Hysteroscopic Morcellation of Submucous Myomas: A Systematic Review

Table 1

Relevant data of retrieved studies.

Authors, year	Type of study	Enrolled cases	Mean age	Type of myomas	Type of HTRs	Mean operative time; (min)	Mean fluid deficit (mL)	Main findings
Rubino and Lukes, 2015 [9]	Randomized, prospective, comparative setting clinical trial	42 myomas	41.4 (overall, including also other pathologies)	Type 0 or 1 myomas > 1.5 and <3.0 cm	MyoSure	NA	NA	(1) 28 myomectomies were performed in office setting and 14 in ambulatory surgical center setting.; (2) The mean percentage of pathology removed was %.; (3) Both Uterine Fibroid Symptom-Quality of Life and Health-Related Quality of Life improved significantly 12 months after procedure.; (4) A fluid deficit of nearly 4 Lt was reported in at least one patient.
van Dongen et al., 2008 [10]	Prospective randomized controlled study	10 myomas	49	Type 0, type 1	Truclear 8.0	10.6	409	The use of the HTRs reduced operating time more than 8 min in comparison to conventional resectoscopy.
Arnold et al., 2016 [11]	Prospective cohort study	102 myomas	43	29 type 0,; 38 type 1,; 17 type 2,; 18 not documented	MyoSure	NA	880	63 complete resection of pathology at the end of the procedure: 18 type 0, 27 type 1, and 11 type 2 myomas.
Lee and Matsuzono, 2016 [12]	Retrospective study	13 myomas	NR	2; patients with myoma protrusion < 60%, 11 patients > 60%; 9 small (≤3 cm) myomas, 4 large (>3 cm) myomas	MyoSure	36.6	1005	(1) No significant differences in overall patient satisfaction and improvement in hemoglobin level between intrauterine morcellation and resectoscopy at 3-month follow-up.; (2) HTRs significantly reduced operative time.
Rajesh and Guyer, 2015 [13]	Retrospective study	17 myomas	58.6	Type 0, type 1, and type 2; size 1–5 cm	MyoSure	NA	495.3	(1) All patients had successful removal of pathology apart from two partial myomectomies (calcified fibroids) and one failed MyoSure for patulous cervix.; (2) No complications occurred.; (3) Intrauterine morcellation is feasible also in outpatient setting.
Hamidouche et al., 2015 [14]	Retrospective study	34 myomas	40.8	Type 0, type 1, and type 2	MyoSure	30.8	NA	No significant differences for mean operative time, complete resection rate, adverse events, and postoperative adhesion between HTRs and bipolar loop resection.
Emanuel and; Wamsteker,; 2005 [15]	Retrospective study	28 myomas	44.6	15 type 0,; 13 type 1	Truclear 8.0	16.4	660	(1) Significant reduction of operative time for HTRs compared to resectoscopy.; (2) No complications.
Hamerlynck et al., 2011 [16]	Retrospective study	37 myomas	45	Type 0, type 1	Truclear 8.0	18.2	440	(1) All procedures were uneventful.; (2) Implementation of the HTRs for removal of type 0 and 1 myomas ≤ 3 cm, and removal of polyps appears safe and effective.

HTRs: Hysteroscopic Tissue Removal systems; NA: not available.