{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:55:18Z","timestamp":1788375318805,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T00:00:00Z","timestamp":1668124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Leiomyomas are the most common pelvic tumors. Submucosal fibroids are a common cause of abnormal bleeding and infertility. Hysteroscopic myomectomy is the definitive management of symptomatic submucosal fibroids, with high efficacy and safety. Several techniques have been introduced over time and will be covered in depth in this manuscript. Advances in optics, fluid management, electrosurgery, smaller diameter scopes, and tissue removal systems, along with improved training have contributed to improving the safety and efficiency of hysteroscopic myomectomy.<\/jats:p>","DOI":"10.3390\/medicina58111627","type":"journal-article","created":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T02:32:01Z","timestamp":1668393121000},"page":"1627","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["HYSTEROSCOPIC MYOMECTOMY"],"prefix":"10.3390","volume":"58","author":[{"given":"Ricardo Bassil","family":"Lasmar","sequence":"first","affiliation":[{"name":"Department of Surgery and Specialized, Faculty of Medicine, Universidade Federal Fluminense, UFF, Niter\u00f3i 24020-141, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo Portugal","family":"Lasmar","sequence":"additional","affiliation":[{"name":"University of the Maternal-Infant Department of the Faculty of Medicine, Universidade Federal Fluminense, UFF, Niter\u00f3i 24020-141, RJ, Brazil"},{"name":"Est\u00e1cio de S\u00e1 University, S\u00e3o Jo\u00e3o de Meriti 25550-100, RJ, Brazil"},{"name":"Gynecological Endoscopy, Hospital Central Aristarcho Pessoa HCAP\u2013CBMERJ, Rio de Janeiro 20261-243, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9401-4785","authenticated-orcid":false,"given":"Nash S.","family":"Moawad","sequence":"additional","affiliation":[{"name":"Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, P.O. Box 100294, Gainesville, FL 32610, USA"},{"name":"UF Health COEMIG, P.O. Box 100294, Gainesville, FL 32610, USA"},{"name":"University of Florida College of Medicine, P.O. Box 100294, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1111\/j.1471-0528.2007.01326.x","article-title":"Diagnostic hysteroscopy in abnormal uterine bleeding: A systematic review and meta-analysis","volume":"114","author":"Jacobi","year":"2007","journal-title":"BJOG"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.mce.2011.05.044","article-title":"The role of progesterone signaling in the pathogenesis of uterine leiomyoma","volume":"358","author":"Kim","year":"2012","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.bpobgyn.2015.11.015","article-title":"Hormones and pathogenesis of uterine fibroids","volume":"34","author":"Reis","year":"2016","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_4","first-page":"736","article-title":"Expression of the CYP19 gene and its product aromatase cytochrome P450 in human uterine leiomyoma tissues and cells in culture","volume":"78","author":"Bulun","year":"1994","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"19887","DOI":"10.1073\/pnas.0808188105","article-title":"Growth of uterine leiomyomata among premenopausal black and white women","volume":"105","author":"Peddada","year":"2008","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1093\/ajcp\/94.4.435","article-title":"The Frequency of Uterine Leiomyomas","volume":"94","author":"Cramer","year":"1990","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1210\/jc.2008-2327","article-title":"High Aromatase Expression in Uterine Leiomyoma Tissues of African-American Women","volume":"94","author":"Ishikawa","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_8","first-page":"395","article-title":"Diet and uterine myomas","volume":"94","author":"Chiaffarino","year":"1999","journal-title":"Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Tinelli, A., Vinciguerra, M., Malvasi, A., Andji\u0107, M., Babovi\u0107, I., and Spari\u0107, R. (2021). Uterine Fibroids and Diet. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18031066"},{"key":"ref_10","first-page":"109","article-title":"Associations between uterine fibroids and lifestyles including diet, physical activity and stress: A case-control study in China","volume":"22","author":"He","year":"2013","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1111\/1471-0528.14640","article-title":"Epidemiology of uterine fibroids: A systematic review","volume":"124","author":"Stewart","year":"2017","journal-title":"BJOG"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/01.AOG.0000136079.62513.39","article-title":"Uterine Myomas: An Overview of Development, Clinical Features, and Management","volume":"104","author":"Wallach","year":"2004","journal-title":"Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.ejrad.2004.01.009","article-title":"Uterine contractions evaluated on cine MR imaging in patients with uterine leiomyomas","volume":"53","author":"Nishino","year":"2005","journal-title":"Eur. J. Radiol."