11958 Optimizing Fertility: Insights into One-Step Hysteroscopic Myomectomy for Large Submucosal Fibroids

Document Type

Conference Proceeding

Publication Date

11-14-2024

Publication Title

J Minim Invasive Gynecol

Abstract

Study Objective: This study aims to assess the feasibility and safety of performing a one-step hysteroscopic myomectomy for large submucosal fibroids by utilizing the tissue morcellator in combination with the slicing technique with a right-angle loop electrode. Design: Case report, literature review. Setting: Teaching hospital. Patients or Participants: A 35-year-old woman, P0, had a 2-year history of infertility and two failed attempts at hysteroscopic myomectomies. Imaging studies revealed a 4 cm submucosal fibroid that failed to decrease in size after GnRH agonist administration. A tissue morcellator was used to reduce the fibroid's size during the procedure. This allowed for a better evaluation of the uterine cavity and intramural extension of the fibroid. The intramural component was then removed utilizing the slicing technique with a right-angle resectoscope loop electrode with monopolar current, and the fibroid was resected entirely with proper hemostasis. An intrauterine Foley catheter was placed in the uterine cavity for one week to reduce postoperative adhesion formation, and a 6-week course of estradiol with medroxyprogesterone acetate was given during the last ten days of estradiol. Postoperative imaging studies were normal. Six months after the surgery, the patient successfully conceived naturally and had a normal spontaneous vaginal delivery. Interventions: One-step hysteroscopic myomectomy, intrauterine pediatric foley balloon, oral estradiol. Measurements and Main Results: Natural conception six months after the surgery and had a normal spontaneous vaginal delivery at 34 weeks. Currently, the patient is pregnant again. Conclusion: This case report describes a successful one-step hysteroscopic myomectomy of a large submucosal fibroid after two previous failed attempts. The technique used a combination of tissue morcellator and slicing technique with a right-angle loop electrode. It was implemented with minimal intraoperative and postoperative complications and proved effective in improving fertility and allowing for natural conception.

Volume

31

Issue

11

First Page

S122

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