Comparison of surgical and postoperative pregnancy outcomes between electrotomy and cold instruments for hysteroscopic myomectomy: a single-center, 3-year retrospective study

Purpose

To compare and analyze surgical outcomes and postoperative pregnancy outcomes between electrotomy and cold instruments for hysteroscopic myomectomy.

Methods

This study included patients who were diagnosed with submucosal fibroids (FIGO 0-2) in our center and underwent hysteroscopic myomectomy from January 2022 to November 2024. Hysteroscopic myomectomy was performed by either bipolar system or cold instruments. Surgical and postoperative pregnancy outcomes were recorded and analyzed.

Results

A total of 36 patients underwent hysteroscopic myomectomy at our center during the 3-year period, 21 in the cold instruments group and 15 in the electrotomy group. The mean age of the patients in the cold instruments group was significantly higher than that of the electrotomy group (39.00 ± 5.18 vs 35.20 ± 3.45, P = 0.019). In the electrotomy group, four patients found residual fibroids and required a second surgery. The incidence of residual fibroids and a second procedure were significantly higher than those in the cold instruments group (4/15(26.67%) vs 0, P = 0.023). The postoperative biochemical pregnancy rate and clinical pregnancy rate were higher in patients in the cold instruments group, but the difference was not statistically significant (14/21 (66.67%) vs 8/15 (53.33%), P = 0.644; 10/21(47.62%) vs 5/15(33.33%), P = 0.607).

Conclusion

Cold instruments for hysteroscopic myomectomy seem to be a safe and feasible surgical procedure. It has an advantage over electrotomy in terms of complete removal of submucosal fibroids. Moreover, cold instruments for hysteroscopic myomectomy have no electrothermal damage to normal endometrium, which is favorable for pregnancy as soon as possible after surgery.