCLUSIONS
In the operative management, the key question is when to perform an invasive procedure. The second question should be which access route is the most convenient. The decision whether to give GnRHa pretreatment is also an individual one, especially in cases of a conventional or laparoscopic operative procedure. A preoperative GnRHa therapy is mandatory before hysteroscopy for submucous myoma.
Wallwiener
D
D
Universitäts-Frauenklinik Heidelberg, Deutschland.
Aydeniz
B
B
Rimbach
S
S
Diel
I J
IJ
Grischke
E M
EM
Rabe
T
T
Bastert
G
G
D000328:Adult; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation / Q000706:statistics & numerical data; D020702:Hysteroscopes; D015907:Hysteroscopy / Q000706:statistics & numerical data*; D015994:Incidence; D020706:Laparoscopes; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007889:Leiomyoma / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000601:surgery*; D014741:Video Recording / Q000295:instrumentation