Predicting outcome of one-step total hysteroscopic resection of sessile submucous myoma.
OBJECTIVE
To analyze variables for successful 1-step hysteroscopic myomectomies of sessile submucous myomas.


METHODS
Retrospective case-control study. (Canadian Task Force classification II-2).


METHODS
Single operator's practice in a university hospital and its related hospitals.


METHODS
Twenty-eight patients with sessile submucous myomas and menorrhagia, infertility, or both.


METHODS
Our strategy for hysteroscopic myomectomy is as follows. First, we scraped and/or vaporized intrauterine dome of myoma until top of myoma was even with level of wall of cavity. Next, the remnant intramural node was squeezed by uterine contractions induced by prostaglandin F2alpha injection. Finally, the newly raised myoma dome was sectioned or vaporized electrosurgically only within the space of the intrauterine cavity and/or was separated mechanically from healthy myometrium without electrosurgery.


RESULTS
Submucous myomas in 16 (57.1%) patients were completely removed after 1 surgery. By logistic regression analysis, thickness of outer myometrial layer of myoma node (OR 3.06, p = .02), myoma size (OR 0.86, p = .04), and intramural extension degree (OR 0.91, p = .03) were significantly associated with outcome of complete resection.


CONCLUSIONS
Thickness of outer myometrial layer of myoma node, myoma size, and intramural extension degree predicted outcome of 1-step hysteroscopic myomectomy. The chance of performing successful surgery increased with increased thickness of outer myometrial layer of myoma, and decreased with larger myomas and greater degrees of intramural extension.
Murakami
Takashi
T
Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan. tm@ob-gy.med.tohoku.ac.jp
Hayasaka
Shinichi
S
Terada
Yukihiro
Y
Yuki
Hiromitsu
H
Tamura
Mitsutoshi
M
Yokomizo
Rei
R
Nabeshima
Hiroshi
H
Yaegashi
Nobuo
N
Okamura
Kunihiro
K
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D009215:Myometrium; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*