title: Hysteroscopic enucleation of type II submucosal uterine leiomyomas using a TRUCLEAR hysteroscopic morcellator: case report and review of the literature.
abstract: OBJECTIVE
  We describe a case of complete enucleation of a Type II leiomyoma using the TRUCLEAR™ (Smith & Nephew Endoscopy, Andover, MA) hysteroscopic morcellator (THM) and demonstrate appropriate preoperative assessment and intraoperative surgical principles during this case. Complete hysteroscopic enucleation of Type II leiomyomas is also systematically reviewed.
  
  
  METHODS
  In this case report and review, performed in a tertiary-care university setting, the THM was used for hysteroscopic resection of two submucosal leiomyomas.
  
  
  RESULTS
  A 41-year-old gravida 1 para 0010 presented with infertility and symptomatic leiomyomas. Preoperative assessment included a hysterosalpingogram, magnetic resonance imaging, and sonohysterography demonstrating several extrinsic impressions on the uterine cavity and two submucosal leiomyomas (Type I and Type II). Diagnostic hysteroscopy confirmed findings. As the THM blade started resecting the Type II leiomyoma, it began to separate from the underlying myometrium. Attempts to release the edge of the leiomyoma, including reverse rotation of the blade, completely enucleated the leiomyoma, which was subsequently removed from the cavity with the THM. Minimal bleeding was encountered; intraoperative ultrasound confirmed normal overlying myometrium. Postoperatively, sonohysterography showed complete closure of the dead space with only a slightly distorted endometrial cavity.
  
  
  CONCLUSIONS
  Hysteroscopic uterine leiomyoma enucleation should only be performed in experienced hands. Inadvertent enucleation of a Type II leiomyoma with a THM device is described, with review of key surgical principles that guided safe resection.
authors.affiliation: Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA. tpakrashi@gmail.com
authors.forename: Tarita
authors.initials: T
authors.lastname: Pakrashi
authors.forename: Ilana B
authors.initials: IB
authors.lastname: Ressler
authors.forename: Julie M
authors.initials: JM
authors.lastname: Sroga
authors.forename: Krystene B
authors.initials: KB
authors.lastname: DiPaola
authors.forename: Michael A
authors.initials: MA
authors.lastname: Thomas
authors.forename: Steven R
authors.initials: SR
authors.lastname: Lindheim
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000295:instrumentation*; D007889:Leiomyoma / Q000145:classification / Q000601:surgery*; D014594:Uterine Neoplasms / Q000145:classification / Q000601:surgery*