2117 Removal of Submucous Myoma with Truclear 8 Tissue Retrieval System

Abstract

Video Objective This video demonstrates that intracervical injection of dilute vasopressin not only helps in smooth cervical dilatation prior to introduction of Truclear8 device, but also has beneficial hemostatic effect on submucous fibroid during intrauterine morcellation. Setting 39 year old primary infertility patient with 2 failed IVF cycles, presented with menorrhagia for 6 months. On trans vaginal sonography there was fundal submucous fibroid 3 × 2.5cm. Patient was counseled for intrauterine morcellation by Truclear 8under general anesthesia. Interventions Diagnostic Hysteroscopy was performed by vaginoscopic technique using the 2.9mm, 30 degree Betocchi hysteroscope with normal saline as distension medium. Submucous fibroid arising from fundus was confirmed. Injection Vasopressin 4 units in 80ml normal saline(0.05units/ ml) was injected 10cc intracervically at 4o'clock and 8o'clock .Cervical dilatation up to 10 hegar's was easily done. Truclear 8 with ultraplus blade was introduced and the window was placed on the fibroid and cutting and aspiration was activated. In single insertion the pale looking fibroid was morcellated without damaging the rest of the endometrium. No bleeding was observed. Conclusion Hysteroscopic myomectomy is the first line treatment for symptomatic submucous fibroid in infertility. Truclear 8 mechanical morcellation is most suitable in infertile patients and vasopressin intracervical injection has dual benefits of smooth cervical dilatation with hemostatic effect on the fibroid.