Hysteroscopic resection of type 3 myoma: a new challenge?
OBJECTIVE
Type 3 myomas are intramural within contact with the endometrium but lack any cavity deformation. There is no guideline for management of symptomatic type 3 myoma. The aim of this study was to evaluate the feasibility of symptomatic type 3 myoma hysteroscopic resection.


METHODS
This retrospective study included symptomatic women (mainly pain, infertility or bleeding) who obtained an operative hysteroscopy for type 3 symptomatic myoma from June 2010 to December 2014 in the gynaecological unit of a teaching hospital.


RESULTS
Thirteen women with an operative resection using bipolar electrosurgery of type 3 myoma during the study period (June 2010 to December 2014) were included in the study. Two women had a hysterectomy 6 and 12 months after the procedure and one woman had an open myomectomy 30 months after the procedure for the recurrence of abnormal bleeding. Postoperative office hysteroscopy show a postoperative synechiae in 3 women out of 8. Incomplete resection was also obtained in 3 women out of 8.


CONCLUSIONS
Hysteroscopic resection is a potential alternative to traditional surgery for type 3 myoma. This procedure must be confined to skilled surgeons because it is a difficult procedure. A postoperative office hysteroscopy is recommended in women of reproductive age.
Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276 Le Kremlin Bicêtre, France; Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, F-94276 Le Kremlin Bicêtre, France. Electronic address: perrine.capmas@aphp.fr.
Perrine
P
Capmas
Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276 Le Kremlin Bicêtre, France.
Audrey
A
Voulgaropoulos
Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276 Le Kremlin Bicêtre, France.
Guillaume
G
Legendre
Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276 Le Kremlin Bicêtre, France; Faculty of Medicine, Univ Paris Sud, F-94276 Le Kremlin Bicêtre, France.
Anne-Gaelle
AG
Pourcelot
Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276 Le Kremlin Bicêtre, France; Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, F-94276 Le Kremlin Bicêtre, France; Faculty of Medicine, Univ Paris Sud, F-94276 Le Kremlin Bicêtre, France.
Hervé
H
Fernandez
D000328:Adult; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery; D007889:Leiomyoma / Q000150:complications / Q000601:surgery*; D008595:Menorrhagia / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000601:surgery*
Fertility; Hysteroscopic resection; Type 3 myoma