Fertility and sterilityJournal Article
27 Dec 2024
To demonstrate the "cold loop technique" for the hysteroscopic treatment of FIGO type 3 myomas.
Step-by-step demonstration of the technique using educative video.
A 45-year-old infertile patient with repeated oocyte donor IVF failures affected by a FIGO type 3 myoma.
FIGO type 3 myomas exhibit complete myometrial development while encroaching upon the endometrium. This hybrid nature, combining features of both submucous and intramural myomas, may have a detrimental "double hit" effect for patients seeking pregnancy. Currently, there is a dearth of robust evidence regarding the ideal surgical approach for FIGO type 3 myomas. Despite the preference for the hysteroscopic approach due to their closer proximity to the uterine cavity compared to the serosa, the primary limitations of the conventional hysteroscopic approach include the risks of damaging healthy myometrium and the significant risk of adhesions. We showcase the hysteroscopic treatment of a 29 mm FIGO type 3 myoma on the anterior uterine wall using the "cold loop technique". The video emphasizes key procedural phases: i) Opening the "endometrial-myometrial window" with minimal sacrifice of myometrium. ii) Identifying the correct cleavage plane through blunt dissection of fibroconnective bridges anchoring the myoma to the pseudo-capsule using cold loops. iii) Slicing the detached intramural component of the fibroid, displaced into the uterine cavity, with an electrical loop.
Integrity of the uterine cavity and the healthy myometrium surrounding the myoma and avoiding post-surgical intrauterine adhesions.
The myoma was completely removed in a single surgical step, and at the end of the procedure, the myoma's "notch" and its intact pseudo-capsule were clearly visible. The patient was discharged in good health the day following the surgery. At the 3-month follow-up, the diagnostic office hysteroscopy revealed a fully recovered uterine cavity.
The "cold loop technique" holds the potential to facilitate the safe removal of FIGO type 3 myomas, minimizing the risk of damage to the adjacent healthy myometrium and resulting in a lower likelihood of postoperative adhesions. This is especially critical for women contemplating conception.
Article info
Journal issue:
Doi:
10.1016/j.fertnstert.2024.12.025
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