ricardo lasmar md, phd ginendo unesp - uerj ricardo@lasmar.com.br lasmar hysteroscopic myomectomy

Ricardo Lasmar MD, PhDRicardo Lasmar MD, PhD

GINENDOGINENDO

UNESP - UERJUNESP - UERJ

ricardo@lasmar.com.br Lasmar

Hysteroscopic Myomectomy

NewNew

Submucous Fibroids Submucous Fibroids

Classification Classification

STEP-W classificationSTEP-W classification

AAGL 35AAGL 35thth Annual Meeting Annual Meeting

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Hysteroscopic Myomectomy

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Classification (ESGE)Classification (ESGE)

0 - Fibroids totally in cavity0 - Fibroids totally in cavity

1 - More than 50% in cavity1 - More than 50% in cavity

2 - Less than 50% in cavity2 - Less than 50% in cavity Wamsteker K, 1993

Hysteroscopic Myomectomy

Lasmar

New ClassificationNew Classification

TargetTarget

More More CorrelationCorrelation with with

DifficultyDifficulty and and Complexity Complexity ofof

Hysteroscopic MyomectomyHysteroscopic Myomectomy

Hysteroscopic Myomectomy

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New ClassificationNew Classification

Including more Including more 44 parameters: parameters: Penetration Penetration Size Size Topography Topography Extension of the baseExtension of the base WallWall

Hysteroscopic Myomectomy

STEPSTEP--WW ClassificationClassification

SSize ize (cm)(cm)

TTopograpopographyhy

EExtensioxtension Basen Base

PPenetratienetrationon

LaterLateralal

WWallallTT

OO

TT

AA

LL00 ≤ ≤ 22 LowLow ≤ ≤ 1/31/3 00

+1+111 > 2 to 5 > 2 to 5 MiddleMiddle >1/3 - 2/3>1/3 - 2/3 ≤ ≤ 50%50%

22 > 5> 5 UpperUpper > 2/3> 2/3 > 50%> 50%

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

Hysteroscopic Myomectomy

02

1>2 to 5

2> 5

SSTEPTEP--WW CLASSIFICATIONCLASSIFICATION SizeSize (cm)(cm)

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Hysteroscopic Myomectomy

0

1

2

SSTTEPEP--WW CLASSIFICATIONCLASSIFICATION TopographyTopography

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upper

middle

low

Hysteroscopic Myomectomy

01/31

>1/3 to 2/3

2> 2/3

STSTEEPP--WW CLASSIFICATION CLASSIFICATION ExtensionExtension ofof thethe basebase

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Hysteroscopic Myomectomy

0

12

STESTEPP--WW CLASSIFICATIONCLASSIFICATIONPenetratioPenetrationn

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Hysteroscopic Myomectomy

0A or P

1L

STEPSTEP--WW CLASSIFICATIONCLASSIFICATION

WallWall

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Hysteroscopic Myomectomy

Hysteroscopic MyomectomySize Size (cm)(cm)

TopograpTopographyhy

Ext. Ext. BaseBase

PenetratiPenetrationon

Lat.WaLat.Wall

TotTotalal

00 ≤ ≤ 22 LowLow ≤ ≤ 1/31/3 00

++11

11 > 2 to 5 > 2 to 5 MiddleMiddle >1/3 - >1/3 - 2/32/3

≤ ≤ 50%50%

22 > 5> 5 UpperUpper > 2/3> 2/3 > 50%> 50%

ScorScoree

++

++

++

++

==T. T. ScoreScore

GrouGroupp

IndicationIndication

0 to 4 I Low complexity hysteroscopic myomectomy.

5 to 6 IIHigh complexity hysteroscopic myomectomy. GnRH? Two-step hysteroscopic myomectomy.

7 to 9 III Hysteroscopic myomectomy is not indicate.

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

Mean Operative Time (min) –62

ESGE STEP-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)

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Average Fluid Balance (ml) = 62

ESGE STEP-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)

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Hysteroscopic Myomectomy

Lasmar

Incomplete Myomectomy

05 (62)

ESGE STEP- W

T 1 = 1 (20%) Group II = 05

T 2 = 4 (80%) (100%)

ricardo@lasmar.com.br

Hysteroscopic Myomectomy

Lasmarricardo@lasmar.com.br

% Complete Hysteroscopic Myomectomy - 62

ESGE STEP-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)

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Hysteroscopic Myomectomy

Lasmar

Lasmar

Conclusion

STEP-WSTEP-W Classification has Classification has

a a biggerbigger CorrelationCorrelation with the with the

DifficultyDifficulty and and Complexity Complexity ofof

Hysteroscopic MyomectomyHysteroscopic Myomectomy

Hysteroscopic Myomectomy

Thank youThank you

Obrigado Obrigado

Ricardo LasmarRicardo Lasmar

ricardo@lasmar.com.br Lasmar

Hysteroscopic Myomectomy

S T E P W

Hysteroscopic Myomectomy