Techniques for Optimizing Safe Hysteroscopic Myomectomy Using the Bipolar Resectoscope Loop

Abstract

Study Objective The objective of this video is to highlight the benefits of the bipolar resectoscope loop for hysteroscopic myomectomy and to review surgical techniques to optimize outcomes. Design Hysteroscopic mechanical morcellators have gained popularity given their ease of use. As a result, resectoscope loops are being used less frequently, resulting in less resident training with this device. Although the bipolar resectoscope loop has a steeper learning curve than mechanical morcellators, the bipolar device offers distinct advantages such as the ability to produce both cutting and coagulation tissue effects with electrosurgery. The ability to achieve electrosurgical hemostasis is unique to the resectoscope loop and may result in less blood loss, less extravasation of intrauterine distention media, and improved visibility allowing for a more efficient and safer surgery. Setting Patients should be in lithotomy position in the operating room. Standard hysteroscopic resectoscope setup is required. Patients or Participants N/A Interventions N/A Measurements and Main Results In this video, we review specific surgical techniques for optimizing outcomes and safety with the bipolar resectoscope loop including the “bow and arrow” technique, identification of the fibroid anatomy (pseudocapsule plane), cold loop blunt dissection, the “push and tuck“ method, and efficient electrosurgical hemostasis. Conclusion The bipolar resectoscope loop is an important tool that offers gynecologic surgeons a wider range of techniques for fibroid removal while still being able to achieve hemostasis. It is important to train residents to learn to use both hysteroscopic mechanical morcellators and resectoscope loops.