title: Predicting outcome of one-step total hysteroscopic resection of sessile submucous myoma.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan. tm@ob-gy.med.tohoku.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hayasaka
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Terada
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Yuki
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Tamura
authors.forename: Rei
authors.initials: R
authors.lastname: Yokomizo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nabeshima
authors.forename: Nobuo
authors.initials: N
authors.lastname: Yaegashi
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Okamura
mesh_terms: 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*