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Hysteroscopic Myomectomy

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  1. Hysteroscopic Myomectomy Ricardo Lasmar MD, PhD GINENDO UNESP - UERJ ricardo@lasmar.com.br Lasmar

  2. Hysteroscopic Myomectomy New Submucous Fibroids Classification STEP-W classification AAGL 35th Annual Meeting www.ginendo.com Lasmar

  3. Hysteroscopic Myomectomy Classification (ESGE) • 0 - Fibroids totally in cavity • 1 - More than 50% in cavity • 2 - Less than 50% in cavity Wamsteker K, 1993 www.ginendo.com Lasmar

  4. Hysteroscopic Myomectomy New Classification Target More Correlation with Difficulty and Complexity of Hysteroscopic Myomectomy Lasmar

  5. Hysteroscopic Myomectomy New Classification Including more 4 parameters: Penetration Size Topography Extension of the base Wall www.ginendo.com Lasmar


  6. Hysteroscopic Myomectomy STEP-WClassification Lasmar.RB.et al., J Minim Invasive Gynecol. 2005 Jul-Aug;12(4):308-11

  7. Hysteroscopic Myomectomy STEP-WCLASSIFICATION Size(cm) 2 > 5 1 >2 to 5 0 2 Lasmar ricardo@lasmar.com.br

  8. Hysteroscopic Myomectomy STEP-WCLASSIFICATION Topography upper 2 1 middle 0 low Lasmar ricardo@lasmar.com.br

  9. Hysteroscopic Myomectomy STEP-W CLASSIFICATION Extensionofthebase 2 > 2/3 0 1/3 1 >1/3 to 2/3 www.ginendo.com Lasmar

  10. Hysteroscopic Myomectomy STEP-WCLASSIFICATION Penetration 0 2 1 www.ginendo.com Lasmar

  11. Hysteroscopic Myomectomy STEP-WCLASSIFICATION Wall 0 A or P 1 L www.ginendo.com Lasmar

  12. Hysteroscopic Myomectomy Lasmar.RB.et al., J Minim Invasive Gynecol. 2005 Jul-Aug;12(4):308-11

  13. Hysteroscopic Myomectomy MeanOperativeTime (min) –62 ESGESTEP-W T 0 = 11 = 5:4 Group I = 50 = 8:2 T 1 = 32 = 9:1 Group II = 12 = 23:2 (p<0,001) T 2 = 19 = 18:1 (p=0,02) www.ginendo.com Lasmar

  14. Hysteroscopic Myomectomy AverageFluidBalance (ml) = 62 ESGESTEP-W T 0 = 11 = 56.2 Group I = 50 = 89.8 T 1 = 32 = 123.2 Group II = 12 = 355.0 (p=0,02) T 2 = 19 = 222.0 (p=0,17) www.ginendo.com Lasmar

  15. Hysteroscopic Myomectomy IncompleteMyomectomy 05 (62) ESGESTEP- W T 1 = 1 (20%) Group II = 05 T 2 = 4 (80%) (100%) ricardo@lasmar.com.br ricardo@lasmar.com.br Lasmar

  16. Hysteroscopic Myomectomy %CompleteHysteroscopicMyomectomy - 62 ESGESTEP-W T 0 = 11/11 (100%) Group I = 50/50 (100%) T 1 = 31/32 (97%) Group II= 07/12 (58%) (p<0,001) T 2 = 15/19 (79%) (p=0,07) www.ginendo.com Lasmar

  17. Hysteroscopic Myomectomy Conclusion STEP-W Classification has a biggerCorrelation with the Difficulty and Complexity of Hysteroscopic Myomectomy Lasmar

  18. Hysteroscopic Myomectomy Thank you Obrigado Ricardo Lasmar ricardo@lasmar.com.br Lasmar

  19. Hysteroscopic Myomectomy