Hysteroscopic myomectomy for menorrhagia using Versascope™ bipolar system: Efficacy and prognostic factors at a minimum of one year follow up

Rajesh Varma, Soneja H, Hemi Soneja, T Justin Clark, Janesh K Gupta, Janesh Gupta, Gupta JK
European journal of obstetrics, gynecology, and reproductive biology · 2008 · vol. 142(2) , pp. 154–159 · doi:10.1016/j.ejogrb.2008.10.006 · PMID:19036492 · W2044047459
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This study evaluated the efficacy of hysteroscopic myomectomy with the Versascope™ bipolar system for menorrhagia, identifying prognostic factors for outcomes at least one year post-procedure.

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Abstract

ObjectiveTo evaluate the effectiveness of hysteroscopic submucous myomectomy for women with heavy menstrual bleeding (HMB) over a minimum 1-year period and assess prognostic factors associated with treatment success.Study designProspective observational study set in a university teaching hospital in UK involving 92 women symptomatic of HMB with submucous myomas consecutively recruited between June 2003 and November 2006. Hysteroscopic myomectomy was performed under outpatient local anaesthetic (n=35, 38%) or daycase general anaesthesia (n=57, 62%) using Gynecare Versascope bipolar system. The main outcome measures were: the need for secondary surgical or medical re-intervention, menstrual improvement and patient satisfaction. Other outcome measures include: successful completion of primary resection, type of secondary treatment.ResultMean follow up was 2.6 years (95% CI 2.3-2.9). Complete fibroid excision was achieved in 66%. Secondary surgical re-intervention was required in 27 (29%) of which 11 (12%) were repeat hysteroscopic myomectomy and 10 (11%) were hysterectomy procedures. Multiple uterine fibroids and adenomyosis were identified in 80% of hysterectomies. At follow up, improved menstrual symptoms and patient satisfaction were reported by 91% and 86%, respectively. Irregular cycle HMB and incomplete fibroid excision were associated with secondary retreatment. Size of the submucous fibroid resected, presence of intramural and subserosal fibroids, or LA vs. GA setting were unrelated to treatment success.ConclusionHMB with submucous myomas may be successfully treated by completely removing the intracavity myoma component, irrespective of co-existent intramural or subserosal fibroids or size of fibroid resected. This effect remains sustained over at least a 1-2 year period.

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MeSH descriptors

Hysteroscopy Leiomyoma Menorrhagia Uterine Neoplasms Adult Female Follow-Up Studies Humans Leiomyoma Leiomyoma Menorrhagia Menorrhagia Menorrhagia Middle Aged Prognosis Prospective Studies Uterine Neoplasms Uterine Neoplasms Young Adult

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