Prostaglandin Injection for Myoma Expulsion (PRIME): Case series of a novel approach to hysteroscopic resection of FIGO type 2 myomas.

OBJECTIVE:To evaluate the use of dilute carboprost tromethamine injection at the endometrium/myoma junction during hysteroscopy to facilitate myoma expulsion and removal in a single procedure. DESIGN:Case Series. SETTING:Single high-volume academic medical center. PARTICIPANTS:Seven patients aged 32-51 years old with FIGO type 2 uterine myomas and symptoms of abnormal uterine bleeding or infertility undergoing hysteroscopic resection with a morcellation device from November 2022 - July 2023. INTERVENTION:Dilute injection of carboprost tromethamine (10 mcg/mL) at time of hysteroscopic myomectomy. RESULTS:The main outcome measure was ability to complete the hysteroscopic myomectomy in a single procedure using a hysteroscopic morcellator. Secondary outcomes included total operative time, fluid deficit, and post-operative pharmacologic side effects and/or surgical complications. Among our seven patients, all had successful single procedure complete resections of myomas ranging from 0.9-4.6 cm in maximal diameter. Average operative time was 30 minutes, and average fluid deficit was approximately 839 mL. The carboprost dosages used ranged from 30-180 mcg. One patient experienced prolonged post-operative nausea and vomiting that resolved with anti-emetics. One patient experienced post-operative endometritis that improved with antibiotics. CONCLUSIONS:In this pilot study, injection of dilute carboprost intra-operatively facilitated one-step hysteroscopic myomectomy of FIGO 2 myomas, via enhanced extrusion of the intramural portion of the fibroid into the uterine cavity, with both short operative times and acceptable fluid deficits.