Uterine leiomyomas (fibroids) are the most common pelvic tumor in women [1,2]. Abnormal uterine bleeding, the most common symptom associated with fibroids, is most frequent in women with tumors that abut the endometrium, including submucosal and some intramural fibroids [3-5]. This is likely due to distortion of the uterine cavity and an increase in the bleeding surface of the endometrium . Submucosal tumors, which derive from myometrial cells just below the endometrium, account for approximately 15 to 20 percent of fibroids.
Historically, hysterotomy or hysterectomy was performed to remove submucosal leiomyomas. This has been largely replaced by hysteroscopic myomectomy, a minimally invasive surgical procedure that effectively and safely removes these lesions [4,7].
Hysteroscopic myomectomy is reviewed here. General principles of hysteroscopy and abdominal approaches to myomectomy are discussed separately. (See "Overview of hysteroscopy" and "Prolapsed uterine leiomyoma (fibroid)" and "Abdominal myomectomy".)
Hysteroscopic myomectomy is performed for intracavitary fibroids, ie, submucosal and some intramural leiomyomas for which most of the fibroid protrudes into the uterine cavity. Appropriate candidates for hysteroscopic myomectomy are women with the following characteristics:
- Symptomatic uterine fibroid(s)
- It is feasible to remove the fibroid(s) hysteroscopically
- An abdominal approach is not required to remove additional fibroids in other locations (eg, intramural or subserosal) or treat other pathology