Hysteroscopic Myomectomy for Submucosal Myoma: Literature Review

Siriluk Tantanavipas MD¹

Affiliation : ¹ Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Uterine myomas are usually asymptomatic, although, most women with submucous myoma have severe symptom including abnormal uterine bleeding and infertility. Hysteroscopic myomectomy is a minimally invasive surgery and is a key benefit to patient care. Patient with submucous myoma no longer requires hysterotomy. Hysteroscopic myomectomy became the gold standard treatment in women who desire to preserve fertility. Complete removal of myoma in one-step procedure should be considered. Pre-operative optimization with cervical ripening agents including osmotic dilators such as laminaria tents and prostaglandin such as misoprostol and dinoprostone is important and decrease the risk of cervical trauma as well as uterine perforation. During the procedure, low viscosity isotonic conductive media such as normal saline are recommended to use with bipolar resectoscope and mechanical morcellator, and fluid deficit should be closely monitored at a minimum of 10-minute intervals. Resectoscope is usually used with slicing technique for resection of myoma. Morcellator can be used as it is easy to use, reduces risk of perforation, and reduces non-electrical currents. However, there is a limited utility in type 2 myoma. In addition, hyaluronic acid and polyethylene oxidesodium carboxymethylcellulose gel may reduce intrauterine adhesion after hysteroscopic myomectomy.
Received 1 April 2021 | Revised 11 June 2021 | Accepted 14 June 2021

doi.org/10.35755/jmedassocthai.2021.08.12807

Keywords : Hysteroscopy; Morcellation; Myoma; Uterine myomectomy

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