Transrectal ultrasound-guided hysteroscopic myomectomy of submucosal myomas with a varying degree of myometrial penetration.

Literature Review Article

Transrectal ultrasound-guided hysteroscopic myomectomy of submucosal myomas with a varying degree of myometrial penetration. Ludwin A, Ludwin I, Pitynski K, Basta P, Banas T, Jach R, Wiechec M, Grabowska R, Stangel-Wojcikiewicz K, Milewicz T, Nocun A. J Minim Invasive Gynecol. 2013; 20 (5): 672-85. 

Dr. John Preston Parry, M.D., M.P.H.

The objective of the study is to assess the degree of completion for associated hysteroscopic myomectomy when guided by transrectal ultrasound (TRUS) and whether this conveyed an advantage relative to unmonitored hysteroscopic myomectomy. One hundred and twenty women with single submucosal fibroids ≤5 cm and with myometrial free margins ≥3 mm were randomized to hysteroscopic myomectomy with or without TRUS. Patients with myomas greater than 3 cm received GnRH agonist therapy for one to three months preoperatively. For those with TRUS, there was a higher percentage of single surgery complete resection (91% vs 73%, p = 0.02), and this seemed particularly beneficial for Grade 2 myomas (89 vs 55%). Of note, size <3 cm (96 vs 71%) and myometrial margin ≥5 mm seemed to have greater single surgery completion with TRUS than size ≥3 cm (70 vs 77%) and <5 mm myometrial margins (75% vs 71%). The authors attribute this lack of benefit with the more difficult cases to inherent issues beyond visualization, such as hysteroscopic deficits with monopolar resection. In summary, this study, which is the first prospective evaluation of TRUS for hysteroscopic myomectomy, found a decreased likelihood of needing repeat surgery when using TRUS for Grade 2 myomas, particularly those <3 cm and with ≥5 mm myometrial margins. 

Dr. Steven Lindheim, M.D.

This prospective clinical study demonstrates the value of intra-operative ultrasound for hysteroscopic myomectomy with significant intramural components, but not G0 or G1 myomas.  Further randomized studies are warranted to assess the value of a transrectal or transabdominal ultrasound approach in assisting complete resection of G2 submucosal myomas


The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.



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