Objective: To assess the long-term efficacy and safety of hysteroscopic morcellation of polyps and submucosal leiomyomas in women with abnormal uterine bleeding (AUB).
Material and methods: We conducted a prospective cohort study including all women with AUB who underwent a hysteroscopic resection by mechanic morcellation of a benign polyp or submucosal leiomyoma confirmed at histopathology. Need for further surgery, patient satisfaction, symptom resolution, and post-operative complications were documented by direct patient contact after a minimum of six months of follow-up.
Results: A total of 122 women were included in the study with a mean length of follow-up of 31±13 months. Pathologies removed were submucosal leiomyomas 63/122 (52%), polyps 48/122 (39%) or both 10/122 (8%) with a mean total size of pathology at the time of index surgery of 33 mm. A total of 28/122 (23%) women required a subsequent surgery with, the estimated 3-year cumulative incidence being 11±3% for hysterectomy and 26±5% for any procedure (operative hysteroscopy, abdominal myomectomy or hysterectomy). Satisfaction rate of participants was 89%. In multivariate Cox proportional analyses, only a total size of pathology of 50 millimetres or more was found to be significantly associated with the risk of further requiring a hysterectomy (hazard ratio=3.5, p=.02) and any procedure (hazard ratio=2.8, p=.01).
Conclusion: Hysteroscopic morcellation of polyps and submucosal leiomyomas is an effective method to manage women with AUB, although women with larger pathology have an increased risk of requiring subsequent surgical procedures.