Hysteroscopic resection of a submucosal fibroid: hints and tips for a successful procedure

The authors present a case of a successful two-stage hysteroscopic resection of a submucosal fibroid and share helpful hints and tips for a successful procedure.A 41 year old female presented with subfertility and heavy, prolonged periods. An MRI scan confirmed a submucosal fibroid measuring 40 mm arising from the posterior wall and projecting in the endometrial cavity by more than 50% (FIGO type 1). A hysteroscopic resection removed approximately 70% of the fibroid. The procedure had to be stopped due to loss of pressure and suboptimal view. Following a course of Prostap, a second hysteroscopic procedure was undertaken 3 months later successfully resecting the remainder of the fibroid.The video demonstrates the importance of case selection with good preoperative planning and imaging, e.g., MRI, to assess the feasibility of resection. Large fibroids extending towards the serosa of the uterus may not be suitable cases for hysteroscopic resection. There is discussion about optimal dilation of the endocervical canal, improving visualisation and trouble shooting techniques if this is suboptimal during the operation. Attention is also given to safe surgical technique and the use of a post-surgical adhesion prevention barrier. Reference is made to the BSGE/ESGE guidance on fluid management and systems to prevent overload, as well as consideration of a two-step procedure should be considered for larger fibroids if necessary.