Does cold loop hysteroscopic myomectomy reduce intrauterine adhesions? A retrospective study

Objective: To estimate the prevalence and the characteristics of intrauterine adhesions after cold loop resectoscopic myomectomy.

Design: Retrospective study.

Setting: Endoscopic gynecologic center.

Patient(s): 688 women with one or more G1-G2 myomas.

Intervention(s): Cold loop resectoscopic myomectomy and diagnostic hysteroscopy in all patients 2 months after surgery.

Main outcome measure(s): Integrity of the uterine cavity and prevalence of intrauterine synechiae.

Result(s): A total of 806 myomas were removed, ranging from a minimum of one to a maximum of five fibroids removed for each surgical procedure. Complications were reported in eight cases (1.16%). No hemorrhage, intravasation clinical syndrome, or perforation with the thermal loop were registered. Synechiae were found in 29 patients (4.23%): in 2 patients a new surgical hysteroscopic treatment was required to remove fibrous synechiae, and in 27 patients light adhesions were removed with the tip of the instrument in outpatient hysteroscopy. Neither intrauterine device nor anti-adherence mixtures were used at the end of surgery.

Conclusion(s): The cold loop hysteroscopic myomectomy is a safe and effective procedure that seems to be associated with a lower rate of intrauterine adhesions in comparison with the reported literature. The issue appears to be of notable importance for fertility patients.