Endometrial preservation in hysteroscopic myomectomy; a new technique versus the classical resectoscopic technique, a randomized controlled trial

Abstract

Background: hysteroscopic myomectomy is the gold standard treatment of submucous fibroid. Intrauterine adhesions (IUAs) represents the major long term complication of hysteroscopic myomectomy. To date, little focus has been placed on the role that the resection technique could have in causing fibrous reactions after hysteroscopic myomectomy. The main aim of this study is to compare a new proposed surgical approach for hysteroscopic myomectomy to the classical approach as regards efficiency, operative time, complications, and prevention of post-operative intrauterine adhesions. Methods: This prospective study was carried out for 60 women diagnosed with grade (0) or (1) submucous fibroid with a diameter < 3 cm, randomly assigned into one of two groups, group (1) 30 women underwent hysteroscopic myomectomy through a new proposed endometrial preservation approach and 30 women in group (2) underwent classical hysteroscopic myomectomy through the slicing technique. Results: no significant statistical difference between the two techniques as regard the operative time, fluid deficit, intraoperative complications, or postoperative intrauterine adhesions. Conclusion: The proposed technique offers comparable results to the classical technique as regards postoperative outcomes in terms of ultrasonographic and hysteroscopic endometrial appearance as well as incidence of IUA, with no significant increase in operative time or risk of complications.

Keywords: submucous fibroid, hysteroscopic myomectomy, intrauterine adhesions.