# Tips and tricks for hysteroscopic resection of a large type I submucosal fibroid: a video presentation

## TL;DR

This paper presents a video guide on safely removing large submucosal fibroids using hysteroscopic techniques to preserve uterine integrity.

## Contribution

The paper introduces a step-by-step surgical approach with specific intraoperative strategies for hysteroscopic myomectomy of large fibroids.

## Key findings

- Minimal cervical dilation and continuous saline infusion improve safety and visibility during the procedure.
- Avoiding repeated scope removal helps maintain intrauterine pressure and prevents perforation.
- Identification of myometrial margins ensures complete fibroid resection.

## Abstract

We present a step-by-step approach for hysteroscopic myomectomy in patients with submucosal fibroids, focusing on key surgical techniques that enhance safety, preserve uterine integrity, and ensure complete fibroid removal. A 49-year-old woman with heavy menstrual bleeding presented with a type I submucosal fibroid measuring 32 × 23 × 20 mm. The procedure was performed using a 27 Fr bipolar resectoscope. Intraoperative strategies include: minimal cervical dilation to reduce fluid leakage, continuous saline infusion with controlled suction for optimal visibility, avoidance of repeated scope removal to maintain intrauterine pressure and identification of myometrial margins to ensure complete resection and prevent perforation. This video highlights essential surgical techniques and intraoperative considerations for performing safe and effective hysteroscopic myomectomy. Attention to fluid management, visualization, and preservation of cervical and uterine integrity is critical for optimal outcomes, especially in women with prior uterine surgery or fertility concerns.