Supermaniam S. , E. Rey V. , Ping T.E. , Kumar P.
Si
A Complete Guide to Hysteroscopic Myomectomy
Capítulo de un Libro
Científica
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01/01/2026
2-s2.0-105037224127
Hysteroscopic myomectomy (HM) remains the gold standard for submucous fibroids =5cm, but alternative treatments are essential when HM is contraindicated or unavailable. This chapter reviews five minimally invasive options: (1) Surgical myomectomy (laparotomy/laparoscopy) for large or deeply embedded fibroids, particularly in virgo intacta patients or settings lacking hysteroscopic expertise; (2) High-Intensity Focused Ultrasound (HIFU), a nonnvasive method, which induces fibroid necrosis via thermal ablation, offering fertility preservation and suitability for all types of submucous fibroids, with studies showing 80%-90% non-perfused volume ratios; (3) Radiofrequency Ablation (RFA), effective for type 2 and types 2-5 fibroids, with transvaginal RFA demonstrating 65% volume reduction and low recurrence (8%); (4) Microwave Ablation (MWA), ideal for vascular fibroids, achieving 90% ablation rates and shorter recovery; and (5) Uterine Artery Embolization (UAE), which shows greater volume reduction for submucous fibroids compared with uterine fibroids in other locations Each modality is evaluated for efficacy, safety, fertility outcomes, and endometrial preservation, supported by case studies and comparative data. The chapter underscores individualized treatment selection based on fibroid characteristics, patient preferences, and resource availability. © 2026 Elsevier Inc. All rights reserved.
Gynecology; Hemodynamics; Magnetic resonance; Ultrasonics; High intensity focused ultrasound; Hysteroscopic myomectomy; Image-guided; Magnetic resonance image guided high intensity focused ultrasound; Microwave ablation; Radiofrequency ablation; Ultrasound guided high intensity focused ultrasound; Ultrasound-guided; Uterine artery embolization; Ablation; Noninvasive medical procedures