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Hysteroscopic myomectomy safe and easy.
(Gynecologic Surgery)
By: Isaacson, Keith
May 1, 2006
Contrary to what many still believe, hysteroscopic myomectomy can be one of the safest, mostly easily learned surgical procedures in gynecology. It is certainly underutilized and continues to be offered and performed by relatively few gynecologists.
With proper training and attention to the preoperative evaluation, surgical technique, and strict fluid management, we can offer patients a treatment for submucous fibroids that is superior in most cases both to other surgical options--such as hysterectomy, open myomectomy, and uterine artery embolization--and to nonsurgical treatments.
The resection of submucosal myomas transcervically is a less invasive approach than are other surgical procedures. We can achieve excellent outcomes in terms of both fertility and the resolution of abnormal uterine bleeding and other symptoms. And we can do so with rates of complications, recurrence, and repeat resection that are much lower than commonly expected.
The Preoperative Evaluation
A comprehensive preoperative evaluation is critical. We want the best possible assessment of the size and location of the fibroid or fibroids, as well as the depth and even the vascularity of each fibroid.
We want to know how deeply each fibroid penetrates into the myometrium and whether it is resectable with the hysteroscope. With such an assessment, we can make a sound decision about whether the fibroid can be treated hysteroscopically and whether we, individually, have the expertise to do it. In general, the risk of fluid absorption, bleeding, and uterine perforation increases as the percentage of fibroid extending into the myometrium increases.