March 2003 · Vol. 15, No. 3Hysteroscopic myomectomy:
Fertility-preserving yet underutilized
Many more patients could benefit from hysteroscopic resection of submucous fibroids, a fertility-preserving alternative to hysterectomy, if more gynecologists were able to offer it. This illustrated review describes preoperative protocols and surgical technique.
KEITH
ISAACSON,
MDDr. Isaacson is director of minimally invasive gynecologic surgery, Newton Wellesley Hospital, Newton, Mass, and associate professor of obstetrics and gynecology, Harvard Medical School,
Boston, Mass.
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KEY POINTS
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The goal of hysteroscopic myomectomy is complete removal of the fibroid without trauma to normal uterine tissue.
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Patients with Type 0 and Type I fibroids often require only 1 surgery; patients with Type II fibroids should be advised that 2 surgeries may be needed to remove the entire fibroid.
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Adjuvant preoperative hormonal therapy facilitates surgical scheduling, helps prevent further blood loss in patients already suffering from anemia, and reduces distention media intravasation.
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The monopolar loop electrode is the fibroid removal system that is used most often.
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Hysteroscopic myomectomy should be offered to all patients with symptomatic submucous fibroids who desire to avoid hysterectomy. Although it is a highly effective, minimally invasive technique, it is underutilized.
Unfortunately, fewer than one third of US gynecologists perform this procedure. In a 1997 survey of members of the American Association of Gynecologic Laparoscopists—an organization committed to minimally invasive surgery—only half of the respondents reported that they perform this surgery.1
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