Predicting success of single step hysteroscopic myomectomy: A single centre large cohort study of single myomas.
BACKGROUND
Submucous myomas represent one of the main indications of operative hysteroscopy. Hysteroscopic resection of submucous fibroids should be a simple, well-tolerated and effective procedure and ideally accomplished in in only one surgical step.


METHODS
Retrospective cohort single Centre study of 1244 women undergoing hysteroscopic myomectomy. Data analysis included patients' and the myomas characteristics. A multiple logistic regression was carried out in order to assess which variables were able to determine a multiple step procedure.


RESULTS
1090 myomas (87.62%) were completely resected in a single-step procedure (SS group) whereas a multiple-step procedure (MS group) was needed for the removal of 154 fibroids (12.38%). The mean size of myomas resected in the SS group was 22.83 ± 9.36 mm whereas fibroids of the MS group measured 29.67 ± 10.76 mm. The overall feasibility of hysteroscopic myomectomy in one surgical procedure was 88.28%. All hysteroscopic myomectomies of G0 fibroids were completed in a single step. The chance of success to accomplish the treatment in a single-step for G1 and G2 myomas were 88.59% and 82.55%, respectively. The multivariate analysis revealed an inverse correlation between age and multiple step procedures and size of myomas were all directly correlated to multiple step procedures.


CONCLUSIONS
The grading, the size of the myomas and the age of patients play a crucial role in completing the hysteroscopic myomectomy in a single step. Only the diameter greater than 3 cm in G2 myomas is correlated to a higher risk of a multiple procedure.
"Arbor Vitae" Centre, Clinica Nuova Villa Claudia, 00191 Rome, Italy.
Ivan
I
Mazzon
Department of Obstetrics and Gynecology, University of Perugia, S.M. Della Misericordia Hospital, 06156 Perugia, Italy.
Alessandro
A
Favilli
"Arbor Vitae" Centre, Clinica Nuova Villa Claudia, 00191 Rome, Italy.
Mario
M
Grasso
"Arbor Vitae" Centre, Clinica Nuova Villa Claudia, 00191 Rome, Italy.
Stefano
S
Horvath
Department of Obstetrics and Gynecology, University of Perugia, S.M. Della Misericordia Hospital, 06156 Perugia, Italy.
Vittorio
V
Bini
Department of Obstetrics and Gynecology, University of Perugia, S.M. Della Misericordia Hospital, 06156 Perugia, Italy.
Gian Carlo
GC
Di Renzo
Department of Obstetrics and Gynecology, University of Perugia, S.M. Della Misericordia Hospital, 06156 Perugia, Italy. Electronic address: sandro.gerli@unipg.it.
Sandro
S
Gerli
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
Cold loop; Feasibility; Hysteroscopic myomectomy; Myomas; One-step procedure