Hysteroscopic Myomectomy Respecting the Pseudocapsule: The Cold Loop Hysteroscopic Myomectomy

Myomas, also called leiomyomas or fibroids, are benign, monoclonal tumors of the smooth muscle cells of the myometrium, widely considered as the most common of the female reproductive tract. Myomas can be responsible for pelvic pain, abnormal uterine bleeding, and infertility. Although more than 50% of fibroids are asymptomatic, the submucous myomas are associated with the most severe symptomatology. The advent of endoscopy in the gynecologic surgery revolutionized the treatment of submucous myomas, introducing a viable uterine-sparing alternative to hysterectomy. In the last four decades, several techniques have been described to perform hysteroscopic myomectomy. The hysteroscopic myomectomy should be a simple, well-tolerated and effective procedure. The cold loop technique, preferably accomplished in only one surgical procedure, seems to be the best option in the treatment of submucous myomas. Such technique, conceived in 1995, for the first time allowed to overcome the limits represented by the classical slicing technique and still today ensures a safe and effective myometrial sparing treatment of submucous myomas.