},{"key":"ref_14","first-page":"126","article-title":"Hysteroscopic myomectomy","volume":"16","author":"Piecak","year":"2017","journal-title":"Przegl\u0105d Menopauzalny"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1093\/humrep\/17.6.1424","article-title":"What are the implications of myomas on fertility? A need for a debate?","volume":"17","author":"Donnez","year":"2002","journal-title":"Hum. Reprod."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Practice Committee of the American Society for Reproductive Medicine (2017). Removal of myomas in asymptomatic patients to improve fertility and\/or reduce miscarriage rate: A guideline. Fertil. Steril., 108, 416\u2013425.","DOI":"10.1016\/j.fertnstert.2017.06.034"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.bpobgyn.2016.09.008","article-title":"The role of leiomyomas in the genesis of abnormal uterine bleeding (AUB)","volume":"40","author":"Lasmar","year":"2017","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_18","first-page":"308","article-title":"Submucous myomas: A new presurgical classification to evaluate the viability of hysteroscopic surgical treatment\u2014Preliminary report","volume":"12","author":"Lasmar","year":"2005","journal-title":"JMIG"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1016\/j.fertnstert.2011.01.142","article-title":"Impact of submucous myoma on the severity of anemia","volume":"95","author":"Yang","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_20","unstructured":"Nash, S.M. (2018). Uterine Fibroids: A Clinical Casebook, Springer. [1st ed.]."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lasmar, R.B., and Lasmar, B.P. (2017). Limiting Factors of Office Hysteroscopic Myomectomy. Hysteroscopy, Springer.","DOI":"10.1007\/978-3-319-57559-9_35"},{"key":"ref_22","first-page":"736","article-title":"Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: Results regarding the degree of intramural extension","volume":"82","author":"Wamsteker","year":"1993","journal-title":"Obstet. Gynecol."},{"key":"ref_23","first-page":"179","article-title":"The importance of pseudocapsule preservation during hysteroscopic myomectomy","volume":"243","author":"Tinelli","year":"2019","journal-title":"EJOG"},{"key":"ref_24","unstructured":"Cittadini, E., Perino, A., Angiolillo, M., and Minelli, L. (1995). Nuovatecnica per la miomectomia isteroscopica: Enucleazionecon ansa fredda. Testo-Atlante Di Chirurgia Endoscopica Ginecologica, Cofese."},{"key":"ref_25","unstructured":"Lasmar, R., and Barroso, P. (2001). Histeroscopia\u2014Uma Abordagem Pr\u00e1tica, Medsi. [1st ed.]."},{"key":"ref_26","unstructured":"Lasmar, R., and Lasmar, B. (2021). Histeroscopia T\u00e9cnica & Arte, Thieme Revinter. [1st ed.]."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/0002-9378(76)90471-3","article-title":"Excision of submucus fibroids with hysteroscopic control","volume":"126","author":"Neuwirth","year":"1976","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_28","first-page":"32","article-title":"Hysteroscopic morcellation versus bipolar resection for removal of type 0 and 1 submucous myomas: A randomized trial","volume":"259","author":"Schoot","year":"2021","journal-title":"EJOG"},{"key":"ref_29","first-page":"207","article-title":"Hysteroscopic tissue removal systems for the treatment of intrauterine pathology: A systematic review and meta-analysis","volume":"10","author":"Yin","year":"2018","journal-title":"Facts Views Vis. ObGyn"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.fertnstert.2009.07.019","article-title":"Hysteroscopic morcellator for removal of intrauterine polyps and myomas: A randomized controlled study among residents in training","volume":"92","author":"Emanuel","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_31","unstructured":"(2022, September 06). Intrauterine Bigatti Shaver. EndoWorld. Gyn 48 7.0 01\/2016-E 2018. Available online: https:\/\/www.karlstorz.com\/cps\/rde\/xbcr\/karlstorz_assets\/ASSETS\/3210338.pdf."