Step-by-step hysteroscopic treatment of International Federation of Gynaecology and Obstetrics type 3 myoma with the cold loop technique.

OBJECTIVE

To demonstrate the "cold loop technique" for the hysteroscopic treatment of International Federation of Gynaecology and Obstetrics (FIGO) type 3 myomas.

DESIGN

Step-by-step demonstration of the technique using educative video.

EXPOSURE

FIGO type 3 myomas exhibit complete myometrial development while encroaching on the endometrium. This hybrid nature, combining features of both submucous and intramural myomas, may have a detrimental "double hit" effect for patients seeking pregnancy. Currently, there is a dearth of robust evidence regarding the ideal surgical approach for FIGO type 3 myomas. Despite the preference for the hysteroscopic approach due to their closer proximity to the uterine cavity compared with the serosa, the primary limitations of the conventional hysteroscopic approach include the risks of damaging healthy myometrium and the significant risk of adhesions. We showcase the hysteroscopic treatment of a 29-mm FIGO type 3 myoma on the anterior uterine wall using the "cold loop technique." The video emphasizes key procedural phases: opening the "endometrial-myometrial window" with minimal sacrifice of myometrium; identifying the correct cleavage plane through blunt dissection of fibroconnective bridges anchoring the myoma to the pseudocapsule using cold loops; and slicing the detached intramural component of the fibroid, displaced into the uterine cavity, with an electrical loop.

MAIN OUTCOME MEASURES

Integrity of the uterine cavity and the healthy myometrium surrounding the myoma and avoiding postsurgical intrauterine adhesions.

RESULTS

The myoma was completely removed in a single surgical step, and at the end of the procedure, the myoma's "notch" and its intact pseudocapsule were clearly visible. The patient was discharged in good health the day after the surgery. At the 3-month follow-up, the diagnostic office hysteroscopy revealed a fully recovered uterine cavity.

CONCLUSION

The "cold loop technique" holds the potential to facilitate the safe removal of FIGO type 3 myomas, minimizing the risk of damage to the adjacent healthy myometrium and resulting in a lower likelihood of postoperative adhesions. This is especially critical for women contemplating conception.