LINDA D. BRADLEY, MD Dr. Bradley is director of hysteroscopic services, section of general gynecology, Cleveland Clinic Foundation, Cleveland, Ohio. She also serves on the OBG Management Board of Editors.
Recently, De Iaco et al17 reported the development of a uterine fistula and discontinuity of the myometrium after hysteroscopic resection of an embolized migrated fibroid. They speculated this was due to the development of an avascular myometrium after UAE. The patient was asymptomatic, but routine diagnostic hysteroscopy revealed a 2-cm discontinuity of the uterine wall at the site of the previous resectoscopic myomectomy. The myometrium was white and less than the full thickness.
Ultrasound guidance improves outcomes
Coccia et al18 described the benefits of intraoperative ultrasound guidance during operative hysteroscopy in fibroid treatment and uterine septum removal. Prospective evaluation of 81 patients involved an experienced ultrasonographer who mapped the limits of treatment. Patients were compared to 45 historical controls who had been similarly treated with laparoscopic monitoring. Satisfactory outcomes included relief of menorrhagia, complete resection of fibroids (including full resection of intramural fibroids), and thorough metroplasty of uterine septum.
Ultrasound guidance made it possible to extend the resection beyond the limit conventionally defined by hysteroscopy; none of the patients in the ultrasound group required reintervention. Among controls, a second operation was necessary in 4 cases. Investigators concluded that a wider resection (10 to 15 mm distance from the external surface of the uterus) of fibroids was achieved using ultrasound guidance.
Dr. Bradley reports that she serves as a consultant to Karl Storz, ACMI, Olympus, and Gynecare, and as a lecturer for Novacept.
