Single-stage total hysteroscopic myomectomies: indications, techniques, and results.

OBJECTIVE: To assess the risks and benefits of myomectomies performed by endouterine resection.

DESIGN: A retrospective analysis of 284 patients, with histologically proven submucous myomas, operated on between April 1984 and April 1993. Outcomes were analyzed by Kaplan-Meier statistics.

SETTING: Author's private practice in University Medical Center.

PATIENTS: The age ranged from 25 to 70 years.

INTERVENTIONS: All the interventions but one were performed entirely at one setting. Myomas ranged in diameter from 10 to 65 mm.

MAIN OUTCOME MEASURES: Clinical symptoms and hysteroscopic appearance.

RESULTS: Good anatomical and functional results were achieved in 95.6% of cases during the first 6 postoperative months, persisting in 94.6% at 1 year, in 89.7% at 2 years, in 87.8% at 3 years, in 83.0% at 4 years, in 76.3% at 5 years, in 73.2% at 6 years, and remained stable at 67.6% by > or = 7 years. The only notable complication was one perforation, which was repaired immediately. Endouterine resection did not improve the outcome in patients with primary infertility but was of benefit in cases of secondary infertility.

CONCLUSIONS: Myomectomy by endouterine resection is a difficult but safe and worthwhile conservative intervention.