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

Abstract 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 F...

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Veröffentlicht in:Journal of minimally invasive gynecology 2009-11, Vol.16 (6), p.748-754
Hauptverfasser: Bettocchi, Stefano, MD, Di Spiezio Sardo, Attilio, MD, Ceci, Oronzo, MD, Nappi, Luigi, MD, Guida, Maurizio, MD, Greco, Elena, MD, Pinto, Lauro, MD, Camporiale, Anna Lina, MD, Nappi, Carmine, MD
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container_end_page 754
container_issue 6
container_start_page 748
container_title Journal of minimally invasive gynecology
container_volume 16
creator Bettocchi, Stefano, MD
Di Spiezio Sardo, Attilio, MD
Ceci, Oronzo, MD
Nappi, Luigi, MD
Guida, Maurizio, MD
Greco, Elena, MD
Pinto, Lauro, MD
Camporiale, Anna Lina, MD
Nappi, Carmine, MD
description Abstract 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.
doi_str_mv 10.1016/j.jmig.2009.07.016
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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 &gt; 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 &gt; 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 &gt; 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.</description><identifier>ISSN: 1553-4650</identifier><identifier>EISSN: 1553-4669</identifier><identifier>DOI: 10.1016/j.jmig.2009.07.016</identifier><identifier>PMID: 19896603</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Ambulatory Surgical Procedures ; Female ; Humans ; Hysteroscopy ; Hysteroscopy - methods ; Intramural myomas ; Middle Aged ; Myoma - pathology ; Myoma - surgery ; Obstetrics and Gynecology ; OPPIuM ; Pilot Projects ; Resectoscopic myomectomy ; Submucous myomas ; Surgery ; Uterine Neoplasms - pathology ; Uterine Neoplasms - surgery</subject><ispartof>Journal of minimally invasive gynecology, 2009-11, Vol.16 (6), p.748-754</ispartof><rights>AAGL</rights><rights>2009 AAGL</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c410t-432af02a8095373357604987d0b3e50e51641c9a468e68110e1bacce0a7d9d13</citedby><cites>FETCH-LOGICAL-c410t-432af02a8095373357604987d0b3e50e51641c9a468e68110e1bacce0a7d9d13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jmig.2009.07.016$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19896603$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bettocchi, Stefano, MD</creatorcontrib><creatorcontrib>Di Spiezio Sardo, Attilio, MD</creatorcontrib><creatorcontrib>Ceci, Oronzo, MD</creatorcontrib><creatorcontrib>Nappi, Luigi, MD</creatorcontrib><creatorcontrib>Guida, Maurizio, MD</creatorcontrib><creatorcontrib>Greco, Elena, MD</creatorcontrib><creatorcontrib>Pinto, Lauro, MD</creatorcontrib><creatorcontrib>Camporiale, Anna Lina, MD</creatorcontrib><creatorcontrib>Nappi, Carmine, MD</creatorcontrib><title>A New Hysteroscopic Technique for the Preparation of Partially Intramural Myomas in Office Setting (OPPIuM technique): A Pilot Study</title><title>Journal of minimally invasive gynecology</title><addtitle>J Minim Invasive Gynecol</addtitle><description>Abstract 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 &gt; 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 &gt; 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 &gt; 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. 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Di Spiezio Sardo, Attilio, MD ; Ceci, Oronzo, MD ; Nappi, Luigi, MD ; Guida, Maurizio, MD ; Greco, Elena, MD ; Pinto, Lauro, MD ; Camporiale, Anna Lina, MD ; Nappi, Carmine, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c410t-432af02a8095373357604987d0b3e50e51641c9a468e68110e1bacce0a7d9d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Ambulatory Surgical Procedures</topic><topic>Female</topic><topic>Humans</topic><topic>Hysteroscopy</topic><topic>Hysteroscopy - methods</topic><topic>Intramural myomas</topic><topic>Middle Aged</topic><topic>Myoma - pathology</topic><topic>Myoma - surgery</topic><topic>Obstetrics and Gynecology</topic><topic>OPPIuM</topic><topic>Pilot Projects</topic><topic>Resectoscopic myomectomy</topic><topic>Submucous myomas</topic><topic>Surgery</topic><topic>Uterine Neoplasms - pathology</topic><topic>Uterine Neoplasms - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bettocchi, Stefano, MD</creatorcontrib><creatorcontrib>Di Spiezio Sardo, Attilio, MD</creatorcontrib><creatorcontrib>Ceci, Oronzo, MD</creatorcontrib><creatorcontrib>Nappi, Luigi, MD</creatorcontrib><creatorcontrib>Guida, Maurizio, MD</creatorcontrib><creatorcontrib>Greco, Elena, MD</creatorcontrib><creatorcontrib>Pinto, Lauro, MD</creatorcontrib><creatorcontrib>Camporiale, Anna Lina, MD</creatorcontrib><creatorcontrib>Nappi, Carmine, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of minimally invasive gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bettocchi, Stefano, MD</au><au>Di Spiezio Sardo, Attilio, MD</au><au>Ceci, Oronzo, MD</au><au>Nappi, Luigi, MD</au><au>Guida, Maurizio, MD</au><au>Greco, Elena, MD</au><au>Pinto, Lauro, MD</au><au>Camporiale, Anna Lina, MD</au><au>Nappi, Carmine, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A New Hysteroscopic Technique for the Preparation of Partially Intramural Myomas in Office Setting (OPPIuM technique): A Pilot Study</atitle><jtitle>Journal of minimally invasive gynecology</jtitle><addtitle>J Minim Invasive Gynecol</addtitle><date>2009-11-01</date><risdate>2009</risdate><volume>16</volume><issue>6</issue><spage>748</spage><epage>754</epage><pages>748-754</pages><issn>1553-4650</issn><eissn>1553-4669</eissn><abstract>Abstract 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 &gt; 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 &gt; 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 &gt; 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>19896603</pmid><doi>10.1016/j.jmig.2009.07.016</doi><tpages>7</tpages></addata></record>
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subjects Adult
Ambulatory Surgical Procedures
Female
Humans
Hysteroscopy
Hysteroscopy - methods
Intramural myomas
Middle Aged
Myoma - pathology
Myoma - surgery
Obstetrics and Gynecology
OPPIuM
Pilot Projects
Resectoscopic myomectomy
Submucous myomas
Surgery
Uterine Neoplasms - pathology
Uterine Neoplasms - surgery
title A New Hysteroscopic Technique for the Preparation of Partially Intramural Myomas in Office Setting (OPPIuM technique): A Pilot Study
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