Hysteroscopic endocervical resection.

A new method was developed to access the uterine cavity in women in whom cervical stenosis precludes hysteroscopic surgery. Thirty-three women with intractable uterine bleeding were chosen to undergo either hysteroscopic myometrial resection or myomectomy. All of them had cervical stenosis that would, in the authors' opinion, not permit safe dilatation to 9 mm, the minimum diameter necessary to introduce a gynecologic resectoscope. Endocervical resection was performed in all 33 patients, with safe, easy access to the uterine cavity. No cases of fluid overload or excess bleeding occurred. We conclude that hysteroscopic endocervical resection is a safe method to create a portal of entry to the uterine cavity in women with absolute or relative cervical stenosis.