The removal of large intracavitary submucous fibroids poses a unique challenge to the hysteroscopic surgeon. When a resectoscope is used, rapid uptake of distension medium occurs through the open sinuses created over the myoma during resection. Also, accumulation of the fibroid pieces makes surgery progressively difficult. In large fibroids, this may force the surgeon to abandon the procedure incompletely, and do a second look surgery to complete the procedure.
The hysteroscopic morcellator completely eliminates the need for electrosurgery, making the procedure safer. Continuous evacuation of the respected chips provide a clear field of surgery without the need for manually removing the pieces. When coupled with a good endomat pump, high flow irrigation and suction ensure that even very large fibroids can be removed in a single sitting, with minimal fluid deficit. This makes the hysteroscopic morcellator an excellent tool in selected cases. The obvious limitation of the instrument, however is it’s inability to tackle myomas that are partially embedded within the uterine myometrium (grade 2 and 3 myomas).