Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-08T05:07:22.876Z Has data issue: false hasContentIssue false

Chapter 12 - Hysteroscopic Management of Fibroids

Published online by Cambridge University Press:  10 September 2020

By
Olav Istre  and
T. Justin Clark
Edited by
Mary E. Connor  and
T. Justin Clark
Mary E. Connor
Affiliation:
Royal Hallamshire Hospital, Sheffield
T. Justin Clark
Affiliation:
Birmingham Women’s Hospital
Get access

Summary

Uterine fibroids or leiomyomas are solid, invariably benign tumours of uterine smooth muscle and connective tissue. The prevalence varies according to the population studied, but is estimated to be 25% in a general female population of reproductive age, although rates of up to 70% have also been reported [1–6]. Fibroids that encroach beyond the myometrium into the uterine cavity are referred to as submucosal, submucous or intracavity, and may account for up to 10% of all fibroids [7]. They are thought to be associated with abnormal uterine bleeding and reproductive failure. The development of endoscopy has allowed removal of submucosal fibroids under direct vision, hysteroscopic myomectomy, which avoids the need for laparotomy or crude, blind intrauterine techniques.

Type
Chapter
Information
Diagnostic and Operative Hysteroscopy , pp. 144 - 157
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baird, DD, Dunson, DB, Hill, MC, Cousins, D, Schectman, JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188: 100–7.Google Scholar
Cramer, SF, Patel, A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94: 435–8.CrossRefGoogle ScholarPubMed
Myers, SL, Baird, DD, Olshan, AF, et al. Self-report versus ultrasound measurement of uterine fibroid status. J Womens Health (Larchmt) 2012; 21: 285–93.Google Scholar
Ryan, GL, Syrop, CH, Van Voorhis, BJ. Role, epidemiology, and natural history of benign uterine mass lesions. Clin Obstet Gynecol 2005; 48: 312–24.CrossRefGoogle ScholarPubMed
Zimmermann, A, Bernuit, D, Gerlinger, C, Schaefers, M, Geppert, K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health 2012; 12: 6.Google Scholar
Marshall, LM, Spiegelman, D, Barbieri, RL, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 1997; 90: 967–73.Google Scholar
Ubaldi, F, Tournaye, H, Camus, M, et al. Fertility after hysteroscopic myomectomy. Hum Reprod Update 1995; 1: 81–90.CrossRefGoogle ScholarPubMed
Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons. Myomas and reproductive function. Fertil Steril 2008; 90(5 Suppl): S125–30.Google Scholar
Russo, M, Suen, M, Bedaiwy, M, Chen, I. Prevalence of uterine myomas among women with 2 or more recurrent pregnancy losses: a systematic review. J Minim Invasive Gynecol 2016; 23: 7026.CrossRefGoogle ScholarPubMed
Emanuel, MH, Verdel, MJC, Stas, H, Wamsteker, K, Lammes, FB. An audit of true prevalence of intra-uterine pathology: the hysteroscopical findings controlled for patient selection in 1202 patients with abnormal uterine bleeding. Gynaecol Endosc 1995; 4: 237–41.Google Scholar
Lasmar, RB, Dias, R, Barrozo, PR, et al. Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding. Fertil Steril 2008; 89: 1803–7.CrossRefGoogle ScholarPubMed
Jansen, FW, Vredevoogd, CB, van Ulzen, K, et al. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol 2000; 96: 266–70.Google ScholarPubMed
Emanuel, MH, Wamsteker, K, Hart, AA, Metz, G, Lammes, FB. Long-term results of hysteroscopic myomectomy for abnormal uterine bleeding. Obstet Gynecol 1999; 93: 743–8.Google ScholarPubMed
Hart, R, Molnar, BG, Magos, A. Long term follow up of hysteroscopic myomectomy assessed by survival analysis. BJOG 1999; 106: 700–5.Google Scholar
Vercellini, P, Zaina, B, Yaylayan, L, et al. Hysteroscopic myomectomy: long-term effects on menstrual pattern and fertility. Obstet Gynecol 1999; 94: 341–7.Google ScholarPubMed
Pritts, EA, Parker, WH, Olive, DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2009; 91: 1215–23.Google Scholar
