Catena Ursula, La Fera Eleonora, Giannarelli Diana, Scalera Andrea, Bonetti Emma, Bernardini Federica, Campolo Federica, Fanfani Francesco, Scambia Giovanni
Unit of Gynecologic Oncology, Department for Women's and Children's Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Facts Views Vis Obgyn. 2025 Jun 27;17(2):110-120. doi: 10.52054/FVVO.2025.10. Epub 2025 May 27.
Uterine fibroids are the most common benign solid neoplasms of the uterus. Hysteroscopy represents the gold standard treatment for submucosal fibroids.
The aim of this study was to retrospectively analyse all consecutive symptomatic patients diagnosed with the International Federation of Gynecology and Obstetrics G0-G3 fibroids who underwent hysteroscopic myomectomy, to identify factors that may influence the feasibility of single step myomectomy.
The study included all consecutive symptomatic patients, diagnosed with G0-G3 fibroid. Surgical procedure was performed by a single experienced surgeon. All patients underwent postoperative hysteroscopic control 30-40 days after the procedure.
Evaluation of feasibility of hysteroscopic myomectomy in a single surgical step.
One hundred and twenty-five patients were included. In 97 women (77.6%) the fibroid was removed in one single step; 28 patients (22.4%) had a residual fibroid. Of these patients, in 10 cases (35.7%) the residual fibroid was removed during the office hysteroscopic control, 16 (57.2%) and 2 (7.1%) patients required II- and III-time myomectomy, respectively. 85.6% of patients did not need a second time surgery under general anaesthesia. At univariate and multivariate analysis, diameter was found to be the parameter most related to single-step fibroid removal with =0.001 and <0.001 respectively. For G0-3 fibroids <3 cm in 72% (66/92) of cases the 15 Fr mini-resectoscope was used with one step myomectomy in 89.4% of cases.
In expert hands, single step hysteroscopic myomectomy is feasible for G0-3 fibroids. The possibility to use miniaturized instruments for myomectomy may improve the surgical outcomes and prevent intra- and post-operative complications, in particular uterine perforation by avoiding cervical dilation. Further studies are needed to evaluate the true efficacy of 15 Fr mini-resectoscope in the removal of G0-G3 fibroids <3 cm.
WHAT IS NEW?: Hysteroscopic myomectomy in a single surgical step is feasible for G0-G3 fibroids, with diameter being the only independent factor influencing the success of the procedure. In expert hands, the success rate of single step myomectomy by using miniaturized instruments in fibroids ≤3 cm, is 89.4%.
子宫肌瘤是子宫最常见的良性实性肿瘤。宫腔镜检查是黏膜下肌瘤的金标准治疗方法。
本研究的目的是回顾性分析所有连续诊断为国际妇产科联合会G0 - G3级肌瘤且接受宫腔镜子宫肌瘤切除术的有症状患者，以确定可能影响单步肌瘤切除术可行性的因素。
该研究纳入了所有连续诊断为G0 - G3级肌瘤的有症状患者。手术由一位经验丰富的外科医生进行。所有患者在术后30 - 40天接受宫腔镜检查。
评估单步宫腔镜子宫肌瘤切除术的可行性。
共纳入125例患者。97例女性（77.6%）的肌瘤在单步手术中被切除；28例患者（22.4%）有残留肌瘤。在这些患者中，10例（35.7%）的残留肌瘤在门诊宫腔镜检查时被切除，16例（57.2%）和2例（7.1%）患者分别需要进行二次和三次肌瘤切除术。85.6%的患者不需要在全身麻醉下进行二次手术。在单因素和多因素分析中，发现肌瘤直径是与单步肌瘤切除最相关的参数，分别为P = 0.001和P < 0.001。对于直径<3 cm的G0 - 3级肌瘤，72%（66/92）的病例使用15 Fr微型切除镜，其中89.4%的病例进行了单步肌瘤切除术。
在专家手中，单步宫腔镜子宫肌瘤切除术对于G0 - 3级肌瘤是可行的。使用小型化器械进行肌瘤切除术的可能性可能会改善手术效果并预防术中及术后并发症，特别是通过避免宫颈扩张来预防子宫穿孔。需要进一步研究来评估15 Fr微型切除镜在切除直径<3 cm的G0 - G3级肌瘤中的真正疗效。
单步宫腔镜子宫肌瘤切除术对于G0 - G3级肌瘤是可行的，直径是影响手术成功的唯一独立因素。在专家手中，使用小型化器械对直径≤3 cm的肌瘤进行单步肌瘤切除术的成功率为89.4%。
