Multidisciplinary Approach in Large-sized Submucosal Myoma: Hysteroscopic Myomectomy after Uterine Artery Embolization

Study Objective: To evaluate the safety and effectiveness of hysteroscopic myomectomy after uterine artery embolization (UAE) for the treatment of large-sized submucosal myomas with deep intramural invasion that are difficult to treat with 1-step hysteroscopy. Design: A retrospective cohort study (Canadian Task Force classification II-2). Setting: An academic university hospital. Patients: Eight premenopausal patients with symptomatic submucosal myomas with intramural invasion. Interventions: All of the patients after bilateral UAE underwent subsequent hysteroscopic operation 3 to 15 months after UAE. Measurements and Main Results: A total of 8 patients who had a large-sized submucosal myoma with deep myometrial invasion were included. The average volume of the submucosal myomas was 87.7 +/- 39.9 cm(3) as confirmed by magnetic resonance imaging,and the average patient age was 37.6 years. The mean volume reduction of the submucosal myomas was 83.3 +/- 16.4% after UAE, and no immediate complications were observed. One-step hysteroscopic myomectomy after UAE was successfully performed in all patients. Leiomyomas with hyaline degeneration were pathologically confirmed. All women showed improved symptoms, and there was no evidence of recurrence 1 year later. One patient conceived naturally and delivered a full-term baby. Conclusion: In premenopausal women with large-sized symptomatic submucosal myomas with deep myometrial invasion, hysteroscopic myomectomy after UAE is very effective and safe. (C) 2018 Published by Elsevier Inc. on behalf of AAGL.