Book contents
- Diagnostic and Operative Hysteroscopy
- Diagnostic and Operative Hysteroscopy
- Copyright page
- Dedication
- Contents
- Videos
- Contributors
- Chapter 1 An Introduction to Hysteroscopy
- Chapter 2 Anatomy and Physiology of the Uterus
- Chapter 3 Infrastructure and Instrumentation for Hysteroscopy
- Chapter 4 Diagnostic Hysteroscopy: Accuracy and Interpretation of Findings
- Chapter 5 Hysteroscopy Techniques and Treatment Settings
- Chapter 6 Analgesia and Anaesthesia for Hysteroscopy
- Chapter 7 Indications for Hysteroscopy
- Chapter 8 Hysteroscopic Electrosurgery
- Chapter 9 Complications of Hysteroscopic Surgery
- Chapter 10 Hysteroscopic Endometrial Polypectomy
- Chapter 11 Endometrial Ablation
- Chapter 12 Hysteroscopic Management of Fibroids
- Chapter 13 Hysteroscopic Sterilisation
- Chapter 14 Management of Congenital Uterine and Vaginal Anomalies
- Chapter 15 Hysteroscopic Management of Uterine Adhesions
- Chapter 16 Unusual Hysteroscopic Situations: Caesarean Niche and Retained Placental Tissue
- Chapter 17 Audit, Data Collection and Clinical Governance in Hysteroscopy
- Chapter 18 Training in Hysteroscopic Skills
- Chapter 19 Research and New Developments in Hysteroscopy
- Index
- References
Chapter 12 - Hysteroscopic Management of Fibroids
Published online by Cambridge University Press: 10 September 2020
Book contents
- Diagnostic and Operative Hysteroscopy
- Diagnostic and Operative Hysteroscopy
- Copyright page
- Dedication
- Contents
- Videos
- Contributors
- Chapter 1 An Introduction to Hysteroscopy
- Chapter 2 Anatomy and Physiology of the Uterus
- Chapter 3 Infrastructure and Instrumentation for Hysteroscopy
- Chapter 4 Diagnostic Hysteroscopy: Accuracy and Interpretation of Findings
- Chapter 5 Hysteroscopy Techniques and Treatment Settings
- Chapter 6 Analgesia and Anaesthesia for Hysteroscopy
- Chapter 7 Indications for Hysteroscopy
- Chapter 8 Hysteroscopic Electrosurgery
- Chapter 9 Complications of Hysteroscopic Surgery
- Chapter 10 Hysteroscopic Endometrial Polypectomy
- Chapter 11 Endometrial Ablation
- Chapter 12 Hysteroscopic Management of Fibroids
- Chapter 13 Hysteroscopic Sterilisation
- Chapter 14 Management of Congenital Uterine and Vaginal Anomalies
- Chapter 15 Hysteroscopic Management of Uterine Adhesions
- Chapter 16 Unusual Hysteroscopic Situations: Caesarean Niche and Retained Placental Tissue
- Chapter 17 Audit, Data Collection and Clinical Governance in Hysteroscopy
- Chapter 18 Training in Hysteroscopic Skills
- Chapter 19 Research and New Developments in Hysteroscopy
- Index
- References
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.
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- Diagnostic and Operative Hysteroscopy , pp. 144 - 157Publisher: Cambridge University PressPrint publication year: 2020
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
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
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