Bosteels, J, Kasius, J, Weyers, S, et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev 2015; (2): CD009461.Google Scholar
Munro, MG, Critchley, HO, Broder, MS, et al. The FIGO classification system (‘PALM-COEIN’) for causes of abnormal uterine bleeding in non-gravid women in the reproductive years, including guidelines for clinical investigation. Int J Gynaecol Obstet 2011; 113: 3–13.Google Scholar
Farquhar, C, Ekeroma, A, Furness, S, Arroll, B. A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol Scand 2003; 82: 493–504.CrossRefGoogle ScholarPubMed
Nieuwenhuis, LL, Hermans, FJ, Leeflang, MM, et al. Three-dimensional saline infusion sonography compared to two-dimensional saline infusion sonography for the diagnosis of focal intracavitary lesions. Cochrane Database Syst Rev 2017; (5): CD011126.Google ScholarPubMed
Lasmar, RB, Xinmei, Z, Indman, PD, Celeste, RK, Di Spiezio Sardo, A. Feasibility of a new system of classification of submucous myomas: a multicenter study. Fertil Steril 2011; 95: 2073–7.Google Scholar
Yang, JH, Lin, L. Changes in myometrial thickness during hysteroscopic resection of deeply invasive submucous myomas. J Am Assoc Gynecol Laparosc 2001; 8: 501–5.CrossRefGoogle ScholarPubMed
van Dongen, H, de Kroon, CD, Jacobi, CE, Trimbos, JB, Jansen, FW. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG 2007; 114: 664–75.CrossRefGoogle ScholarPubMed
Lin, B, Akiba, Y, Iwata, Y. One-step hysteroscopic removal of sinking submucous fibroid in two infertile patients. Fertil Steril 2000; 74: 1035–8.CrossRefGoogle Scholar
Wamsteker, K, Emanuel, MH, de Kruif, JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol 1993; 82: 736–40.Google Scholar
Lasmar, RB, Barrozo, PR, Dias, R, Oliveira, MA. Submucous fibroids: a new presurgical classification to evaluate the viability of hysteroscopic surgical treatment – preliminary report. J Minim Invasive Gynecol 2005; 12: 308–11.Google Scholar
Donnez, J, Tatarchuk, TF, Bouchard, P, et al. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med 2012; 366: 409–20.CrossRefGoogle ScholarPubMed
Donnez, J, Tomaszewski, J, Vazquez, F, et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med 2012; 366: 421–32.Google Scholar
Gutmann, JN, Corson, SL. GnRH agonist therapy before myomectomy or hysterectomy. J Minim Invasive Gynecol 2005; 12: 529–37.Google Scholar
Campo, S, Campo, V, Gambadauro, P. Short-term and long-term result of resectoscopic myomectomy with and without pretreatment with GnRH analogs in premenopausal women. Acta Obstet Gynecol Scand 2005; 84: 756–60.Google Scholar
Mavrelos, D, Ben-Nagi, J, Davies, A, et al. The value of pre-operative treatment with GnRH analogues in women with submucous fibroids: a double-blind, placebo-controlled randomized trial. Hum Reprod 2010; 25: 2264–9.Google Scholar
Muzii, L, Boni, T, Bellati, F, et al. GnRH analogue treatment before hysteroscopic resection of submucous myomas: a prospective, randomized, multicenter study. Fertil Steril 2010; 94: 1496–9.Google Scholar
Bizzarri, N, Ghirardi, V, Remorgida, V, Venturini, PL, Ferrero, S. Three-month treatment with triptorelin, letrozole and ulipristal acetate before hysteroscopic resection of uterine myomas: prospective comparative pilot study. Eur J Obstet Gynecol Reprod Biol 2015; 192: 22–6.CrossRefGoogle ScholarPubMed
Bhattacharya, S, Parkin, DE, Reid, TMS, et al. A prospective randomised study of the effects of prophylactic antibiotics on the incidence of bacteraemia following hysteroscopic surgery. Eur J Obstet Gynecol Reprod Biol 1995; 63: 37–40.Google Scholar
Agostini, A, Cravello, L, Shojai, R, et al. Postoperative infection and surgical hysteroscopy. Fertil Steril 2002; 77: 766–8.CrossRefGoogle ScholarPubMed
Al-Fozan, H, Firwana, B, Al Kadri, H, Hassan, S, Tulandi, T. Preoperative ripening of the cervix before operative hysteroscopy. Cochrane Database Syst Rev 2015; (4): CD005998.Google Scholar
