New hysteroscopic techniques for submucosal uterine fibroids

Curr Opin Obstet Gynecol. 2014 Aug;26(4):308-13. doi: 10.1097/GCO.0000000000000076.


Purpose of review: To review the preoperative preparation, intraoperative equipment and techniques to facilitate hysteroscopic resection of submucous fibroids.

Recent findings: The use of preoperative ultrasound can guide safe resection of submucous fibroids and should be an integral part of a preoperative workup. The data regarding misoprostol use for cervical dilation prior to hysteroscopy is somewhat conflicting and the decision to preoperatively administer misoprostol should be on a case-by-case basis. Hysteroscopic resection of submucous intrauterine fibroids can now be performed under low-dose spinal anesthesia and with the development of smaller instruments and bipolar technology, in an office-based setting without any anesthesia and, sometimes, analgesia. Although the complete removal of type 1 and 2 submucous fibroids remain a challenge, the development of newer techniques such as office preparation of partially intramural myomas and cold-loop myomectomy can result in better removal of these submucous fibroids with an intramural component.

Summary: Hysteroscopic resection of submucous uterine fibroids should be a simple, well tolerated and effective procedure. Innovations to the existing hysteroscopic techniques and the development of the hysteroscopic morcellator will hopefully result in a greater number of gynecologic surgeons being able to safely perform hysteroscopic resection of submucous uterine fibroids.

Publication types

  • Review

MeSH terms

  • Female
  • Humans
  • Hysteroscopy* / methods
  • Leiomyoma / complications
  • Leiomyoma / pathology
  • Leiomyoma / surgery*
  • Misoprostol / administration & dosage
  • Oxytocics / administration & dosage
  • Patient Selection
  • Treatment Outcome
  • Uterine Hemorrhage / etiology
  • Uterine Hemorrhage / pathology
  • Uterine Hemorrhage / surgery*
  • Uterine Myomectomy* / methods
  • Uterine Neoplasms / complications
  • Uterine Neoplasms / pathology
  • Uterine Neoplasms / surgery*


  • Oxytocics
  • Misoprostol