Cold loops applied to bipolar resectoscope: A safe one-step myomectomy for treatment of submucosal myomas with intramural development

Aim: To assess the safety and efficacy of cold loop myomectomy applied to bipolar resectoscope to perform one-step myomectomy of submucosal myomas with intramural involvement. Methods: Seventy-two patients with at least one symptomatic G1 or G2 myoma (Wamsteker's classification) underwent cold loop myomectomy from January 2011 to January 2013. All surgical procedures were performed using a 26Fr resectoscope and bipolar energy source. At one month after the procedure, all patients underwent an office hysteroscopy check-up. A subgroup of seven infertile patients underwent an office hysteroscopy every two-weeks to evaluate recovery time of the myometrial fovea. Results: Resectoscopic myomectomies were successfully performed in one surgical step in 70 out of 72 patients without any significant complications. Overall, the mean diameter of resected myomas was 32.2 +/- 9 mm. Median operative time was 34.2 +/- 24.1 min. Median fluid deficit was 761.22 +/- 480.34 ml. The fovea was almost completely restored (>80%) six weeks after surgery in six of the seven infertile patients who underwent repeated follow-up office hysteroscopies every two weeks. Conclusions: Data from the present study show that the use of cold loops applied to bipolar resectoscope represent an effective, safe technique for one-step myomectomy of G1-G2 myomas, allowing rapid recovery of the myometrial fovea.