The case presented is that of a 40 year-old woman who has been bleeding for the past 60 days as a result of this 3 cm intracavitary fibroid. Visualizing the fibroid by hysteroscopy reveals a large 3 cm specimen with large vessels that are feeding the fibroid tissue. As a result the decision was made to inject dilute Pitressin (vasopressin) in order to cause vasospasm of the vessels and decrease the complication rate, fluid absorption, and bleeding at the time of hysteroscopic resection.
Here the cervix is injected, and the needle is placed at level of the lower segment of the uterus. Following injection of dilute Pitressin for hysteroscopy reveals a pale specimen with vessels that have been contracted and constricted. A Myosure device is being used now to resect the fibroid. Myosure was developed in 2009 and at a rate of 6,000 revolutions per minute, is able to remove 1.5 grams per minute. Despite the fact that the specimen is quite hard, the morecellator is able to remove it in a very sequential and progressive way, with remarkably little bleeding despite the large vessels that we saw earlier. The tissue gets drawn into the morecellating window, and the mechanical morcellator chops it and suctions the tissue away.
Here approximately half of the fibroid has been removed, and the pale tissue is visible with remarkably little bleeding.
Here three quarters of the specimen has been now removed and we’re starting to see the level of the normal endometrium. The last remaining pieces are divided and suctioned, and now we’ve achieved 100% removal.
The uterine cavity is now deinsufflated to demonstrate that there are no remaining pieces of fibroid in the cavity or wall of the uterus that could extrude. A small polyp is now removed to create a perfect endometrial environment.
Video courtesy of Magdy Milad MD
Since 1995, Dr. Magdy Milad has been the Director of Gynecologic Endoscopy at Northwestern University, and is the Division Chief for Graduate Medical Education. He has authored 80 peer-reviewed manuscripts and 90 national presentations, and has developed an expertise in advanced minimally invasive surgeries including laparoscopy, hysteroscopy for conditions including endometriosis, fibroids, adhesions, tubal disease and ovarian cysts.