This video demonstrates the hysteroscopic resection of a large anterior wall submucous fibroid in a patient with a history of multiple unsuccessful dilatation and curettage (D&C) procedures. Initial hysteroscopy confirms the location and attachment of the fibroid before proceeding with resection using a 22 Fr bipolar resectoscope. The surgeon explains the correct direction of resection, safe handling of the passive resectoscope, and techniques to maintain excellent visualization by minimizing fluid leakage. Practical teaching points are provided on loop control, cavity distension, and systematic removal of the myoma from its free surface toward its base. This is an excellent instructional video for surgeons learning operative hysteroscopic myomectomy.

Four key takeaways from this video
Learn the hysteroscopic management of a large submucous fibroid
This video demonstrates the step-by-step resectoscopic removal of a large anterior wall submucous myoma, highlighting preoperative cavity assessment, planning the direction of resection, and safe completion of the procedure.
Master the correct technique of hysteroscopic myomectomy
The surgeon explains the principles of using a 22 Fr bipolar resectoscope, including proper loop positioning behind the myoma, passive activation of the working element, and sequential resection from the free portion towards the base.
Understand practical fluid management and visualization
Viewers will learn why misoprostol (Cytotec) is not always beneficial in patients with large intracavitary pathology, how excessive cervical leakage can collapse the uterine cavity, and techniques to maintain optimal visualization throughout surgery.
Gain expert resectoscopic operating pearls
Throughout the procedure, the surgeon shares valuable tips on safe loop movement, maintaining the correct trajectory during resection, avoiding inadvertent injury, and recognizing the appropriate endpoint of hysteroscopic myomectomy