Discussion
fibroid-related, intraoperative bleeding, AUB, perforation, fibroids, Leiomyomas
HEAVY MENSTRUAL BLEEDING, LEIOMYOMA, LEIOMYOMAS, EXCESSIVE MENSTRUAL BLEEDING, STERILE, FIBROIDS, LEIOMYOMAS, INTRAOPERATIVE BLEEDING, HYPOTONIC
Hysteroscopic myomectomy remains one of the minimally invasive surgical options for treating AUB, typically excessive menstrual bleeding, in premenopausal women with submucosal leiomyomas. Although several treatment options are available, including medical interventions, these are primarily to treat heavy menstrual bleeding characteristic of women with submucosal leiomyomas. This study is the first prospective randomized analysis comparing outcomes of medical therapy versus hysteroscopic myomectomy using a hysteroscopic tissue removal system to treat heavy menstrual bleeding from submucosal leiomyoma(s).Studies have shown that quality of life after hysteroscopic myomectomy was significantly better than after laparoscopic myomectomy due to shorter operative duration, less intraoperative bleeding, and shorter hospitalization [The hysteroscopic myomectomy technique performed is with a mechanical hysteroscopic tissue removal system driven by their distinct advantages over the utilization of electrical current or laser energy with hysteroscopic removal of submucosal fibroids [An additional benefit is that device insertion is only done once on initial entry through the operative port, decreasing the risk for perforation and increasing procedural efficiency. Moreover, mechanical hysteroscopic tissue removal system allows use of isotonic or electrolyte solutions such as sterile normal saline or lactated ringer, mitigating the risks associated with hypotonic solutions [Although evaluation of the submucosal leiomyomas in terms of size, number, and location was tracked perioperatively, complete resection of submucosal leiomyoma(s) was not calculated. There was also no continuous monitoring of the size and number of sumucosal leiomyomas in the two study arms. Leiomyomas were classified according to the intramural extension of the submucosal leiomyoma using the European Society for Gynecological Endoscopy (ESGE) classification. A study limitation is the lack of correlation of the preoperative ESGE classification of intramural involvement with the QOL scores. Predictors for successful hysteroscopic myomectomy include small leiomyoma size, fewer intracavitary leiomyomas, and mainly intracavitary location [Although a study limitation is the small sample size, homogeneity of surgical technique and device use, which served to provide consistency in methodology and procedural skill as all cases were performed by a single surgeon, is a study strength. Another study strength is the use of a validated assessment tool, the patient-reported fibroid-related symptom severity and health-related quality-of-life (HR-QOL) questionnaire, with each patient acting as her own control.Comparative effectiveness research (CER) is a directive of the Patient Protection and Affordable Care Act that was passed in 2010 to compare health outcomes and clinical effectiveness, risks, and benefits of two or more medical treatments, services, or clinical management and health practices [