Phillips, DR, Nathanson, HG, Milim, SJ, Haselkorn, JS. The effect of dilute vasopressin solution on the force needed for cervical dilatation: a randomized controlled trial. Obstet Gynecol 1997; 89: 507–11.Google Scholar
AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol 2012; 19: 152–71.Google Scholar
Royal College of Obstetricians and Gynaecologists. Best Practice in Outpatient Hysteroscopy. Green-top Guideline No. 59. London: RCOG; 2011. www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg59 (accessed November 2019).Google Scholar
Bettocchi, S, Di Spiezio Sardo, A, Ceci, O, et al. A new hysteroscopic technique for the preparation of partially intramural myomas in office setting (OPPIuM technique): a pilot study. J Minim Invasive Gynecol 2009; 16: 748–54.CrossRefGoogle ScholarPubMed
Haimovich, S, Mancebo, G, Alameda, F, et al. Feasibility of a new two-step procedure for office hysteroscopic resection of submucous myomas: results of a pilot study. Eur J Obstet Gynecol Reprod Biol 2013; 168: 191–4.Google Scholar
Umranikar, S, Clark, TJ, Saridogan, E. BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy. Gynecol Surg 2016; 13: 289–303.Google Scholar
AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL Practice Report. Practice guidelines for the management of hysteroscopic distending media. J Minim Invasive Gynecol 2013; 20: 137–48.Google Scholar
Clark, TJ, Mahajan, D, Sunder, P, Gupta, JK. Hysteroscopic treatment of symptomatic submucous fibroids using a bipolar intrauterine system: a feasibility study. Eur J Obstet Gynecol Reprod Biol 2002; 100: 237–42.Google Scholar
Varma, R, Soneja, H, Clark, TJ, Gupta, JK. Hysteroscopic myomectomy for menorrhagia using Versascope bipolar system: efficacy and prognostic factors at a minimum of one year follow up. Eur J Obstet Gynecol Reprod Biol 2009; 142: 154–9.CrossRefGoogle Scholar
Bettocchi, S, Nappi, L, Ceci, O, et al. Treatment of submucosal and partially intramural myomas using the bipolar Versapoint system. J Am Assoc Gynecol Laparosc 2004; 11: S17–18.CrossRefGoogle Scholar
Di Spiezio Sardo, A, Mazzon, I, Bramante, S, et al. Hysteroscopic myomectomy: a comprehensive review of surgical techniques. Human Reprod Update 2008; 14: 101–19.CrossRefGoogle ScholarPubMed
Brooks, PG. Resectoscopic myoma vaporizer. J Reprod Med 1995, 40: 791–5.Google Scholar
Emanuel, MH, Wamsteker, K. The intra uterine morcellator: a new hysteroscopic operating technique to remove intrauterine polyps and myomas. J Minim Invasive Gynecol 2005; 12: 62–6.Google Scholar
van Dongen, H, Emanuel, MH, Wolterbeek, R, Trimbos, JB, Jansen, FW. Hysteroscopic morcellator for removal of intrauterine polyps and myomas: a randomized controlled pilot study among residents in training. J Minim Invasive Gynecol 2008; 15: 466–71.Google Scholar
Mazzon, I, Favilli, A, Grasso, M, et al. Is cold loop hysteroscopic myomectomy a safe and effective technique for the treatment of submucous myomas with intramural development? A series of 1434 surgical procedures. J Minim Invasive Gynecol 2015; 22: 792–8.CrossRefGoogle ScholarPubMed
Munro, MG. Hysteroscopic myomectomy of FIGO type 2 leiomyomas under local anesthesia: bipolar radiofrequency needle–based release followed by electromechanical morcellation. J Minim Invasive Gynecol 2016; 23: 12–13.CrossRefGoogle ScholarPubMed
Hysteroscopy. Oppium Technique. www.youtube.com/watch?v=XIp6-5rASpM (accessed October 2019).Google Scholar
Yang, JH, Chen, MJ, Wu, MY, et al. Office hysteroscopic early lysis of intrauterine adhesion after transcervical resection of multiple apposing submucous myomas. Fertil Steril 2008; 89: 1254–9.Google Scholar
Van Dongen, H, Emanuel, MH, Smeets, MJ, Trimbos, B, Jansen, FW. Follow-up after incomplete hysteroscopic removal of uterine fibroids. Acta Obstet Gynecol Scand 2006; 85: 1463–7.Google Scholar
Casini, ML, Rossi, F, Agostini, R, Unfer, V. Effect of the position of fibroids on fertility. Gynecol Endocrinol 2006; 22: 106–9.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×