Likelihood of Accomplishing an In-Patient Hysteroscopic Myomectomy in a One-Step Procedure: A Systematic Review and Meta-Analysis

Table 2

Summary of techniques reported for removing the deep portion of myomas.

Author	Short description of the technique for treating the deep portion
Bernard [28]	Inducing uterine contraction by changing intrauterine pressure (“hydromassage”)
Darwish [39] Group A.	Vertical linear incision of the myoma to facilitate the sliding into the endometrial cavity. Ergometrine administration to promote uterine contractions. The base was cut and the whole myoma extracted through the primed cervical canal using a ring forceps.
Hallez [44]	Massage of the uterus manually, applying a pressure on the deep portion of myoma (so-called “manual massage”)
Jayakrishnan, 2013 [50]	Classical slicing under laparoscopic check in 86.5% of patients. Laparoscopic removal of larger myomas with intramural portion
Korkmazer [52]	Cavitation of the cleavage. The cleavage was detected by transabdominal ultrasonography. Then, slicing of the deep portion under transabdominal sonographic check.
Lasmar [53]	Collins' electrode was used to encircle the entire myoma and to reach the pseudocapsule. From this point, the fibroid was mobilized and the fibrous bundles were individualized and sectioned with electrical energy.
Lin [56]	Cutting the pseudocapsule of the myoma. Lin' grasper for pulling the deep portion into uterine cavity. Slicing under ultrasonographic check.
Litta [55]	Elliptical incision of the mucosa that covers the myoma at the level of uterine wall and detection of the cleavage. Cutting of the fibrous bridges between myoma and uterine wall, thereby obtaining expulsion of the deep portion into uterine cavity.
Ludwin [61], Group I.	Classic slicing and cut of pseudocapsule, under trans rectal ultrasonographic check.
Murakami [12]	Resection of the intrauterine dome of the myoma. Induction of strong contraction by using PGF2alpha within uterine body. Slicing or vaporization of the deep portion. Sometimes, mechanical detachment. Echographic check.
Vercellini [10]	Deactivated electrode within the cleavage for pulling and detaching the deep portion from the uterine wall.
Wang [78]	Exposing the myoma edges by cutting endometrium close to the myoma dome. Classic slicing. Oxytocin for inducing contractions in case of large myomas and forceps for pulling the residual portion of the deep myoma. Echographic check.
Zayed [83]	Introducing the loop into the cleavage; traction of the deep portion into uterine cavity. Hydromassage. Manual massage. Echographic check. Multiple slicing session after each induced protrusion of the myoma into uterine cavity.
Mazzon [17]	“Cold loop”: classic slicing of the intrauterine portion of the myoma. Exposure of the pseudocapsule. Change of the loop and use of the cold loop to mobilize the myoma from the uterine wall thereby pulling the deep portion into uterine cavity.

The description of the techniques for treating the deep portion of the myomas is usually reported in the texts. Sometimes, the authors recall the papers where the techniques have been described.