Likelihood of Accomplishing an In-Patient Hysteroscopic Myomectomy in a One-Step Procedure: A Systematic Review and Meta-Analysis

Ugo Indraccolo, Vittorio Bini, Alessandro Favilli, Ugo Indraccolo, Vittorio Bini, Alessandro Favilli

Abstract

Purpose: To assess the feasibility rate of one-step hysteroscopic myomectomy according to the technique adopted.

Methods: In July 2016, PubMed, ClinicalTrials.gov, SCOPUS, Scielo, and AJOL databases were used for searching references. Series of in-patient hysteroscopic myomectomies reporting success rate in only one-step procedure, categorization of submucous fibroids, explanation of the surgical technique, and description of patients were considered eligible for meta-analysis (retrospective, prospective randomized studies). Two authors extracted the data. Rate of myomectomies accomplished in only a surgical step and rate of intraoperative complications were extracted per protocol. A modified GRADE score was used for quality assessment. Random-effect models were already assumed. Mean rates were compared among subgroups.

Results: One thousand two hundred and fifty-seven studies were screened and 241 of these were read for eligibility. Seventy-eight series were included in qualitative synthesis and 24 series were included in quantitative synthesis. Wide heterogeneity was found. In series with <50% of G2 myomas treated, the slicing technique feasibility rate was 86.5% while techniques for enucleating the deep portion of the myomas showed a feasibility rate of 92.3% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (.

Conclusion: In case of submucous myomas with intramural development, the slicing technique was correlated with a lower rate of in-patient hysteroscopic myomectomies accomplished in a one-step procedure and a higher complications rate.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2020 Ugo Indraccolo et al.

Figures

Figure 1
Figure 1
Flow chart of the phases for selecting studies and series.
Figure 2
Figure 2
Flow chart of the organization of subgroups.
Figure 3
Figure 3
Forest plot of slicing technique feasibility in series with less than 50% of G2 myoma rate.
Figure 4
Figure 4
Forest plot of slicing technique feasibility in series with at least 50% of G2 myoma rate.
Figure 5
Figure 5
Forest plot of the feasibility of techniques conceived to enucleate the deep portion of myomas in series with less than 50% of G2 myoma rate.
Figure 6
Figure 6
Forest plot of the feasibility of techniques conceived to enucleate the deep portion of myomas in series with at least 50% of G2 myoma rate.
Figure 7
Figure 7
Forest plot of “Cold loop” feasibility in series with less than 50% of G2 myoma rate.
Figure 8
Figure 8
Forest plot of “Cold loop” feasibility in series with at least 50% of G2 myoma rate.

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