Two-Step Office-Based Hysteroscopic Operation for Submucosal Myoma

BACKGROUND AND OBJECTIVES: In the past, diagnostic hys- teroscopy was used to diagnose an intrauterine mass or abnormality and surgical hysteroscopy was used to treat a uterine polyp, uterine synechia, uterine septum, and submucosal myoma. The old hysteroscope had large diameters. Thus, general anesthesia was needed for inpatient management. However, due to the development of smalldiameter hysteroscopes, hysteroscopic diagnosis and surgery are now possible on an outpatient basis. Despite the development of small-diameter hysteroscopes, resection of submucosal myoma is possible only through resecto- scopic operation under general anesthesia, including type 0 uterine myoma. The objective of the present study was to determine the usefulness of secondary office operating hysteroscopy after cutting the pedicle of submucosal myoma via primary office operating hysteroscopy. METHODS: We primarily cut the pedicle of type 0 submucosal myoma with the first rigid 5-mm operating mini- hysteroscopy in the outpatient clinic. We then expected the myoma to shrink. Two months later, we confirmed the size with use of 3-mm flexible diagnostic hysteroscopy. If the myoma was shrunk to less than one-third the original size, it was removed with the second rigid 5-mm operating mini-hysteroscopy. RESULTS: In 14 of 24 patients, the myoma had shrunk to less than one-third the size. The rest was successfully removed with the second operating mini-hysteroscopy. In 5 of 24 patients, the myoma mass was not present in the uterine cavity. However, in another 5 of 24 patients, the myoma size had not changed significantly. The myomas were removed via resectoscopic operation under general anesthesia. CONCLUSIONS: The trial with this 2-step operation was very useful for the removal of type 0 submucosal myoma in an outpatient clinic.