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Ricardo Lasmar MD, PhDRicardo Lasmar MD, PhD
GINENDOGINENDO
UNESP - UERJUNESP - UERJ
[email protected] 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)
Hysteroscopic Myomectomy
0
1
2
SSTTEPEP--WW CLASSIFICATIONCLASSIFICATION TopographyTopography
upper
middle
low
Hysteroscopic Myomectomy
01/31
>1/3 to 2/3
2> 2/3
STSTEEPP--WW CLASSIFICATION CLASSIFICATION ExtensionExtension ofof thethe basebase
Lasmarwww.ginendo.com
Hysteroscopic Myomectomy
0
12
STESTEPP--WW CLASSIFICATIONCLASSIFICATIONPenetratioPenetrationn
Lasmarwww.ginendo.com
Hysteroscopic Myomectomy
0A or P
1L
STEPSTEP--WW CLASSIFICATIONCLASSIFICATION
WallWall
Lasmarwww.ginendo.com
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%)
Hysteroscopic Myomectomy
% 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
[email protected] Lasmar
Hysteroscopic Myomectomy
S T E P W
Hysteroscopic Myomectomy
