title: A new hysteroscopic technique for the preparation of partially intramural myomas in office setting (OPPIuM technique): A pilot study.
abstract: OBJECTIVE
  To assess the safety and the effectiveness of a novel hysteroscopic technique for the Office Preparation of Partially Intramural Myomas (OPPIuM), to facilitate the subsequent, already scheduled, resectoscopic myomectomy.
  
  
  METHODS
  Pilot study.
  
  
  METHODS
  University of Bari, Naples and Foggia.
  
  
  METHODS
  Fifty-nine fertile women (age 27-48 years) diagnosed at office hysteroscopy as having symptomatic submucous myomas>1.5 cm with intramural development (G1 and G2), scheduled for resectoscopic surgery.
  
  
  METHODS
  The OPPIuM technique consisted of an incision of the endometrial mucosa covering the myoma by means of Fr scissors or bipolar Versapoint Twizzle electrode, along its reflection line on the uterine wall, up to the precise identification of the cleavage surface between the myoma and its pseudo-capsule. Such procedure was aimed at triggering the protrusion of the intramural portion of the myoma into the uterine cavity during the following menstrual cycles, thus facilitating the subsequent total removal of the lesion via resectoscopic surgery. All patients underwent follow-up in-patient hysteroscopy after 2 menstrual cycles before resectoscopic surgery were performed.
  
  
  RESULTS
  The OPPIuM technique was successfully performed in all cases. The mean diameter of successfully prepared myomas was 2.9+/-0.8 cm. At follow-up hysteroscopy, the conversion of partially intramural myomas into totally or prevalently intracavitary ones was observed in 93.2% (55/59) of cases. In 2 of 3 cases of failure, the myomas' size was>4 cm. One patient was excluded from the study because of the occurrence of total spontaneous expulsion of the myoma at the subsequent menstrual cycle.
  
  
  CONCLUSIONS
  Our preliminary findings seem to support the safety and the effectiveness of the OPPIuM procedure by reporting the conversion of myomas with intramural development>1.5 cm into totally or prevalently intracavitary ones in nearly 93% of cases. Such technique may allow surgeons to perform resectoscopic surgery more safely and quickly as dealing with prevalently intracavitary lesions. However, further studies are mandatory to validate its use in daily practice.
authors.affiliation: Department of General and Specialist Surgical Sciences, University of Bari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bettocchi
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Spiezio Sardo
authors.forename: Oronzo
authors.initials: O
authors.lastname: Ceci
authors.forename: Luigi
authors.initials: L
authors.lastname: Nappi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Guida
authors.forename: Elena
authors.initials: E
authors.lastname: Greco
authors.forename: Lauro
authors.initials: L
authors.lastname: Pinto
authors.forename: Anna Lina
authors.initials: AL
authors.lastname: Camporiale
authors.forename: Carmine
authors.initials: C
authors.lastname: Nappi
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D008875:Middle Aged; D009214:Myoma / Q000473:pathology / Q000601:surgery*; D010865:Pilot Projects; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*