Likelihood of Accomplishing an In-Patient Hysteroscopic Myomectomy in a One-Step Procedure: A Systematic Review and Meta-Analysis

Abstract EN

Purpose.

To assess the feasibility rate of one-step hysteroscopic myomectomy according to the technique adopted.

Methods.

In July 2016, PubMed, ClinicalTrials.gov, SCOPUS, Scielo, and AJOL databases were used for searching references.

Series of in-patient hysteroscopic myomectomies reporting success rate in only one-step procedure, categorization of submucous fibroids, explanation of the surgical technique, and description of patients were considered eligible for meta-analysis (retrospective, prospective randomized studies).

Two authors extracted the data.

Rate of myomectomies accomplished in only a surgical step and rate of intraoperative complications were extracted per protocol.

A modified GRADE score was used for quality assessment.

Random-effect models were already assumed.

Mean rates were compared among subgroups.

Results.

One thousand two hundred and fifty-seven studies were screened and 241 of these were read for eligibility.

Seventy-eight series were included in qualitative synthesis and 24 series were included in quantitative synthesis.

Wide heterogeneity was found.

In series with <50% of G2 myomas treated, the slicing technique feasibility rate was 86.5% while techniques for enucleating the deep portion of the myomas showed a feasibility rate of 92.3% (p<0.001).

In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (p<0.001).

Complications were significantly lower for alternative techniques to the classical slicing.

Conclusion.

In case of submucous myomas with intramural development, the slicing technique was correlated with a lower rate of in-patient hysteroscopic myomectomies accomplished in a one-step procedure and a higher complications rate.