Hysteroscopic Removal of Large, Submucosal Fibroids: Preoperative and Intraoperative Considerations

INTRODUCTION: While submucosal fibroids only make up ∼15–20% of all fibroids, they are clinically significant due to their strong association with abnormal uterine bleeding, anemia, and reproductive dysfunction. For patients with large submucosal fibroids, minimally invasive removal can be life-altering, with significant improvement in their symptoms. Nonetheless, surgeons may avoid hysteroscopic removal of these lesions due to their association with rapid fluid deficit, increased blood loss, and inadequate visualization. OBJECTIVE: The objectives of this video are to briefly review the pre- and intraoperative considerations to help surgeons undertake hysteroscopic removal of large submucosal fibroids to help surgeons. METHODS: Preoperative and intraoperative considerations were emphasized with the use of patient footage, including MRI/ SIS clips and recordings from the hysteroscopic removal of a 5-cm submucosal fibroid. RESULTS: Preoperative considerations, including ideal imaging, timing, and use of adjunctive medications, were outlined. Patient footage of a successful hysteroscopic myomectomy was then used to detail important intraoperative techniques and pointers, such as instrument choice and handling of the resectoscope, as well as methods of lesion delineation and recognition of procedure completion. CONCLUSIONS: Viewers should gain useful tips and tricks for more efficient, complete hysteroscopic resection of large submucosal fibroids.