Resectoscopic Surgery Part II: Introducing Ultrasound Guidance for Intermediate-Level Surgical Procedures

In Part I of this three-part series, the author reviewed the importance of resectoscopic surgery and the many advantages it provides to the patient and to the minimally invasive gynecologic surgeon. In Part I, we reviewed the obstacles to mastering this 30-year-old technology and how the motivated surgeon can overcome them. Although many basic resectoscopic procedures have been supplanted by global endometrial ablation (GEA) devices and hysteroscopic morcellators (HMs), the limitations of these restrictive technologies are quickly evident as the surgeon encounters increasingly complex and demanding cases. In Part II, the author examines intermediate-level procedures that cannot be managed with global endometrial ablation or hysteroscopic morcellators-endomyometrial resection (EMR), the resection of larger and multiple submucous leiomyomas and endometrial polyps, the incision of uterine septae, and the management of severe cervical stenosis. In Part II, we will also describe how to incorporate ultrasound guidance into one's surgical armamentarium and its role in assisting the minimally invasive gynecologic surgeon in the safe execution of these more challenging cases.