Vaginal Transisthmic Myomectomy: a Step by Step Video Tutorial

OBJECTIVE:To provide a video tutorial on vaginal transisthmic myomectomy in women with large submucosal fibroids.DESIGN:Stepwise demonstration of the technique, with a narrated video footage.SETTING:Submucosal fibroids protrude into the uterine cavity and can cause numerous symptoms, including abnormal uterine bleeding, dysmenorrhea, subfertility, and obstetric complications. Over the last decades, hysteroscopic resection has become the preferred surgical approach for submucosal fibroids because it provides significant advantages regarding perioperative morbidity and postoperative recovery time when compared with laparotomy or laparoscopy with complete transection of the uterine wall. However, in large or multiple fibroids, longer surgery durations of hysteroscopic resection can lead to higher complication rates and incomplete resection. In some cases, hysteroscopic resection might even be impossible to perform. Furthermore, in many regions, special equipment for hysteroscopic myomectomy might not be available. Herein, we present a minimally invasive surgical alternative for approaching submucosal fibroids.PATIENT(S):A 26-year-old woman presenting with hypermenorrhea and dysmenorrhea (on a numeric rating scale from 0-10) caused by a recurrent International Federation of Gynaecology and Obstetrics (FIGO) type 0 fibroid measuring 5 cm in diameter.INTERVENTION(S):Vaginal transisthmic myomectomy performed with a longitudinal transection of the uterine cervix and isthmus, morcellation of the fibroid with a scalpel, and multilayer reconstruction.MAIN OUTCOME MEASURE(S):Vaginal transisthmic myomectomy is a fast and relatively simple, minimally invasive surgical technique suitable for large or multiple FIGO 0 and some FIGO 1 fibroids, necessitating the use of only basic surgical equipment.RESULT(S):Vaginal transisthmic myomectomy provides an additional minimally invasive surgical approach for submucosal fibroids.CONCLUSION(S):This surgical option for selected patients may help prevent complications resulting from prolonged hysteroscopic surgery, repeated hysteroscopic procedures owing to incomplete resection, and the morbidity of transabdominal approaches for myomectomy. With this video, we aim to expedite the clinical learning curve of this technique, which should be investigated on a broader scale in the future.