},{"key":"ref_32","first-page":"748","article-title":"A New Hysteroscopic Technique for the Preparation of Partially Intramural Myomas in Office Setting (OPPIuM technique): A Pilot Study","volume":"16","author":"Bettocchi","year":"2009","journal-title":"JMIG"},{"key":"ref_33","first-page":"709","article-title":"Radiofrequency Ablation of Uterine Myomas and Pregnancy Outcomes: An Updated Review of the Literature","volume":"29","author":"Polin","year":"2022","journal-title":"JMIG"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"8429047","DOI":"10.1155\/2018\/8429047","article-title":"Risk Factors for the Completion of the Cold Loop Hysteroscopic Myomectomy in a One-Step Procedure: A Post Hoc Analysis","volume":"2018","author":"Mazzon","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s10397-008-0416-8","article-title":"Hysteroscopic myomectomy in a submucous fibroid near from tubal ostia and 5 mm from the serosa: A case report from the Endoscopy Service of Ginendo-RJ","volume":"6","author":"Lasmar","year":"2009","journal-title":"Gynecol. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s10397-006-0242-9","article-title":"Hysteroscopic myomectomy in a submucous fibroid 3 mm from the serosa: A case report","volume":"4","author":"Lasmar","year":"2007","journal-title":"Gynecol. Surg."},{"key":"ref_37","first-page":"232","article-title":"Long-term results of hysteroscopic myomectomy in 235 patients","volume":"130","author":"Polena","year":"2007","journal-title":"EJOG"},{"key":"ref_38","first-page":"266","article-title":"Complications of hysteroscopy: A prospective, multicenter study","volume":"96","author":"Jansen","year":"2000","journal-title":"Obstet. Gynecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1016\/j.fertnstert.2011.01.147","article-title":"Feasibility of a new system of classification of submucous myomas: A multicenter study","volume":"95","author":"Lasmar","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1093\/bja\/aei279","article-title":"Fluid absorption in endoscopic surgery","volume":"96","author":"Hahn","year":"2005","journal-title":"Br. J. Anaesth."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1111\/j.1471-0528.1996.tb09806.x","article-title":"Irrigating fluid absorption from the intact uterus","volume":"103","author":"Olsson","year":"1996","journal-title":"Br.J. Obstet. Gynaecol."},{"key":"ref_42","first-page":"184","article-title":"Oxytocin infusion in laparoscopic myomectomy may decrease operative blood loss","volume":"14","author":"Wang","year":"2007","journal-title":"JMIG"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0029-7844(97)00006-9","article-title":"The effect of dilute vasopressin solution on the force needed for cervical dilatation: A randomized controlled trial","volume":"89","author":"Phillips","year":"1997","journal-title":"Obstet. Gynecol."},{"key":"ref_44","first-page":"241","article-title":"Embolism of Air and Gas in Hysteroscopic Procedures: Pathophysiology and Implication for Daily Practice","volume":"15","author":"Groenman","year":"2008","journal-title":"JMIG"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/S1074-3804(05)60478-1","article-title":"Role of Endometrial Suppression on the Frequency of Intrauterine Adhesions after Resectoscopic Surgery","volume":"7","author":"Taskin","year":"2000","journal-title":"J. Am. Assoc. Gynecol. Laparosc."},{"key":"ref_46","first-page":"2672","article-title":"Meta-analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations","volume":"19","author":"Zheng","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1097\/GCO.0b013e3283630e10","article-title":"Surgical techniques and outcome in the management of submucous fibroids","volume":"25","author":"Capmas","year":"2013","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1080\/09513590600604673","article-title":"Effects of the position of fibroids on fertility","volume":"22","author":"Casini","year":"2006","journal-title":"Gynecol. Endocrinol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1016\/j.fertnstert.2008.01.051","article-title":"Fibroids and infertility: An updated systematic review of the evidence","volume":"91","author":"Pritts","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1196\/annals.1335.010","article-title":"Myomas, Pregnancy Outcome, and In Vitro Fertilization","volume":"1034","author":"Bulletti","year":"2004","journal-title":"Ann. N. Y. Acad. Sci."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1627\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:14:30Z","timestamp":1760145270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1627"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,11]]},"references-count":50,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["medicina58111627"],"URL":"https:\/\/doi.org\/10.3390\/medicina58111627","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,11]]}}}