title: Transrectal ultrasound-guided hysteroscopic myomectomy of submucosal myomas with a varying degree of myometrial penetration.
abstract: OBJECTIVE
  To predict the 1-step complete resection rate after transrectal ultrasound-guided hysteroscopic myomectomy and to determine the usefulness of intraoperative transrectal ultrasonography (TRUS) in monitoring hysteroscopic electroresection of submucosal myomas.
  
  
  METHODS
  Prospective cohort study (Canadian Task Force classification II-1).
  
  
  METHODS
  University hospital.
  
  
  METHODS
  One hundred twenty women with symptomatic (abnormal uterine bleeding or reproductive disorder), single, submucosal myomas underwent hysteroscopic electroresection. Groups 1 and 2 were monitored, respectively, with or without TRUS. Anatomical inclusion criteria were myoma ≤5 cm and myometrial free margin ≥3 mm above the myoma.
  
  
  METHODS
  Myomas were evaluated preoperatively via sonohysterograpy and were graded according to the guidelines outlined by the European Society of Hysteroscopy (ESH), including size and myometrial free margin, and according to the STEPW (size, topography, extension, penetration, and lateral wall) classification. On the basis of sonographic findings, patients with myomas >3 cm received gonadotropin-releasing hormone therapy for 1 to 3 months. Hysteroscopic myomectomy was performed with or without TRUS guidance. At 4 to 8 weeks after the initial procedure, postoperative transvaginal ultrasonography, sonohysterography, or second-look hysteroscopy was performed.
  
  
  RESULTS
  In the TRUS group, a significantly higher percentage of 1-step complete resections was observed than in the group without TRUS (91% vs 73%) (p = .02). This was associated with a statistically significant difference in the subgroups of myomas that were deeply penetrating into the myometrium (89% vs 55%) (p < .01). One-way logistic analysis of data for all treated patients indicated the use of TRUS, as well as the ESH and STEPW classifications, as significant factors influencing the 1-step complete resection. At multivariable logistic regression analysis, use of TRUS (odds ratio [OR], 2.74; p < .001), myomas graded 0 or 1 according to ESH (OR, 3.55; p < .001), and size <3 cm (OR, 2.35; p < .05) were significantly associated with 1-step complete resection (area under the curve, 0.80; p < .001). In the TRUS group there were two significant predictors: size <3 cm (OR = 5.21; p < .05) and myometrial free margin <5 mm (OR, 0.18; p < .05).
  
  
  CONCLUSIONS
  Intraoperative use of TRUS during hysteroscopic myomectomy increases the chance of complete 1-step removal of submucosal myomas that deeply penetrate the myometrium.
authors.affiliation: Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland. Electronic address: ludwin@cm-uj.krakow.pl.
authors.forename: Artur
authors.initials: A
authors.lastname: Ludwin
authors.forename: Inga
authors.initials: I
authors.lastname: Ludwin
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Pityński
authors.forename: Paweł
authors.initials: P
authors.lastname: Basta
authors.forename: Antoni
authors.initials: A
authors.lastname: Basta
authors.forename: Tomasz
authors.initials: T
authors.lastname: Banas
authors.forename: Robert
authors.initials: R
authors.lastname: Jach
authors.forename: Marcin
authors.initials: M
authors.lastname: Wiecheć
authors.forename: Rita
authors.initials: R
authors.lastname: Grabowska
authors.forename: Klaudia
authors.initials: K
authors.lastname: Stangel-Wójcikiewicz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Milewicz
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Nocuń
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000601:surgery; D063186:Uterine Myomectomy / Q000379:methods*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*
keywords: Hysteroscopic myomectomy; Hysteroscopy; Intraoperative transrectal ultrasound; Myomas; Sonohysterography; Submucosal myomas; Ultrasound-guided operative hysteroscopy