Long term follow up of hysteroscopic myomectomy assessed by survival analysis

Authors

  • Roger Hart,

    Clinical Research Fellow
    1. Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, London
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  • Béla G. Molnár,

    Visiting Research Fellow
    1. Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, London
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  • Adam Magos

    Consultant (Obstetrics and Gynaecology) , Corresponding author
    1. Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, London
      Correspondence: Mr A. Magos, Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, Pond Street, London NW3 2QG, UK.
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Correspondence: Mr A. Magos, Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, Pond Street, London NW3 2QG, UK.

Abstract

Objective To identify patient characteristics which affect outcome after hysteroscopic myomectomy for submucous fibroids.

Design Prospective observational study.

Setting A university teaching hospital.

Sample One hundred and twenty-two consecutive patients treated by hysteroscopic myomectomy for submucous leiomyoma over a period of almost eight years.

Methods Hysteroscopic electroresection of the leiomyoama using a continuous flow resectoscope.

Main outcome measures The avoidance of further surgery and patient satisfaction.

Results The average age of the patients at the time of their surgery was 424 years. A total of 194 fibroids were removed. The mean follow up period was 2.3 years (range 1–7.6). Of those asked, 71.4% were satisfied with the results of surgery. Sixteen women required further surgery for fibroids, and six ultimately underwent hysterectomy. Survival analysis showed that the risk of further surgery was 21% at four years after the myomectomy, and 0% thereafter. Univariate regression analysis suggested that outcome was significantly better in older women, and in cases where the uterus was equivalent in size to I 6 weeks of gestation, the fibroid was I 3 cm in diameter and mainly intracavitary, and the proce- dure time was I 20 minutes. The influence of hormonal pre-treatment and the number of fibroids excised was not statistically significant. After multivariate regression analysis, only overall uterine size and the position of the fibroid being removed were found to significantly influence the success of surgery.

Conclusions Hysteroscopic myomectomy is an effective way to manage patients with symptomatic submucous leiomyomata, particularly when the uterus is not grossly enlarged and the fibroid(s) are mainly inside the uterine cavity.

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