title: Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question.
abstract: OBJECTIVE
  To evaluate the feasibility of the hysteroscopic resection of type II submucous fibroids regardless of the myometrial free margin separating them from the serosa and to report the dynamic changes the margin undergoes after the various phases of resection.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  A tertiary-level university hospital.
  
  
  METHODS
  Thirteen women with single type II submucous fibroids of ≤ 5 cm in diameter regardless of the myometrial free margin.
  
  
  METHODS
  Hysteroscopic myomectomy and ultrasound evaluation of myometrial free margin before and after each phase of the procedure.
  
  
  METHODS
  The possibility of a complete one-step resection, the incidence of intraoperative or postoperative complications, and the analysis of the dynamic changes occurring in myometrial free margin.
  
  
  RESULTS
  Complete resection was performed successfully in all patients. No complications were registered. The myometrial free margin decreased on the distension of the uterine cavity and then increased progressively and significantly after the various phases of resection.
  
  
  CONCLUSIONS
  In selected cases and in experienced hands, hysteroscopic myomectomy of type II submucous fibroids may be performed successfully and safely regardless of the myometrial free margin. Myometrial free margin increases progressively with each step of the procedure probably leading to an increasing margin of safety.
authors.affiliation: Department of Obstetrics, S. Orsola Malpighi University Hospital, Bologna University, Bologna, Italy. p.casadio@unibo.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Casadio
authors.forename: Aly M
authors.initials: AM
authors.lastname: Youssef
authors.forename: Emanuela
authors.initials: E
authors.lastname: Spagnolo
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Rizzo
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Talamo
authors.forename: Denise
authors.initials: D
authors.lastname: De Angelis
authors.forename: Elena
authors.initials: E
authors.lastname: Marra
authors.forename: Tullio
authors.initials: T
authors.lastname: Ghi
authors.forename: Luca
authors.initials: L
authors.lastname: Savelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Farina
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pelusi
authors.forename: Ivan
authors.initials: I
authors.lastname: Mazzon
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D057230:Limit of Detection; D008875:Middle Aged; D009092:Mucous Membrane / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009873:Operating Rooms / Q000379:methods; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*