Uterine leiomyomas are the most common pelvic tumor in women  (20% of all benign tumours in women) and risk of malignancy is less than 0.2 to 0.5 percent.

Women with fibroids may suffer abnormal uterine bleeding, in addition to risks in pregnancy. These include poor implantation sites and restriction of normal uterine enlargement, resulting in preterm labor and miscarriage.

A systematic literature review found that only those fibroids with a submucosal or an intracavitary component were associated with adverse reproductive outcomes and suggested hysteroscopic myomectomy may be of benefit.

In case of hysteroscopic myomectomy we will avoid laparotomy, uterine incision, and hospital stay.

Many different instruments are used for hysteroscopic myomectomy. They include the resectoscope, scissors, morcellator and laser.

Two-step procedures: the observation of the rapid migration of the residual intramural component of the fibroid towards the uterine cavity, with the parallel increase of myometrial thickness during hysteroscopic myomectomy is the basis of this treatment.

During the first step, the fibroid can be resected to the level of the endometrium or just below and the second step, performed 2 months later, can resect the remainder of the fibroid.

We begin resection by placing the loop just beyond the most cephalad portion of the fibroid and gradually draw the loop towards the operator by moving either the loop alone, through its spring mechanism, or by moving the entire resectoscope.

 Hysteroscopic myomectomy is especially effective if the fibroid is less than 3 cm.

Notify that resection of a completely intramural fibroid has the risk of intravasation of media due to prolonged procedure time.

If the intramural component of the fibroid is greater than 50%, the patient is at risk for recurrent symptoms.

When we face small pieces of myoma accumulating in the field during resection, we may remove the inner sheath of the resectoscope, which allows drainage of the uterine cavity and will clear the field. Polyp forceps may be needed to remove larger debris. The tissue is collected for histologic examination.

Whether treatment with GnRH agonist before myomectomy offers any significant advantage is still a matter of debate.

Some gynecologists use vasopressin injected into the cervical stroma before the procedure in an attempt to decrease blood loss and operative time.

The surgical area will become covered with newly proliferated endometrium postoperatively. Estrogen therapy has not been effective in decreasing intrauterine adhesions.

It is not known whether hysteroscopic myomectomy affects placentation in subsequent pregnancies. In addition, there have been no case reports of uterine rupture after hysteroscopic myomectomy.