Single-step hysteroscopic myomectomy for submucous leiomyoma

OBJECTIVE: Leiomyomas are most commonly observed benign tumors in the female genital tract. Depending on the size, number, and location, the complete resection of Type 0, 1, and 2 leiomyomas by hysteroscopy can be completed in a single-step or multi-step procedure. The purpose of this study is to document the cases of hysteroscopic myomectomy performed via the resectoscopic technique in the gynecology department of a university hospital. Moreover, we assessed the applicability of single- or multi-step hysteroscopic myomectomy with respect to the diameter of the leiomyoma. MATERIALS AND METHODS: We retrospectively reviewed the records of hysteroscopic myomectomy performed between 2012 and 2018. According to the diameter of the submucous leiomyomas, we divided 46 patients into 2 groups. Group 1 (n=25) consisted of patients with submucous leiomyomas <3 cm, whereas patients in group 2 (n=21) had submucous leiomyomas ≥3 cm in diameter. We recorded the number of removed leiomyomas and completed hysteroscopy sessions. RESULTS: Myomectomy was completed by single-step hysteroscopy in all the patients of group 1, whereas eight patients in group 2 needed multiple sessions of hysteroscopy. None of the patients in group 1 had fluid overload; however, two patients in group 2 had mild asymptomatic hyponatremia. CONCLUSION: The success of hysteroscopic myomectomy depends on the diameter, localization, and number of the leiomyomas. This study revealed that Type 0, 1, and 2 leiomyomas of less than 3 cm can be resected by single-step hysteroscopy. For larger leiomyomas, the possibility of need for further sessions should be shared with the patients.