In recent years we are witnessing the emergence of different devices and surgical techniques for in office hysteroscopic treatment of submucosal fibroid. In many cases the procedure can be performed without any anesthesia, allowing the use of different types of energy through instrument of 4-5mm in diameter with a working channel of 5Fr such as VersapointR with bipolar energy or laser, and apply different techniques that allows even the excision deeper myomas. Still, currently 40% of the hysteroscopic myomectomy are carried out in the operating room.
Important aspects for performing in office myomectomy are:
– Availability of hysteroscopes with working channels of small diameter.
– Complexity of fibroid: size, intra-myometrial component, location, etc. (Lasmar classification)
– Hysteroscopist skill level and experience: myomas type G1-G2 need for complete resection in a short operative time that is only achieved by expert hysteroscopists
– Operating time: It is related to the size and location of the fibroid, the device used and the skill of hysteroscopist. Usually the operative time varies between 15 to 30 minutes.
– Patient ability to tolerate the procedure.