title: Hysteroscopic Myomectomy of FIGO Type 2 Leiomyomas Under Local Anesthesia: Bipolar Radiofrequency Needle-Based Release Followed By Electromechanical Morcellation.
abstract: OBJECTIVE
  To demonstrate a technique designed to expand the capabilities of hysteroscopic intrauterine morcellators to deep type 1 and type 2 lesions. The technique comprises "release" of the tumor using a bipolar radiofrequency needle, followed by dissection and extraction with an electromechanical morcellator, all under local anesthesia.
  
  
  METHODS
  Description of technique using images and video (Canadian Task Force classification Class III).
  
  
  METHODS
  Office uterine procedure and imaging center; academic medical center.
  
  
  METHODS
  Following the administration of local anesthesia and access to the endometrial cavity with a 5.5-mm-o.d. hysteroscopic sheath with a 5 Fr operative channel, a 5 Fr bipolar needle electrode system is used to circumscribe the leiomyoma and enter the pseudocapsule, thereby "releasing" the lesion. Blunt dissection is performed as appropriate and then the system is switched to a hysteroscopic morcellating system (MyoSure; Hologic, Bedford, MA), which is then used to further dissect and remove the target lesion with electromechanical morcellation.
  
  
  CONCLUSIONS
  The development of intrauterine morcellators has facilitated the performance of hysteroscopic myomectomy, especially under local anesthesia, but the side aperture-based design of the systems limits their use in International Federation of Gynecology and Obstetrics (FIGO) type 1 and 2 tumors, particularly those located at the uterine fundus. This technique, based in part on a previously published technique of leiomyoma release, improves access of the electromechanical morcellator to leiomyomas that previously were inaccessible, and minimizes myometrial trauma by dissecting the tumor via the relatively avascular pseudocapsule.
authors.affiliation: Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA/Kaiser Permanente Medical Center, Los Angeles, CA. Electronic address: mmunro@ucla.edu.
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Munro
mesh_terms: D000772:Anesthesia, Local; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000295:instrumentation; D007889:Leiomyoma / Q000473:pathology* / Q000601:surgery; D000069577:Morcellation; D011247:Pregnancy; D063186:Uterine Myomectomy / Q000379:methods; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Bipolar needle; Electromechanical morcellation; Hysteroscopic myomectomy; Hysteroscopy; Leiomyoma; Myoma; Myomectomy