Hysteroscopy pp 533-543 | Cite as

Alternative Techniques for Office Myomectomy: What Are the Limits?

  • Cinta Vidal Mazo
  • Carmen Forero Díaz
  • Consol Plans Carbonell


Uterine fibroids are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms, and obstetric complications. One-third of women with leiomyomas will request treatment due to symptoms.

Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by the patient’s age and the desire to preserve fertility or avoid surgery such as hysterectomy. The management of uterine fibroids also depends on the number, size, and location of fibroids as well as techniques available. There is general consensus that hysteroscopy is the current gold standard for evaluation and treatment of intrauterine pathology, including submucous myomas. Hysteroscopy in the outpatient setting appears to have an accuracy and acceptability of the patient equivalent to hospital hysteroscopy under general anesthesia. The economic impact of uterine fibroid management is significant, so new alternatives are necessary to promote and improve office myomectomy.

The main objective of this chapter is to provide a high quality literature review on office myomectomy. The chapter includes an in-depth analysis of the treatment of fibroids, techniques for office myomectomy, and discussion about the limits of the hysteroscopy approach for removing the submucous myoma.


Uterine fibroids Leiomyomas Surgery therapy Hysteroscopy Myomectomy Office myomectomy Limits 


  1. 1.
    Batra N, et al. Hysteroscopic myomectomy. Obstet Gynecol Clin N Am. 2004;31:669–85.CrossRefGoogle Scholar
  2. 2.
    Cammareri GA, et al. Office hysteroscopic myomectomy: effective and efficient procedure. Int J Gynecol Obstet. 2012;119S3:S261–530.Google Scholar
  3. 3.
    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.PubMedGoogle Scholar
  4. 4.
    Polena V, et al. Long-term results of hysteroscopic myomectomy in 235 patients. Eur J Obstet Gynecol Reprod Biol. 2007;130:232–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Munro MG, Storz K, Abbott JA, et al. AAGL practice report: practice guidelines for the management of hysteroscopic distending media: replaces hysteroscopic fluid monitoring guidelines. J Am Assoc Gynecol Laparosc 2000;7:167–8. J Minim Invasive Gynecol. 2013;20:137.CrossRefPubMedGoogle Scholar
  6. 6.
    Closon F, Tulandi T. Future research and developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol. 2015;29:994–1000.CrossRefPubMedGoogle Scholar
  7. 7.
    Muzii L, et al. GnRH analogue treatment before hysteroscopic resection of submucous myomas: a prospective, randomized, multicenter study and Sterility. Fertil Steril. 2010;94(4):1496–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Campo R, Molinas CR, Rombauts L, et al. Prospective multicentre randomized controlled trial to evaluate factors influencing the success rate of office diagnostic hysteroscopy. Hum Reprod. 2005;20:258–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Lasmar RB, Xinmei Z, et al. Feasibility of a new system of classification of submucous myomas: a multicenter study. Uterine Fibroid. 2011;95((6):2073–7.Google Scholar
  10. 10.
    Camanni M, et al. Is it possible to obtain a presurgical Lasmar score for hysteroscopic myomectomy by ultrasound alone? Ultrasound Obstet Gynecol. 2012;40:106–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Bakour SH, et al. Ambulatory hysteroscopy: evidence-based guide to diagnosis and therapy. Best Pract Res Clin Obstet Gynaecol. 2006;20(6):953–75.CrossRefPubMedGoogle Scholar
  12. 12.
    Di Spiezio SA, Mazzon I, Bramante S, et al. Hysteroscopic myomectomy: a comprehensive review of surgical techniques. Hum Reprod Update. 2008;14:101–19.CrossRefGoogle Scholar
  13. 13.
    Haimovich S, et al. Office hysteroscopic laser enucleation of submucous myomas without mass extraction: a case series study. Biomed Res Int. 2015;2015:Article ID: 905204.CrossRefGoogle Scholar
  14. 14.
    Bettocchi S, DiSpiezioSardoA CO, 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.CrossRefPubMedGoogle Scholar
  15. 15.
    Haimovich H, 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.CrossRefPubMedGoogle Scholar
  16. 16.
    Di-Spiezio-Sardo A, Di-Carlo GCC, et al. Cold loops applied to bipolar resectoscope: a safe “one-step” myomectomy for treatment of submucosal myomas with intramural development. J Obstet Gynaecol Res. 2015;41(12):1935–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Alba DV, Rodríguez JC. Fundamentos del Láser y su aplicación en Urología. Monográfico: Endourologia y Láser. Arch Esp Urol. 2008;61(9):965–70.Google Scholar
  18. 18.
    Noventa M, et al. Intrauterine morcellator devices: the icon of hysteroscopic future or merely a marketing image? A systematic review regarding safety, efficacy, advantages, and contraindication. Reprod Sci. 2015;22(10):1289–96.CrossRefPubMedGoogle Scholar
  19. 19.
    Pakrashi T. New hysteroscopic techniques for submucosal uterine fibroids. Curr Opin Obstet Gynecol. 2014;26:308–13.CrossRefPubMedGoogle Scholar
  20. 20.
    Murakami TJ. Safe techniques in surgery for hyteroscopic myomectomy. Obstet Gynaecol Res. 2005;31(3):216–23.CrossRefGoogle Scholar
  21. 21.
    Ahmad G, O’Flynn H, Attarbashi S, Duffy JM, Watson A. Pain relief for outpatient hysteroscopy. Cochrane Database Syst Rev. 2010;11:CD007710.Google Scholar
  22. 22.
    Deffieux X, Gauthier T, Ménager N, Legendre G, Agostini A, Pierre F. Prevention of complications related to hysteroscopy: guidelines for clinical practice. Gynecol Obstet Biol Reprod. 2013;42:1032–49.CrossRefGoogle Scholar
  23. 23.
    O’Flynn H, Murphy LL, Ahmad G, Watson A. Pain relief in out-patient hysteroscopy: a survey of current UK clinical practice. Eur J Obstet Gynecol Reprod Biol. 2011;154:9–15.CrossRefPubMedGoogle Scholar
  24. 24.
    Campo S, Campo V, Gambadauro P. Short term and long term results of resectoscopic myomectomy with and without pretreatment with GnRH analogue in premenopausal women. Acta Obstet Gynecol Scand. 2005;84:756e760.CrossRefGoogle Scholar
  25. 25.
    Capmas P, et al. Hysteroscopic resection of type 3 myoma: a new challenge? Eur J Obstet Gynecol Reprod Biol. 2016;205:165–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Van Dongen H, et al. Hysteroscopic morcellator for removal polyps anda myomas: a randomized controlled pilot study among resident in training. J Minim Invasive Gynecol. 2008;15(4):466–71.CrossRefPubMedGoogle Scholar
  27. 27.
    Ferrero S, et al. Three-month treatment with ulipristal acetate prior to laparoscopic myomectomy of large myomas. Unit of Obstetrics and Gynaecology, Irccs aou san martinoist, dinogmi, University of Genova, Genova, Italy. Fertil Steril. 2016;205:43–57.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Cinta Vidal Mazo
    • 1
  • Carmen Forero Díaz
    • 1
  • Consol Plans Carbonell
    • 1
  1. 1.Department of Obstetrics and GynecologyUniversity Hospital of HuelvaHuelvaSpain

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