Fibroids of FIGO Type 0, 1 and 2 and:
- Bleeding disorders or
- Patient desires pregnancy
Careful ultrasound evaluation using the STEPW classification system ideally combined with diagnostic (office) hysteroscopy or alternatively use of saline infusion sonohysterography.
Use bipolar energy and saline solution and keep track of the fluid deficit. If you exceed 1000ml it would be best to not perform the surgery in one step. In older, frail patients, this limit should be lowered to about 750ml. Inform your patient preoperatively about the possibility of a two- or even three-step procedure in case the STEPW score is high.
- STEPW Score > 6 (group III).
- Non-submucous myomas.
Uterine perforation, bleeding.
The patient can go home on the same day.
- Loddo, A., Djokovic, D., Drizi, A., De Vree, B. P., Sedrati, A., & van Herendael, B. J. (2022). Hysteroscopic myomectomy: The guidelines of the International Society for Gynecologic Endoscopy (ISGE). European journal of obstetrics, gynecology, and reproductive biology, 268, 121–128. https://doi.org/10.1016/j.ejogrb.2021.11.434
- Piecak, K., & Milart, P. (2017). Hysteroscopic myomectomy. Przeglad menopauzalny = Menopause review, 16(4), 126–128. https://doi.org/10.5114/pm.2017.72757
- Lasmar, R. B., Xinmei, Z., Indman, P. D., Celeste, R. K., & Di Spiezio Sardo, A. (2011). Feasibility of a new system of classification of submucous myomas: a multicenter study. Fertility and sterility, 95(6), 2073–2077. https://doi.org/10.1016/j.fertnstert.2011.01.147