Predicting Outcome of One-Step Total Hysteroscopic Resection of Sessile Submucous Myoma

Study Objective: To analyze variables for successful 1-step hysteroscopic myomectomies of sessile submucous myomas. Design: Retrospective case-control study. (Canadian Task Force classification II-2). Setting: Single operator's practice in a university hospital and its related hospitals. Patients: Twenty-eight patients with sessile submucous myomas and menorrhagia, infertility, or both. Interventions: Our strategy for hysteroscopic myomectomy is as follows. First, we scraped and/or vaporized intrauterine dome of myoma until top of myoma was even with level of wall of cavity. Next, the remnant intramural node was squeezed by uterine contractions induced by prostaglandin F_2α injection. Finally, the newly raised myoma dome was sectioned or vaporized electrosurgically only within the space of the intrauterine cavity and/or was separated mechanically from healthy myometrium without electrosurgery. Measurements and Main Results: Submucous myomas in 16 (57.1%) patients were completely removed after 1 surgery. By logistic regression analysis, thickness of outer myometrial layer of myoma node (OR 3.06, p = .02), myoma size (OR 0.86, p = .04), and intramural extension degree (OR 0.91, p = .03) were significantly associated with outcome of complete resection. Conclusion: Thickness of outer myometrial layer of myoma node, myoma size, and intramural extension degree predicted outcome of 1-step hysteroscopic myomectomy. The chance of performing successful surgery increased with increased thickness of outer myometrial layer of myoma, and decreased with larger myomas and greater degrees of intramural extension.