Submucous Fibroids: Clinical Profile and Hysteroscopic Management

EDITORIAL COMMENTS: This paper was accepted for publication because it reports a further use of the hysteroscope other than endometrial ablation. Some of the cases clearly involved more than pedunculated polyps lying free in the uterine cavity; the technique included removal of intramural fibromyomas. It is too soon to judge the impact this new technology will have on avoidance of hysterectomy in women with menorrhagia and/or pain. The hysteroscopist reviewer made the comment that, in his view, laparoscopy should be performed by a second operator when intramural fibromyomas are resected during hysteroscopy, to avoid perforation of the uterus and thermal damage to pelvic structures. The laparoscopist at these procedures sometimes sees the uterine wall become inverted as the subjacent fibromyoma is resected, a fact that should be drawn to the attention of the hysteroscopist! The author's response to this editorial comment is the paragraph of the discussion section of this paper printed in italics. Summary: Fifty submucous fibroids were removed by hysteroscopic resection from 37 patients with abnormal uterine bleeding. Thirty‐seven fibroids were completely resected and 13 incompletely resected. Nine patients also had rollerball endometrial ablations. The average follow‐up period was 14 months (4 to 51 months) in 33 patients available for follow‐up. All of these patients had cure of their symptoms, 3 after repeat operations. The 1 immediate complication was a postoperative infection. A normal uterine cavity was found in 13 of 14 patients examined by office hysteroscopy at follow‐up.