- •Type 0 and 1 submucous myomas are removed the fastest using hysteroscopic morcellation.
- •Overall, the procedure time of hysteroscopic morcellation and resection are the same.
- •Calcified myomas are challenging for both procedures.
- •Fluid deficit remains a limiting factor.
- •Optimal preoperative assessment of the myoma is key to select the best technique.
To compare hysteroscopic morcellation with bipolar resection for the removal of submucous type 0 and 1 myomas, in terms of procedure time (primary outcome), adverse events, tissue availability, short term effectiveness and postoperative adhesion formation (secondary outcomes).
The study was performed from May 2011 to May 2018 in the Catharina hospital (Eindhoven, the Netherlands) and the Ghent University hospital (Ghent, Belgium). Women with type 0 and 1 submucous myomas up to 3 cm were randomized to hysteroscopic morcellation with the 8.0 Tissue Removal System or to bipolar resection with a rigid 8.5-mm resectoscope. Skewed time variables were log-transformed and analyzed with the Student t-test. Multiple linear regression analysis was performed to assess the effect of myoma diameter on operating time.
Forty-five and 38 women were included in the hysteroscopic morcellation and resection group, respectively. The median operating time was significantly shorter for hysteroscopic morcellation compared with resection (9.2 min [interquartile range 5.6–14.4] versus 13.4 min [interquartile range 8.6–17.5], P = .04). In the morcellation group, operating time, corrected for the myoma diameter, was reduced by 26 % (95 % CI 5–43%; P = .02). The median setup time was significantly longer in the morcellation group (5.2 min [interquartile range 4.2–6.9] versus 3.8 min [interquartile range 3.3–5.3], P = .006). The median total procedure time was not significantly different between the two techniques (14.4 min [interquartile range 11.4–19.2] versus 17.3 [interquartile range 12.7–23.8], P = .18). Two procedures of the morcellation group were converted to bipolar resection because of the myoma hardness. Complete resection was found in 89 % of the morcellation group and 95 % of the resection group. Adverse events occurred in 3 patients of the morcellation group, namely a fluid deficit > 2500 mL with the need of potassium suppletion, an asystolic vasovagal response after conversion to resection and postoperative fever requiring antibiotics. Tissue was available for pathology analysis in all cases. Routine second-look hysteroscopy performed in one center showed no intrauterine adhesions.
Overall, there is no difference in total procedure time between hysteroscopic morcellation using the system compared to bipolar resection for the removal of smaller type 0 and 1 submucous myomas. Although hysteroscopic morcellation is faster, its setup time is longer. Calcified myomas can be challenging and fluid deficit remains a limiting factor.
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Published online: January 29, 2021
Accepted: January 25, 2021
Received in revised form: January 19, 2021
Received: December 15, 2020
☆Oral presentation at the ESGE 27th Annual Congress, 2018, Vienna, Austria
© 2021 Elsevier B.V. All rights reserved.