Removing a large submucous fibroid hysteroscopically with the two-resectoscope method.

Hysteroscopic myomectomy was performed in 25 patients using resectoscopes of two different sizes because of large submucous fibroids causing severe menorrhagia and anemia. The cervix was softened and dilated by inserting a laminaria tent the night before the operation. During the procedure a 7-mm resectoscope was first used to cut the pedicle to a size smaller than 10 mm. A sessile myoma was resected into a pedunculated myoma, and its body resected with a 9-mm resectoscope. The smaller portions were removed with a pair of forceps. Simultaneous ultrasonography was used to monitor the procedure. Specimen weights ranged from 50 to 145 g (mean 78.5 g). The operation time was 13 to 118 minutes (mean 49 min). No complications were encountered, other than a cervical laceration caused by forceps. Postoperatively, 22 patients had improvement of menorrhagia and anemia. Three women underwent the same procedure due to recurrence of the fibroid; two had full-term deliveries. Our method has proved to be safe and efficient for treatment of a sessile or large submucous fibroid.