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Salvatore Giovanni Vitale [1] and Fabrizio Sapia [2] and Agnese Maria Chiara Rapisarda [2] and Gaetano Valenti [2] and Fabrizia Santangelo [3] and Diego Rossetti [4] and Benito Chiofalo [1] and Giuseppe Sarpietro [2] and Valentina Lucia La Rosa [5] and Onofrio Triolo [1] and Marco Noventa [6] and Salvatore Gizzo [6] and Antonio Simone Laganà [1]

Academic Editor: Markus Wallwiener

1, Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy, unime.it

2, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy, unict.it

3, Department of Obstetrics and Gynecology, University of Naples “Federico II”, Naples, Italy, unina.it

4, Department of Maternal and Child Health, Gavardo Hospital, Brescia, Italy

5, Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy, unict.it

6, Department of Woman and Child Health, University of Padua, Padua, Italy, unipd.it

Received Feb 10, 2017; Revised May 22, 2017; Accepted Aug 1, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

The progressive improvement of hysteroscopic instruments and the standardization of techniques allowed feasible and daily management of submucous myomas (SMs). Hysteroscopic myomectomy is usually performed with a progressive slicing of the intracavitary portion of the SM, a subsequent “cold loop” pushing of the intramural part (to preserve the pseudocapsule), and, finally, a slicing resection of it [1–3]. As was widely reported, a careful and conscious management of uterine myomas improves not only symptoms, but also fertility outcomes [4, 5].

To date, the availability of Hysteroscopic Tissue Removal systems (HTRs) opened a new scenario for hysteroscopic myomectomy: indeed, the learning curve for resectoscopic management of SM is challenging for both the residents and specialists and may lead also to severe complications [6]. In this regard, HTRs may reduce the learning curve and complication rate of hysteroscopic myomectomy for SM with respect to traditional resectoscopy.

The use of morcellators in gynecologic surgery started for myomectomy and hysterectomy first in laparoscopy; however in 2014 the U.S. Food and Drug Administration warned against the use of laparoscopic power morcellators for the risk of spreading an unsuspected...

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