title: Feasibility of a new two-step procedure for office hysteroscopic resection of submucous myomas: results of a pilot study.
abstract: OBJECTIVE
  To assess the feasibility of a new two-step technique for office hysteroscopic resection of submucous myomas.
  
  
  METHODS
  Between January 2010 and December 2011, all consecutive patients of reproductive age with symptomatic lesions sonographically diagnosed as single mainly intracavitary (G1 or G2) myoma ≤4.0 cm were eligible to participate in a prospective study. They underwent a two-step hysteroscopic procedure, which included preparation of partially intramural myomas with incision of the endometrial mucosa and the pseudocapsule covering the myoma in the first step, and excision of the myoma by means of diode laser four weeks later. All procedures were performed on an outpatient basis and without anesthesia.
  
  
  RESULTS
  A total of 43 women (mean age 36.7 years) were included. The two-step myomectomy technique was successfully performed in 34 (79.1%) patients. All myomas ≤18 mm were successfully enucleated as compared with 85% of 19-30 mm, and 0% of ≥30 mm (P<0.001). Also, myomas located in the anterior/posterior walls and those located in the fundus/lateral walls were enucleated in 87.9% and 50% of cases, respectively (P=0.020). Success of surgery was not influenced by the initial type of myoma.
  
  
  CONCLUSIONS
  The new two-step hysteroscopic myomectomy carried out as an outpatient procedure and without anesthesia is feasible for the excision of symptomatic submucous fibroids.
authors: Service of Obstetrics and Gynecology, Hospital Universitari Parc de Salut Mar, Auniversitat Autònoma de Barcelona, Barcelona, Spain. sergio@haimovich.net
authors: Sergio
authors: S
authors: Haimovich
authors: Gemma
authors: G
authors: Mancebo
authors: Francesc
authors: F
authors: Alameda
authors: Silvia
authors: S
authors: Agramunt
authors: Josep M
authors: JM
authors: Solé-Sedeno
authors: José Luis
authors: JL
authors: Hernández
authors: Ramón
authors: R
authors: Carreras
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects; D004717:Endometrium / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects; D007431:Intraoperative Complications / Q000517:prevention & control; D054023:Lasers, Semiconductor / Q000009:adverse effects / Q000627:therapeutic use; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D060787:Neoplasm Grading; D010044:Outpatient Clinics, Hospital; D010865:Pilot Projects; D011446:Prospective Studies; D013030:Spain; D047368:Tumor Burden; D014463:Ultrasonography; D063186:Uterine Myomectomy / Q000009:adverse effects; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014595:Uterine Perforation / Q000517:prevention & control