Hysteroscopic treatment of symptomatic submucous fibroids using a bipolar intrauterine system: a feasibility study.
OBJECTIVE
To determine the feasibility (safety, potential efficacy and cost effectiveness) of a miniature endoscopic bipolar electrosurgical intrauterine system in the treatment of symptomatic submucous fibroids.


METHODS
A total of 37 women with symptomatic submucous fibroids were identified on outpatient hysteroscopy. All underwent hysteroscopic excision or ablation using a bipolar intrauterine system (Versapoint). The main outcomes measures were change in uterine bleeding symptoms measured on a continuous and ordinal scale, patient satisfaction, time of work and use of health service resources at 6 months following treatment.


RESULTS
36/37 (97%) women returned completed outcome questionnaires. The mean amount of abnormal uterine bleeding was reduced at 6 months compared to immediately prior to treatment (P=0.0001). Improvement in bleeding symptoms was reported by 28/36 (78%) women and satisfaction with treatment by 33/36 (92%) women. All procedures were successfully completed, there were no serious operative complications and at 6 months no repeat hysteroscopic procedures were necessary. The mean cost of diagnosis and treatment of submucous fibroids using an endoscopic bipolar intrauterine system was 40% cheaper at 6 months follow-up than a hysterectomy or open myomectomy ( pound 1266 versus pound 2123).


CONCLUSIONS
Hysteroscopic treatment of symptomatic submucous fibroids appears to be safe, efficacious and cost effective. It seems feasible to launch a randomised controlled trial to confirm these provisional results in both the short and longer term.
Clark
T Justin
TJ
Academic Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, B15 2TG, Birmingham, UK. t.j.clark@bham.ac.uk
Mahajan
Deepa
D
Sunder
Ponnamal
P
Gupta
Janesh K
JK
D000328:Adult; D003362:Cost-Benefit Analysis; D004564:Electrocoagulation; D004714:Endometrial Hyperplasia / Q000175:diagnosis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000191:economics; D007889:Leiomyoma / Q000175:diagnosis* / Q000601:surgery*; D016239:MEDLINE; D008875:Middle Aged; D017060:Patient Satisfaction; D011127:Polyps / Q000175:diagnosis; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014592:Uterine Hemorrhage; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000601:surgery*