This video demonstrates hysteroscopic management of a predominantly intramural fibroid protruding into the endometrial cavity in a patient with multiple uterine fibroids.
Initial hysteroscopy identifies endometrial polyps and cavity-distorting fibroids, prompting careful consideration of which lesions require hysteroscopic versus laparoscopic removal.
The surgeon demonstrates incision of the fibroid pseudocapsule, explaining how this maneuver can encourage further intracavitary protrusion.
Repeated uterine pressurization and depressurization progressively mobilize the fibroid, transforming its appearance from a deeply embedded lesion to an almost completely intracavitary Type 0 fibroid.
A resectoscope is subsequently used to remove the protruding fibroid while avoiding unnecessary deep myometrial resection.
As the base is approached, distension pressure is reduced and cold-loop dissection without energy is demonstrated to separate residual fibroid tissue safely.
The video concludes with inspection of the myometrial bed, confirmation of complete hysteroscopic removal and discussion of the importance of correlating the removed lesion with the remaining fibroids.