418 Views | Sep 26, 2019
Affliations: University of Ottawa
The objective of this video is to review a technique for the hysteroscopic resection of Type 2 uterine fibroids. This is an educational video review featuring a case patient. Visual identification of fibroid type, surgical technique, and perioperative considerations are discussed. Gynecologists frequently perform hysteroscopic fibroid resections; however, Type 2 fibroids present a unique challenge where long operative time, excessive blood loss and fluid absorption, incomplete resection, and uterine perforation are important considerations. Our case patient is a 35 year old G1P0A1 woman with a history of secondary infertility, dysmenorrhea and heavy menstrual bleeding. Ultrasound demonstrated a 4.0 x 4.6 x 4.3cm Type 2 uterine fibroid, with a maximal distance of 7.8mm between the outer edge of the fibroid and the uterine serosa. The hysteroscopic management of Type 2 fibroids includes perioperative optimization, including preoperative planning and medical optimization. Ultrasound images should be reviewed prior to surgery, to determine the type of fibroid and the distance to the serosa. Visual identification of fibroid type at the time of hysteroscopy is also possible by observing the angle between the fibroid at its intersection with the endometrium. The techniques demonstrated in this educational video demonstrate visual identification and hysteroscopic resection of a Type 2 fibroid, including the creation of an endometrial flap overlying the defect after resection, to minimize postoperative intrauterine adhesions. In this case, resection is performed in the operating room using a monopolar resectoscope. Identification of fibroid type, including visual diagnosis, as well as attention to surgical technique and perioperative considerations, are essential for hysteroscopic resection of Type 2 uterine fibroids.