A New Hysteroscopic Technique for the Preparation of Partially Intramural Myomas in Office Setting (OPPIuM technique): A Pilot Study

Objective: To assess the safety and the effectiveness of a novel hysteroscopic technique for the Office Preparation of Partially Intramural Myomas (OPPIuM), to facilitate the subsequent, already scheduled, resectoscopic myomectomy. Design: Pilot Study. Setting: University of Bari, Naples and Foggia. Patients: Fifty-nine fertile women (age 27-48 years) diagnosed at office hysteroscopy as having symptomatic submucous myomas > 1.5 cm with intramural development (G1 and G2), scheduled for resectoscopic surgery. Interventions: The OPPIuM technique consisted of an incision of the endometrial mucosa covering the myoma by means of Fr scissors or bipolar Versapoint Twizzle electrode, along its reflection line on the uterine wall, up to the precise identification of the cleavage surface between the myoma and its pseudo-capsule. Such procedure was aimed at triggering the protrusion of the intramural portion of the myoma into the uterine cavity during the following menstrual cycles, thus facilitating the subsequent total removal of the lesion via resectoscopic surgery. All patients underwent follow-up in-patient hysteroscopy after 2 menstrual cycles before resectoscopic surgery were performed. Measurements and Main Results: The OPPIuM technique was successfully performed in all cases. The mean diameter of successfully prepared myomas was 2.9 +/- 0.8 cm. At follow-up hysteroscopy, the conversion of partially intramural myomas into totally or prevalently intracavitary ones was observed in 93.2% (55/59) of cases. In 2 of 3 cases of failure, the myomas' size was > 4 cm. One patient was excluded from the study because of the occurrence of total spontaneous expulsion of the myoma at the subsequent menstrual cycle. Conclusions: Our preliminary findings seem to support the safety and the effectiveness of the OPPIuM procedure by reporting the conversion of myomas with intramural development > 1.5 cm into totally or prevalently intracavitary ones in nearly 93% of cases. Such technique may allow surgeons to perform resectoscopic surgery more safely and quickly as dealing with prevalently intracavitary lesions. However, further studies are mandatory to validate its use in daily practice. Journal of Minimally Invasive Gynecology (2009) 16, 748-754 (C) 2009 AAGL. All rights reserved.