Simplified Submucosal Myomectomy by Operating Hysteroscopy on OPD Basis / 대한산부인과학회잡지

ABSTRACT

OBJECTIVE: To evaluate possibility of simplified hysteroscopic operation instead of resectoscopic operation on OPD basis for sumucosal myoma with small pedicle. MATERIALS AND METHODS: On twenty five patients, who diagnosed submucosal myoma with small pedicle by sonohysterogram and diagnostic hysteroscopy, simplified hyteroscopic operations were performed on OPD. Used expanding media was normal saline. At first, pedicle was incised by hysteroscopic scissors and myoma mass was dissected by pushing of scope. After dissection of myoma mass, remained pedicle was cut by hysteroscopic scissors. The bleeding from cut pedicle site was controlled by bipolar coagulation. Cut myoma mass was removed to outside of uterus by ring forceps. However if removal of myoma mass is failed, let it in uterine cavity and it is removed at second-look hysteroscopy 1 month later after degeneration. RESULTS: On 1 of 25 patients, cutting of pedicle was failed due to fundal invisible pedicle on hysteroscopic view. On 20 of 24 patients, pedicles were completely cut. On 12 of these 20 patients, myoma masses were completely removed to outside of uterus by grasping forceps. However on remained 8 of 20 patients, myoma mass was removed easily on second-look hysteroscopy 1 month later due to shrinkage of mass. On 4 of 24 patients, pedicles were not cut completely due to large submucosal myoma. They were removed also easily on second-look hysteroscopy. Postoperative bleeding from cutting pedicle was surprisingly minimal in most cases and moderate bleeding was only in 3 cases. Severe bleeding case was not observed. Preoperative GnRH agonist therapy had not so big benefit due to these minimal to moderate postoperative bleeding. CONCLUSION: Therefore simplified hysteroscopic operation on OPD basis for submucosal myoma with small pedicle should be considered before resectoscopic operation, because this simplified hysteroscopic operation has many benefit economically and psychologically to patients on submucosal myoma with small pedicle. It is better that resectoscopic operation is performed in failed case of this simplified operation.