One-step hysteroscopic myomectomy: unusual cases and a review of the literature.

Operative hysteroscopy has enabled us to resect submucosal myomas transcervically as a minimally invasive surgery. However, not all submucosal leiomyomas are easily treated by hysteroscopic resection. We report two unusual and difficult cases of submucosal myomas associated with infertility, treated successfully by one-step hysteroscopic resection. One was a large (20 cm diameter) intracavitary submucosal myoma, and the other was a deeply invasive submucosal myoma invading into the broad ligament. Hysteroscopic myomectomy of such myomas has not been reported in the literature. Since hysteroscopic myomectomy is a relatively minor procedure associated with lower morbidity, submucosal myomas with infertility should be resected hysteroscopically whenever possible.