ABSTRACT
Hysteroscopic resection has become the first-line surgical option and the gold standard for many submucosal fibroids with or without intramural components. Methods of preoperative evaluation of fibroids include transvaginal ultrasound, saline-infused sonography, magnetic resonance imaging, and office hysteroscopy. Patients should be appropriately selected based on tumor type (International Federation of Gynecology and Obstetrics [FIGO] type 0-2) and size (generally less than 4 cm). Patients should be properly counseled and consented preoperatively. The procedure is generally done in the operating room but can be performed in the office in selected cases. Dilute vasopressin injection is usually used. Particular attention should be paid to type of distention medium and fluid deficit. Different devices with various technologies are used for intrauterine morcellation of fibroids. Available devices include Mazzon cold loops, Versapoint, Truclear, MyoSure, and Symphion. The outcome is generally favorable, with a 3-year recurrence rate around 30% and a 3- to 4-year reoperation rate of 5%–20%. Success of the procedure must always be individualized to patient risk factors; number, type, size, and location of fibroids; and goal of the procedure.
