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  • Title: The need for further surgical intervention following primary hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding.
    Author: Maheux-Lacroix S, Mennen J, Arnold A, Budden A, Nesbitt-Hawes E, Won H, Abbott J.
    Journal: Aust N Z J Obstet Gynaecol; 2018 Oct; 58(5):570-575. PubMed ID: 29355897.
    Abstract:
    BACKGROUND: Intrauterine hysteroscopic morcellators have been studied as an alternative method for removing submucosal leiomyomas. AIMS: To assess the long-term efficacy of hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding (AUB). MATERIALS AND METHODS: We conducted a prospective cohort study including all women with AUB who underwent a hysteroscopic resection with mechanical morcellation of a benign submucosal leiomyoma confirmed at histopathology. Need for further surgery, patient satisfaction, symptom resolution and post-operative complications were documented by direct patient contact after a minimum of six months of follow-up. RESULTS: A total of 73 women were included in the study with a mean length of follow-up of 32 ± 13 months. Mean total size of pathology at the time of index surgery was of 42 ± 20 mm. A total of 9/73 (12%) women required subsequent hysterectomy and 20/73 (27%) any subsequent related surgery (operative hysteroscopy, abdominal myomectomy or hysterectomy) with the estimated three-year cumulative incidence being 30 ± 6%. Satisfaction rate of participants was 84%. In multivariate Cox proportional analyses, only a total size of pathology of 50 mm or more was found to be significantly associated with the risk of requiring further surgical procedures (hazard ratio = 2.9, P = 0.02). CONCLUSIONS: Hysteroscopic morcellation of submucosal leiomyomas is an effective method to manage women with AUB, although women with larger pathology have an increased risk of requiring subsequent surgical procedures.
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