Office Hysteroscopic Treatment of Uterine Fibroids

Advances in endoscopic and therapeutic hysteroscopic technology have made the removal of submucosal fibroids possible in the outpatient setting. Removal of submucosal fibroids can be particularly challenging in the outpatients due to intramural components of some submucosal fibroids and the hard consistency of fibroids which makes specimen retrieval rather difficult through the endocervical canal. Fibroids which are <2 cm and completely intracavitary are easier to remove in the outpatients. Specimen retrieval can be addressed either by slicing the fibroid using bipolar electrodes, by using a hysteroscopic morcellator or leaving the fibroid in the uterine cavity after enucleation to be expelled with uterine contractions. Patient acceptability appears to be high in a small number of retrospective case series published in the literature. Further reports and data from prospective trials would be beneficial in improving our understanding of this procedure which appears to be performed by a relatively small number of centres.