In 2005, we developed an Hysteroscopic myoma classification, the “STEPW or Lasmar”Classification. Our purpose was to develop a new preoperative classification of submucous myomas for evaluating the viability and the degree of difficulty of hysteroscopic myomectomy. The ESGE classification considers only the degree of penetration of the myoma into the myometrium, and some times it not a good predictor of myomectomy difficulty. Our classification considers not only the degree of penetration of the myoma into the myometrium, but also adds in such parameters as the distance of the base of the myoma from the uterine wall, the size of the nodule (cm), and the topography of the uterine cavity. Each parameter receives a score, and the total sum of them indicates the myoma group.
A major advantage of the STEPW classification is in its ability to group the submucous fibroids by score, identifying a group in which 100% of the myomectomies will be complete and another group in which some incomplete myomectomies will occur. This will permit the surgeon to plan and better prepare for the surgery, to better inform the patient prior to consenting to the procedure, and guide the assignment of cases for the purposes of teaching operating technique to students and trainees in accordance with their degree of experience.”