Hysteroscopic resection of a large submucosal fibroid using intermittent bimanual uterine massage and a bipolar resectoscope: a case report.

BACKGROUND: Hysteroscopic resection of large sub-mucosal myomas embedded deep in the myometrium is often unsuccessful due to absorption of large amounts of nonionic fluid that may result in water intoxication or incomplete resection of the intramural portion of the tumor, which later protrudes within the cavity.

CASE: A 35-year-old woman with a large, sessile, sub-mucosal leiomyoma underwent hysteroscopic resection using a bipolar resectoscope under laparoscopic monitoring with intermittent uterine massage. An isotonic electrolyte solution was used for uterine distention and visualization. Frequent massaging of the uterus during the procedure resulted in the expulsion of the fibroid into the endometrial cavity and facilitated complete resection.

CONCLUSION: A bipolar resectoscope, which can be used with electrolyte solutions, such as 0.9% NaCl, combined with uterine massage, allows complete removal of large leiomyomas without adverse electrolyte imbalances.