Hysteroscopic Myomectomy of a Large Submucosal Leiomyoma with Novel Use of Fluid Warming

Uterine myoma size is often considered a limiting factor when choosing the surgical approach to myomectomy. In this case, a 35-year-old woman presented with heavy menstrual bleeding and desire for fertility. Ultrasound performed 3 months earlier could not assess the endometrium and suggested leiomyoma. Magnetic resonance imaging of the pelvis identified a fundal submucosal myoma measuring 6.8 × 7.1 × 3.5cm. A planned staged hysteroscopic resection of the large submucosal myoma with intramural component was achieved. Unassisted conception occurred 2 months later. She delivered by cesarean section at term without complications. This case demonstrates that hysteroscopic mechanical tissue removal device combined with ultrasound guidance and a fluid warming system can complete myomectomy for very large uterine myomas without the need for laparoscopy or laparotomy.