Comment on “Does cold loop hysteroscopic myomectomy reduce intrauterine adhesions? A retrospective study”

To the Editor:

Ivan Mazzon et al. recently published an interesting paper focusing on “the prevalence and the characteristics of intrauterine adhesions after cold loop resectoscopic myomectomy” for G1 and G2 submucous myomas (1).

Although retrospective, the large number of operated patients (688) and removed myomas (806) make this study robust and relevant. The authors interestingly concluded that “cold loop resectoscopic myomectomy of G1-G2 myomas is effective and safe, with a prevalence of postsurgical intrauterine adhesions that appears to be lower than those reported in the literature. The technique we have described could thus contribute to improving fertility, making it especially noteworthy for patients who desire pregnancy.”

Comment on: “Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question.”

To the Editor:

Paolo Casadio et al. recently published an interesting paper focusing on the dynamic changes of the myometrial free margin separating type II submucous fibroids from the serosa during hysteroscopic resection (1). Although the number of patients of this prospective observational study is limited (n = 13), the authors interestingly concluded that “myometrial free margin increases progressively with each step of the procedure probably leading to an increasing margin of safety.” This study updates and reinforces the previous observation by Yang et al., which first demonstrated that the myometrial free margin is not a static parameter but it “increased gradually after each step of the resection, reaching its maximum after the completion of the procedure” (2). They observed the progressive thickening of myometrium at transabdominal sonography while the myoma is progressively enucleated, suggesting two possible mechanism for this phenomenon: the reshaping of the distended uterine myometrial fibers and the contractions induced by electrosurgery and the myoma grasping by forceps.