An alternative for hysteroscopic myomectomy: Ultrasound-guided single-step myomectomy for submucous myoma uteri with ring forceps, a retrospective study

Objective: Hysteroscopic myomectomy is widely regarded as safe and feasible, although achieving single-session results for larger myomas often requires alternative methods. This study introduces a novel approach: ultrasound-guided myoma extirpation using ring forceps combined with hysteroscopy.

Methods: This retrospective, single-center study includes patients who underwent ultrasound-guided myoma extirpation between 2016 and 2024. Data were collected retrospectively, and myomas were classified according to the International Federation of Gynecology and Obstetrics leiomyoma subclassification system. Under ultrasound guidance, the myoma was extirpated using ring forceps. The pre-, peri-, and postoperative outcomes were recorded and analyzed.

Results: A total of 25 patients were included, with a mean age of 44.76 ± 8.09 years. Most patients (92%) were premenopausal, and the primary symptoms were irregular bleeding (76%) and menorrhagia (68%). The median myoma size was 3 cm (interquartile range [IQR]: 2-4 cm). The median operation time was 30 min (IQR: 20-42 min). There was no statistically significant correlation between the duration of the operation and the diameter of the myoma uteri. Most myomas were located in the fundus, left side, or anterior wall (20% each), with 60% classified as type 0. Postoperative assessments revealed no residual myomas in 84% of cases. Uterine perforation and cervical laceration occurred as complications in two cases, while four cases required an additional session. Two patients with infertility achieved full-term pregnancies post-surgery.

Conclusion: This new, minimally invasive technique might be a feasible option for large myomas, particularly in low-resource settings. It minimizes the need for multiple sessions, providing reassuring results for patients with suitable indications.