“Cold loop” hysteroscopic myomectomy

The “cold loop” hysteroscopic myomectomy was presented at the beginning of the nineties for the first time at the National Congress of the Italian Society of Gynecologic Endoscopy

The main objective of the “cold loop hysteroscopic myomectomy” is to avoid the contact of the electrical cutting loop with the myometrium: in this way it is possible to achieve efficacy and safety.

The technique is articulated in two phases:
1) Slicing the Intracavitary Component of the Myoma
The intracavitary component of myoma is removed using the conventional slicing technique powered by monopolar or bipolar current (in pure cutting mode). When the cleavage plane between the myoma and myometrium is identified, the slicing has to be stopped. In order to identify the correct cleavage plane between myoma and myometrium, it is very important to reach accurately the plane of the endometrial surface: remaining above or falling below of such plane makes it difficult to recognize the correct dissection plane.
2) Enucleation of the Intramural Component of the Myoma
The electric cutting loop is subsequently replaced with a not electrified cold loop (mechanical loops of Mazzon; Karl Storz, Tuttlingen, Germany). Usually, it is better to start with the “straight cold loop” (the most atraumatic), which is inserted into the cleavage plane and applied repeatedly along the surface of the myoma. In this way, the connective fibers anchoring the myoma to the pseudocapsule are disconnected by blunt dissection. In case of wide and tough fibro-connectival bridges, it is useful to resort to the “rake-shaped” or to the “knife-shaped” cold loops. In this way, the intramural component of myoma is progressively detached from the myometrium and becomes an endocavitary neoformation, safely removable by slicing. In case of myomas of large volume, it is possible to repeat for more times this phase.

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